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Valiant Dancer
Forum Goalie
USA
4826 Posts |
 Posted - 05/26/2011 : 17:32:04 [Permalink]
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Originally posted by marfknox
Val wrote: No, marf, they aren't. I've read the legislation. There are far reaching items with nothing to do with healthcare as well as significant new burdens on health care insurers. MLR goals which, if missed, require premium refunds. Unrealistic MLR goals which thus far has caused health insurance companies to shed significant numbers of customer service staff. Big pharma gets a big pass..... again. Seniors are also impacted with the closing of Medicare Advantage plans to new members and significant Medicaid changes.
Perhaps I'm a bit jaded on this whole thing, but in my 22 years working in healthcare, I know we have the best care anywhere. Some things do need to change, such as the ERISA malpractice carveout for HMO's. The availability of diagnostic testing equipment is superior. Rural healthcare has been lagging but the government has been trying to address that through subsidies to rural hospitals and greater reimbursement rates.
Some of Cain's proposals are somewhat moderate. His reworking of SS has some merit. Splitting the money taken in between the standard "bank account" that currently exists and a 401(k) type plan that people can direct where to go. (no early cash outs, government overseen directed investment in typical 401(k) products) His fair tax provision is something that has been touted by Republicans (it does disproportionately hit the poor) but he isn't as mouth-frothing as Ron Paul. |
Okay, you're sort of all over the place. Nothing you stated in the first paragraph convinces me that the health care reforms are dramatic or making us worse off. Big Pharma gets a pass, so that ain't worse. What you said about MLR goals is some speculation and some which just causes me to shrug since I don't see how it is better when people can't get insurance because they can't afford it or have a pre-existing condition. My argument is that our system for distributing health care is broken. It doesn't cover everyone by a long shot, and the access that any given American has to health care can change radically based on personal financial circumstances, where they live, their age, and other things they can't help.
We only have the best health care for those who have access to it. Our quality of health care per capita is not rated highly relative to the rest of the industrialized world because the people who don't have access because of costs and circumstances drag it down. And the cost of our health care per capita is much higher than anywhere else in the world. Again, my argument is that our system is already fucked up beyond all recognition, and the reforms that went into the place just rearrange things a little, rather than make things worse or much better.
As for your paragraph on Cain, you still haven't answered my question about why you think he is really more moderate despite his public stances on issues. His advocating a fair tax provision that disproportionately hits the poor seems to lend credence to the idea that he is NOT a moderate.
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It is not speculation about MLR goals. It is from my personal experience with the sixth largest health insurer in the country. The kind of cash being removed from the insurance companies is significant. $6.5 billion per year adjusted up for inflation.
It makes it much harder for companies to do business. The kind of bloated legislation put forth forbids pre-existing conditions (same as the plan floated by Republicans during the debates), health care exchanges (ditto), requires new reporting by group classifications on MLR, requires premium refunds for any group that does not meet that MLR. It leaves 15-20% of the premium for administrative costs. My company has shed 400 employees over the last three months. All in customer service.
If you are looking for 100% coverage for everyone, then you are advocating for socialized medicine. One that stiffles innovation by refusing to allow new treatments. (It has already happened in the history of the US. When HMO's made their appearance, they refused to pay for "experimental" treatments.) Essentially, your plan would put everyone on Medicaid. Medicaid does not pay based on the cost of the procedure. In some cases, the procedure costs more than the reimbursement. And the reimbursement is chronically late. It has gotten better only being 5-6 months behind (when Medicaid changed their computer systems over, reimbursements were delayed to 12 months. Remember that you only have 18 months to dispute any underpayment.)
I should correct myself. Cain is more moderate than most of the Republican candidates out there. |
Cthulhu/Asmodeus when you're tired of voting for the lesser of two evils
Brother Cutlass of Reasoned Discussion |
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Dave W.
Info Junkie
USA
26022 Posts |
Posted - 05/26/2011 : 21:26:41 [Permalink]
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Originally posted by Valiant Dancer
It makes it much harder for companies to do business. |
Should they be in business?| If you are looking for 100% coverage for everyone, then you are advocating for socialized medicine. One that stiffles innovation by refusing to allow new treatments. (It has already happened in the history of the US. When HMO's made their appearance, they refused to pay for "experimental" treatments.) |
HMOs are not socialized medicine. HMOs are private profit-seeking businesses, not public health care providers. Nationalizing health care would not eliminate the NIH or other research-granting institutions.| Essentially, your plan would put everyone on Medicaid. |
Any plan that does that doesn't go far enough.| Medicaid does not pay based on the cost of the procedure. In some cases, the procedure costs more than the reimbursement. And the reimbursement is chronically late. It has gotten better only being 5-6 months behind (when Medicaid changed their computer systems over, reimbursements were delayed to 12 months. Remember that you only have 18 months to dispute any underpayment.) |
And all of that is exactly why it doesn't go far enough. Any health plan that includes reimbursement of anything isn't nationalized, it's a bunch of private providers waiting on Federal repayment. Private providers of health care include inefficiencies such as (but not limited to) redundant HR departments, record-keeping and absolutely insane marketing budgets.
Health care should be a guaranteed right, not a privilege that is rationed out based on ability to pay. And the only way to assure that is to nationalize the whole industry, eliminating the pointless and wasteful middle-men that are insurance companies in the process.
Edited to add that the above is a leftist position. In comparison, Obama's health care plan is only slightly less of a right-wing corporatist position than just slapping a personal mandate on what we had in 2008. Indeed, to get to a centrist plan, one needs to go as far as "single payer," a solution which preserves the for-profit mindset behind providing health care while socializing only the payments for it. |
- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too. |
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marfknox
SFN Die Hard
USA
3739 Posts |
Posted - 05/27/2011 : 11:33:19 [Permalink]
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I am in total agreement with everything Dave just wrote.
Val wrote: | If you are looking for 100% coverage for everyone, then you are advocating for socialized medicine. |
Whatever you want to call it is fine with me. I am advocating for 100% coverage for everyone. I don't see why every other industrialized nation can do this and we can't. As I said, I agree with Dave: "Health care should be a guaranteed right, not a priviledge that is rationed out based on ability to pay." Or rationed out for other reasons. It really pisses me off that liberals have to desperately try to gain more health care by first pleading for uninsured children and old people. What about young and middle-aged adults? Like they never get sick? So if you happen to be a 35 year old with diagnosed and treatable bipolar or thyroid problems or cysts on your ovaries that can be treated, you are just shit out of luck because those problems won't kill you (or at least kill you quick enough) that you can take care of it in an emergency room? My friend who is 31 an uninsured and unemployed just got a leg infection. He had to go the emergency room. After wiping out ALL of his meager savings and landing him back in debt (I mean debt beyond his student loan debt, which is huge) they told him "If you had insurance we'd keep you here for a few days to monitor the healing, but since you don't have insurance we're going to send you home, and if you develop any new symptoms go to the emergency room immediately." And you want to talk about unrealistic demands being put on insurance companies?
| Essentially, your plan would put everyone on Medicaid. |
No. I put forth no plan. I would be fine with many different sort of plans modeled off any number of countries like Japan, Germany, France - all of whom have very different types of universal health care. I'd like us to actually have a plan (which we don't in the USA. What type of health care "plan" you are on totally depends on a whole number of circumstances, most of which you can't help.) and one which guarantees health care for 100% of the people who reside in the United States. It is pathetic that we don't have it and Americans should be ashamed.
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"Too much certainty and clarity could lead to cruel intolerance" -Karen Armstrong
Check out my art store: http://www.marfknox.etsy.com
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Valiant Dancer
Forum Goalie
USA
4826 Posts |
Posted - 05/27/2011 : 13:11:54 [Permalink]
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Originally posted by Dave W.
Originally posted by Valiant Dancer
It makes it much harder for companies to do business. |
Should they be in business? |
Yes, they should.
| If you are looking for 100% coverage for everyone, then you are advocating for socialized medicine. One that stiffles innovation by refusing to allow new treatments. (It has already happened in the history of the US. When HMO's made their appearance, they refused to pay for "experimental" treatments.) |
HMOs are not socialized medicine. HMOs are private profit-seeking businesses, not public health care providers. Nationalizing health care would not eliminate the NIH or other research-granting institutions. |
HMO's are a methodology of price controls that is mirrored by every government healthcare coverage including Medicare and Medicaid.
| Essentially, your plan would put everyone on Medicaid. |
Any plan that does that doesn't go far enough. |
And how does it get paid for? By essentially turning the government into a Medicaid type of coverage. It is how it is set up in the European countries. And now some of them are seriously faltering.
Elderly thristing to death
| Medicaid does not pay based on the cost of the procedure. In some cases, the procedure costs more than the reimbursement. And the reimbursement is chronically late. It has gotten better only being 5-6 months behind (when Medicaid changed their computer systems over, reimbursements were delayed to 12 months. Remember that you only have 18 months to dispute any underpayment.) |
And all of that is exactly why it doesn't go far enough. Any health plan that includes reimbursement of anything isn't nationalized, it's a bunch of private providers waiting on Federal repayment. Private providers of health care include inefficiencies such as (but not limited to) redundant HR departments, record-keeping and absolutely insane marketing budgets.
Health care should be a guaranteed right, not a privilege that is rationed out based on ability to pay. And the only way to assure that is to nationalize the whole industry, eliminating the pointless and wasteful middle-men that are insurance companies in the process.
Edited to add that the above is a leftist position. In comparison, Obama's health care plan is only slightly less of a right-wing corporatist position than just slapping a personal mandate on what we had in 2008. Indeed, to get to a centrist plan, one needs to go as far as "single payer," a solution which preserves the for-profit mindset behind providing health care while socializing only the payments for it.
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The legislation does more than just slap a individual mandate (Constitutionally questionable overreach of the Commerce Clause) on having healthcare. It yanks great sums of money out of the healthcare industry, DME industry, and lesser for pharmacology industry. It addresses the symptoms but not the root causes.
Healthcare insurance companies are being singled out as the bad guys. MLR's which do not take into account the myriad of other laws that are state specific regarding payment. The cost of complying at short notice to changes in law. And preventing the acquision of additional staff through limits on earnings which would allow the companies to better handle the requests.
But lests go through the legislation.
Page 16, does away with lifetime limits. Forbids coverage dropping.
Page 17, forbids copays for immunizations or evidence based items or services that have an A or B rating in the US Preventative services task force child preventative healthcare.
Page 18, Dependants now covered until 26. At least 1 year notification of changes in guidelines for A or B ratings before implementation.
Page 19, standardization of explaination of coverage documents. Effective 1 year after passage.
Page 22, requires health plans to provide a summary of benefits to all members within 24 months after passage. $1,000/person fine for everyone not so informed.
Page 26, employers cannot offer better coverage to executives than is offered to regular employees. Quality of care reporting to a central reporting agency. Government website with copies of desease/condition management improvement plans.
Page 29, wellness and prevention programs covered including smoking cessation, weight management, stress management, nutrition, diabetes prevention, healthy living.
Page 30-31, clear accounting for costs breaking down into three categories. Percentage expended on care, percentage expended on administration, percentage expended on health improvement activities. Forces rebates of premium where administrative costs exceed 15% for large groups (50+ members), 20% for small groups (1-49 members), and 25% in individual markets.
Page 32, hospitals must publish price list with uniform descriptions.
Page 34-36, Health insurance oversight agency. Checks compliance of health plans by state.
Page 37-39, premium review. Regulates health insurance like an utility.
Page 41, no more pre-existing conditions language. Limits on premium for high risk pool of 4x normal premium.
Page 44, illegal aliens not covered.
Page 46, health plans cannot bribe or coerce members to drop. government pays up to $5 billion to pay claims for high risk pool individuals to limit losses. Expires 1 January, 2014.
Page 57, serious infrastructure mandates. Changes to HIPAA transmission standards, requires providers to accept EFT (no checks), swipable ID cards, standardization of explaination of benefits and remittance advices.
Page 67, Health plans must now be certified through the Federal government. penalties add up per day.
Page 97, employers cannot make new employees wait longer than 90 days before health benefits are extended.
Page 109, group maximum deductibles $2,000 for a single, $4,000 for family coverage.
Page 349, penalties for large employers for waiting times for coverage greater than 30 days.
Page 426, all unemployed now eligible for Medicaid.
Page 432, increase Social Security withholding based on 55% of gross vs current 50% of gross.
Page 451, hospitals can now put in for Medicaid on behalf of patients whether they want to be or not.
Page 480, new study for home care for elderly and mentally ill.
Page 590-600, pregnancy center funding ($25 million), post-partum depression study ($3 million)
Page 790-810, sets up specific treatment and periodic medical advisory board.
Page 868, HHS study on rural hospitals and expanding rural additional payments.
Page 890-943, Closed Medicare Advantage plans to new members.
Page 1091, sets uniform standards for trauma care centers.
Page 1150-1167, School health programs and funding to establish and operate nutrition, physicals, mental health certifications, and free clinics in schools to underserved children by grant. 20% outside funding requirement for grant.
Page 1174, annual wellness physical for Medicare patients at no cost.
Page 1184, preventative services fully covered under Medicare.
Page 1228, nutritional labeling of standard menu items at chain resturaunts that must occur next to the menu.
Page 1233, nutritional labeling must be displayed prominently for each item in a vending machine if the owner/operator of the vending machine has more than 20.
Page 1278-1316, National Healthcare Workforce Commission labor market analysis (15 total) Level IV - Executive Schedule ($122,400/year each)
Page 1316-1528, Student loan funds. No parental need test. Breaks for school nurses and rural healthcare providers for underserved areas. Grants for students going to underserved areas for 5 years.
Page 1584-1694, Quality Assurance Phyician Outcome project committee (17 members) Level IV - Executive Schedule.
Page 1694, Fee for insurance companies to exist. $1/covered life/year for the average number of covered lives. Jumps to $2/life in 2014.
Page 1705, Hikes application fees for Medicare providers. Requires providers to get a NPID.
Page 1765, requires direct physician contact with people before authorization of home health services or DME under Medicare.
Page 1799-1858, Elder abuse and Adult Protective Services committee. (27 members) Helps states investigate and prosecute elder abuse, neglect, and exploitation.
Page 1858, Medical malpractice suits require arbitration before lawsuits can commence.
Page 1925-1979, community living assistance services and support assisted living minimum standards set.
Page 1979, new taxes in 2013. If your coverage is above a set dollar amount, you pay an additional 40% above the nominal amount. ($8,500/year for single, $23,000 family)
Page 2009, taxes profits of non-profit healthcare providers.
Page 2011-2019, Name brand prescription drug sales taxed to a maximum of $2.3 billion (adjusted up for inflation annually) across all providers by percentage of gross reciepts from name brand drugs.
Page 2020-2026, DME taxes, same thing as name brand drugs only applied to all DME gross sales. Total take $2 billion.
Page 2026, Health insurance plans taxes, on net premiums and 3rd party administration charges. Total take $6.7 billion.
Page 2040, FICA and SECA withholding increased .5% on individuals making $200,000+/year ($250,000 for joint)
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Cthulhu/Asmodeus when you're tired of voting for the lesser of two evils
Brother Cutlass of Reasoned Discussion |
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Dave W.
Info Junkie
USA
26022 Posts |
Posted - 05/27/2011 : 14:37:02 [Permalink]
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Originally posted by Valiant Dancer
Originally posted by Dave W.
Originally posted by Valiant Dancer
It makes it much harder for companies to do business. |
Should they be in business? |
Yes, they should. |
Why? What do health insurance companies provide that the Federal government cannot?| HMO's are a methodology of price controls that is mirrored by every government healthcare coverage including Medicare and Medicaid. |
Well, it appears to be a broken model. Health care insurance is a bad model in general, because insurance is for things which might happen, but everybody should be using health care. Having to pay for routine check-ups ensures that some people's diseases won't be caught until the situation is dire (and thus more expensive).| And how does it get paid for? By essentially turning the government into a Medicaid type of coverage. |
As I said, that doesn't go far enough. We don't need health-care coverage, we need health care. Of extant US programs, the VA comes closest to doing things the right way, but even it has shortcomings that I'd like to see surmounted.Yeah, I'm sure that we can find all sorts of horror stories for any style of health care provision. I'm less than impressed with any individual tale of woe as an attempt to indict the whole. Someone needs to create a metric which combines the costs of the various programs themselves with the economic costs associated with mistakes and abuse (and the frequency of them), and then compare various plans. The private health insurance industry in the US will probably not be a high-scorer.| The legislation does more than just slap a individual mandate (Constitutionally questionable overreach of the Commerce Clause) on having healthcare. |
I know, but it doesn't do nearly enough.| It yanks great sums of money out of the healthcare industry, DME industry, and lesser for pharmacology industry. It addresses the symptoms but not the root causes. |
And that's one of my problems with it, too.| Healthcare insurance companies are being singled out as the bad guys. |
In terms of providing health care, they do nothing.| MLR's which do not take into account the myriad of other laws that are state specific regarding payment. |
Another good reason to nationalize health care.| The cost of complying at short notice to changes in law. And preventing the acquision of additional staff through limits on earnings which would allow the companies to better handle the requests. |
Ditto.| But lests go through the legislation. |
Why? It's a 1990s Republican piece of junk which does nothing to get towards my goal of truly national health care. I'm only arguing that it's not any sort of "moderate" plan in the sense that it's somewhere between left and right politics. It's nowhere close to being in the middle. |
- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too. |
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marfknox
SFN Die Hard
USA
3739 Posts |
Posted - 05/27/2011 : 16:08:58 [Permalink]
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Is the list of items from the legislation supposed to convince me that the legislation is bad? Because it does quite the opposite. All of those requirement are part of providing adequate health care to 100% of the population. That should be the goal, and it should be a highly prioritized goal.
The article on patients thirsting to death in the U.K. doesn't prove that the U.S. system works better for the reasons well-stated by Dave. This article fully articulates the conclusions I've come to regarding Obama's health care reforms: http://www.urban.org/uploadedpdf/411947_ushealthcare_quality.pdf
On the basis of this review it is
safe to say that U.S. health care is
not pre-eminent on quality;
furthermore, one can surely argue
that U.S. health care quality is not
at risk from the kinds of health
reform proposals receiving
attention. On the contrary, our
findings strengthen arguments that
reform is needed to improve the
relative performance of the U.S.
health system on quality. If reform
accomplishes no more than
extending insurance coverage to
the more than 45 million
Americans without insurance, it
will be an important step forward,
but more is needed to ensure health
care quality improvement. |
Val, two questions. Do you agree that lack of adequate access to health care is a serious problem in this country, and serious enough to be one of the highest priorities? If the answer to that question is yes, what would you propose to deal with the problem? If the answer to that question is no, then you and I disagree on this subject in a very fundamental way. |
"Too much certainty and clarity could lead to cruel intolerance" -Karen Armstrong
Check out my art store: http://www.marfknox.etsy.com
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| Edited by - marfknox on 05/27/2011 16:10:26 |
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Valiant Dancer
Forum Goalie
USA
4826 Posts |
Posted - 05/31/2011 : 06:33:09 [Permalink]
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Originally posted by Dave W.
Originally posted by Valiant Dancer
Originally posted by Dave W.
Originally posted by Valiant Dancer
It makes it much harder for companies to do business. |
Should they be in business? |
Yes, they should. |
Why? What do health insurance companies provide that the Federal government cannot? |
Better cost controls for care.
| HMO's are a methodology of price controls that is mirrored by every government healthcare coverage including Medicare and Medicaid. |
Well, it appears to be a broken model. Health care insurance is a bad model in general, because insurance is for things which might happen, but everybody should be using health care. Having to pay for routine check-ups ensures that some people's diseases won't be caught until the situation is dire (and thus more expensive).| And how does it get paid for? By essentially turning the government into a Medicaid type of coverage. |
As I said, that doesn't go far enough. We don't need health-care coverage, we need health care. Of extant US programs, the VA comes closest to doing things the right way, but even it has shortcomings that I'd like to see surmounted. |
The VA is doing things the right way?
I worked for the VA for a year. They are severely underfunded. They cannot attract competent providers because they don't pay anywhere near the going rate. They directly provide services but bill outside insurance now to cover their costs.
VA Lakeside in Chicago has serious infrastructure issues. Issues that have rendered the top three floors uninhabitable for over a decade. The VA has been pushing off building maintanance to be able to provide care.
Yeah, I'm sure that we can find all sorts of horror stories for any style of health care provision. I'm less than impressed with any individual tale of woe as an attempt to indict the whole. Someone needs to create a metric which combines the costs of the various programs themselves with the economic costs associated with mistakes and abuse (and the frequency of them), and then compare various plans. The private health insurance industry in the US will probably not be a high-scorer.| The legislation does more than just slap a individual mandate (Constitutionally questionable overreach of the Commerce Clause) on having healthcare. |
I know, but it doesn't do nearly enough.| It yanks great sums of money out of the healthcare industry, DME industry, and lesser for pharmacology industry. It addresses the symptoms but not the root causes. |
And that's one of my problems with it, too.| Healthcare insurance companies are being singled out as the bad guys. |
In terms of providing health care, they do nothing. |
But they help PAY for it. Something government does poorly.
| MLR's which do not take into account the myriad of other laws that are state specific regarding payment. |
Another good reason to nationalize health care.| The cost of complying at short notice to changes in law. And preventing the acquision of additional staff through limits on earnings which would allow the companies to better handle the requests. |
Ditto.| But lests go through the legislation. |
Why? It's a 1990s Republican piece of junk which does nothing to get towards my goal of truly national health care. I'm only arguing that it's not any sort of "moderate" plan in the sense that it's somewhere between left and right politics. It's nowhere close to being in the middle.
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Cthulhu/Asmodeus when you're tired of voting for the lesser of two evils
Brother Cutlass of Reasoned Discussion |
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Valiant Dancer
Forum Goalie
USA
4826 Posts |
Posted - 05/31/2011 : 06:49:32 [Permalink]
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Originally posted by marfknox
Is the list of items from the legislation supposed to convince me that the legislation is bad? Because it does quite the opposite. All of those requirement are part of providing adequate health care to 100% of the population. That should be the goal, and it should be a highly prioritized goal. |
So.... you want access to healthcare and don't care about how the people providing it are able to get a living wage. The providers have to get paid. The government is very slow about paying and do not pay as well as the insurance companies. And the list of items was to show you how far the legislation went. You claimed that it was modest.
The article on patients thirsting to death in the U.K. doesn't prove that the U.S. system works better for the reasons well-stated by Dave. This article fully articulates the conclusions I've come to regarding Obama's health care reforms: http://www.urban.org/uploadedpdf/411947_ushealthcare_quality.pdf
On the basis of this review it is
safe to say that U.S. health care is
not pre-eminent on quality;
furthermore, one can surely argue
that U.S. health care quality is not
at risk from the kinds of health
reform proposals receiving
attention. On the contrary, our
findings strengthen arguments that
reform is needed to improve the
relative performance of the U.S.
health system on quality. If reform
accomplishes no more than
extending insurance coverage to
the more than 45 million
Americans without insurance, it
will be an important step forward,
but more is needed to ensure health
care quality improvement. |
Val, two questions. Do you agree that lack of adequate access to health care is a serious problem in this country, and serious enough to be one of the highest priorities? If the answer to that question is yes, what would you propose to deal with the problem? If the answer to that question is no, then you and I disagree on this subject in a very fundamental way.
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I do not agree that lack of adequate access is an issue. I posit that lack of focus on the major factors which cause health care to be so expensive is the issue.
Under the "must treat" rule in force for over 30 years, no emergency room may turn away people who are ill. They must be treated. This has saddled hospitals (private organizations) with a great deal of bad debt. This passes on the cost to everyone else. Big Pharma cranks up their costs in the US because other nations put price controls on their product. (add in patent abuse, and big pharma gets quite a payday) Health care insurance companies have been the ones paying for these services. There are no more fee-for-service options that are cost effective. With the government pushing Health Savings Accounts (which do nothing for major medical) and the malpractice insurance rates soaring, the cost of care continues to rise. As states turn to the insurance companies to inflict fees on for providing services, the cost of those plans will go up as well as responses to rising health care costs.
Historical MLR's have been in the 80-90 range. Sometimes over 100%. In some good quarters, it can drop as low as 75%. These good quarters have to pay for the times that the MLR goes over 100%. This doesn't take into account administrative costs and broker fees. |
Cthulhu/Asmodeus when you're tired of voting for the lesser of two evils
Brother Cutlass of Reasoned Discussion |
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Kil
Evil Skeptic
USA
13477 Posts |
Posted - 05/31/2011 : 07:07:57 [Permalink]
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Okay Val. You seem to not like the new health care bill. And you seem to be against the creation of any new government health care law that covers everyone or the extension of any existing government health care programs. That suggests to me that you were also against the government option. I dunno.
Here's what I do know. Like many millions of Americans ( I have heard estimates as high as 45 million now and growing.) I have lost my health insurance and there is no way back for me. Until I turn 65, I will be uninsured. And I'm not getting from what I'm reading here that you think that's much of a problem. After all, you did say that this country provides the best health care in the world. That's honky dory for those who have health insurance, but what about the rest of us? Whether it's 20, 30 or as high as 45 million, it's a failed system with those kinds of numbers of uninsured.
So what's the plan that you favor to get us all insured? I'd really like to know?
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Uncertainty may make you uncomfortable. Certainty makes you ridiculous.
Why not question something for a change?
Genetic Literacy Project |
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Ebone4rock
SFN Regular
USA
894 Posts |
Posted - 05/31/2011 : 08:26:09 [Permalink]
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This is just food for thought but everyone does realize that health insurance does not require employer sponsorship right? A person can purchase it on their own and there are quite a variety of plans to choose from. There is a plan out there that will work for everyone!
That being said I personally think that the insurance companies are a major cause of the bloated prices we see for health care.
I have told the story before about how my wife and I went uninsured for a number of months. During that time she required a CT scan. We were billed $2500 which we had to pay all on our own. A year or two later, now with insurance, my wife required another CT scan. We received our insurance statement. The retail price of the CT scan was still $2500 (same hospital, same exact machine) but with the discount the insurance company gets they only paid $650!
See, cut out the middle man. Bill me directly for the $650. I'll write a check. Easy, breezy, beautiful.
So, we get it taken care of so that those who can afford to pay for reasonably priced health care are actually able to do so. They carry insurance for major, unexpected things. At that point we can work on a plan so that all the rest of the people who cannot afford it get some sort of government assistance with it. |
Haole with heart, thats all I'll ever be. I'm not a part of the North Shore society. Stuck on the shoulder, that's where you'll find me. Digging for scraps with the kooks in line. -Offspring |
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Dave W.
Info Junkie
USA
26022 Posts |
Posted - 05/31/2011 : 08:45:11 [Permalink]
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Originally posted by Valiant Dancer
Originally posted by Dave W.
Why? What do health insurance companies provide that the Federal government cannot? |
Better cost controls for care. |
Why can't the US just mandate price controls, like other nations?| The VA is doing things the right way? |
I said, "closest to."I worked for the VA for a year. They are severely underfunded. They cannot attract competent providers because they don't pay anywhere near the going rate. They directly provide services but bill outside insurance now to cover their costs.
VA Lakeside in Chicago has serious infrastructure issues. Issues that have rendered the top three floors uninhabitable for over a decade. The VA has been pushing off building maintanance to be able to provide care. |
Yes, and all that is a horrible situation exacerbated by legislators who don't want "socialized" medicine to succeed. They need to be "reformed" if any serious effort is going to be made to make a working and cheap health care industry in this country.| But they help PAY for it. Something government does poorly. |
No, health insurance customers pay for it. The corporations don't get their money from nowhere, it all comes out of the wallets of the insured and the investors. Health insurance companies aren't being magnanimous when they pay for some procedure or other, they're using money that wasn't theirs to begin with. And health care in general would be less expensive if we didn't need to pay middlemen like them.
I don't want to pay for health insurance companies' executives salaries. I don't want to have to pay for a half-dozen doctors offices' different accountants. I don't want to have to pay for the tax preparation services my pharmacy uses. There are a zillion little things that I pay for, through premiums and copays that I really shouldn't need to pay for in order to get health care. Making the industry public could reduce all of this needless waste and redundancy by quite a large amount.
United Healthcare paid its CEO $102 million in 2009 and made nearly $5 billion profit. We could have paid over 30,000 GS-15/10 health care workers for the same amount. And that's just one insurance company out of many.
(For comparison, the annual salary for the United States Secretary of Health and Human Services has been $199,700 since January, 2010.) |
- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too. |
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marfknox
SFN Die Hard
USA
3739 Posts |
Posted - 05/31/2011 : 12:17:31 [Permalink]
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Val wrote: | So.... you want access to healthcare and don't care about how the people providing it are able to get a living wage. The providers have to get paid. The government is very slow about paying and do not pay as well as the insurance companies. |
I don't find this convincing when I look at other countries that have MUCH MORE socialistic system than ours and yet they manage to continue to have people go into medical professions. There are doctor shortages, but the U.S. also has that problem in areas, and the overall health care per capita received by people in France, Britain, Germany, Canada, Hong Kong, Japan, and many other industrialized nations continues to be BETTER than in the United States and cheaper! So you explain to me how they manage to do that with so many more government controls? I think the answer is that each of those countries actually has system for distributing health care, while the United States doesn't. We have this weird mix of some government regulation and control and a lot of free market, and the result is that depending on what your job is, who you are married to, your age, and your current state of health, your health care could be managed in any number of ways, some of which offer the best care in the world and others which are identical to health care management in some third world nations. We need a system in this country. If we have a single system, then we can deal with the problems with that one system as they arise.
| And the list of items was to show you how far the legislation went. You claimed that it was modest. |
I do consider it to be modest relative to the problem and what sort of radical changes need to be made to adequately reform the health care system in America. The measure of how modest or not a plan is must be relative to something. The changes that have been made with the current legislation mostly shifts a lot of thing around; it doesn't make any fundamental changes to the way we do health care in America, which is a problem.
| I do not agree that lack of adequate access is an issue. I posit that lack of focus on the major factors which cause health care to be so expensive is the issue. |
Why is it an issue that health care is so expensive? It is an issue because that problem has lead to inadequate health care for many Americans. That is what is at the heart of the issue. Who cares how expensive it is if everyone has access to good health care?
| Under the "must treat" rule in force for over 30 years, no emergency room may turn away people who are ill. They must be treated. This has saddled hospitals (private organizations) with a great deal of bad debt. This passes on the cost to everyone else. |
I agree. And what is your proposed solution? Are you actually arguing that the "must treat" rule is the cause of this problem? Also, emergency rooms can't turn away someone at the door, but they sure as hell do NOT have to treat non-life threatening illnesses. And most of the people going to emergency rooms wouldn't be there in the first place if they had regular checkups and health care access, which they don't because they are either underinsured or uninsured. What are you proposing? That "must treat" rule be eliminated?
| Big Pharma cranks up their costs in the US because other nations put price controls on their product. (add in patent abuse, and big pharma gets quite a payday) |
Yes, that's a problem. I assume you are proposing that the U.S. use price controls, too, and if so, I agree with you.
| Health care insurance companies have been the ones paying for these services. There are no more fee-for-service options that are cost effective. With the government pushing Health Savings Accounts (which do nothing for major medical) and the malpractice insurance rates soaring, the cost of care continues to rise. As states turn to the insurance companies to inflict fees on for providing services, the cost of those plans will go up as well as responses to rising health care costs. |
Again, what are you proposing? Tort reform with regards to medical malpractice? If so, I agree. However, the estimates I've read from studies argue that about 10% of the increases in medical costs are the result of medical malpractice costs and defensive medicine done to avoid suits. That's a lot, but not the bulk of the problem, so fixing it alone won't be the bulk of the solution.
The only solutions you have seemed to suggest are tort reform and cost controls for Pharmaceuticals. And you complain that the new reforms don't do either of these, right? And that the things it does do will exacerbate the problem of high medical costs, right? If I'm reading you right, I really do see and agree with those points. However, I don't agree with you that insurance companies will run things better than a single payer government run system, and I don't see why you think the problem of high costs is a worse problem than the severely unequal distribution and access to health care across the American population. |
"Too much certainty and clarity could lead to cruel intolerance" -Karen Armstrong
Check out my art store: http://www.marfknox.etsy.com
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marfknox
SFN Die Hard
USA
3739 Posts |
Posted - 05/31/2011 : 12:25:50 [Permalink]
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Kil wrote: | That's honky dory for those who have health insurance, but what about the rest of us? Whether it's 20, 30 or as high as 45 million, it's a failed system with those kinds of numbers of uninsured. |
Let's please not forget the underinsured. In other words, those who have health insurance but who cannot afford the copays. My brother in law had health insurance and got swine flu a couple years ago. It landed him into thousands of dollars of more debt than he already had and couldn't pay. He also lost his job about a month after getting out of the hospital, and since then he's either been unemployed or working paycheck to paycheck as a server. When I've asked him about his medical bills from that event, he laughs and says, "Fuck 'em, I can't pay it! What are they going to do? Take the treatment they gave me back?" That might seem irresponsible on his part, but he really can't afford to pay. His wife is already paying for his car insurance, while he struggles to just come up with rent and money for food and diapers and such every month. Full time work ain't so great when you're only making $8/hr, and in Ohio the guy is lucky to have a job. Actually, right now I'm basically underinsured in the sense that Will and I are also living paycheck to paycheck and have no savings. So if we had a major medical expense, we'd have to turn to relatives to help cover co-pays. So the only reason we wouldn't be thrown into huge debt and at risk of losing our house is because we have middle class family to rely on. I don't think a generation from now my kids will be so lucky, so I guess they'll be on their own. If things keep going this way, I don't know what to tell them. Work hard and follow your passions and skills doesn't seem to be enough. |
"Too much certainty and clarity could lead to cruel intolerance" -Karen Armstrong
Check out my art store: http://www.marfknox.etsy.com
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marfknox
SFN Die Hard
USA
3739 Posts |
Posted - 05/31/2011 : 12:53:41 [Permalink]
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Ebone4Rock wrote: | This is just food for thought but everyone does realize that health insurance does not require employer sponsorship right? A person can purchase it on their own and there are quite a variety of plans to choose from. There is a plan out there that will work for everyone! |
Is this meant to be sarcastic? Private health insurance is more expensive than that which you get through an employer (about twice as expensive), and if you don't have an employer, you probably have a mix of less income and more expenses. I have a friend who worked for 5 years as a part time music teacher (the only work she could find at the time) married to an independent contractor carpenter. They had one child. Their family health insurance cost more than her entire paycheck - and she worked 25 hours a week doing work that required a college degree!!!
The average cost of health insurance plans is typically around $4-5K for individuals and $9-10K for families. That's a quarter of the average family's income! And that's before copays. Now add in food, housing, utilities, oh wait, stop there. We've already reached the point beyond what the average family income can afford. Gee, I wonder why we have such a historically high number of American families and individuals using social services... Yeah, I guess all those people need to just pull themselves up by their bootstraps or something, and find a way to turn shit into gold.
| That being said I personally think that the insurance companies are a major cause of the bloated prices we see for health care. |
I agree with that. But I just plain do not like the system of using health insurance companies to distribute health care. As Dave pointed out, insurance works as something that everyone pays into with the idea that most people will never have to use it. That's the only way it works. I don't see how it works when everyone eventually has to use it, and when it comes to health care, everyone SHOULD be going for regular general checkups, vaccinations, eye appointments and dental cleanings, and they SHOULD be getting the treatment necessary for basic maintenance of health that prevents more serious conditions in the future.
| I have told the story before about how my wife and I went uninsured for a number of months. During that time she required a CT scan. We were billed $2500 which we had to pay all on our own. A year or two later, now with insurance, my wife required another CT scan. We received our insurance statement. The retail price of the CT scan was still $2500 (same hospital, same exact machine) but with the discount the insurance company gets they only paid $650! |
Huh, I never heard of that sort of thing before.
| See, cut out the middle man. Bill me directly for the $650. I'll write a check. Easy, breezy, beautiful. |
We just paid about that to find our sidewalk. We had to save for 6 months to do so. So I'd have to save for 6 months just to have one discounted CT scan. According to the billing statement (which my insurance company paid) having my daughter cost $32K. Had I not had last minute complications during labor that lead to an emergency c-section and 3 day stay in the hospital (they would have paid for 4 days, but I wanted to go home) having my daughter would have only cost about $4K. My point: we can't just leave it up to the free market and count on lowered prices to make health care accessible to all people. If people have to pay out of pocket for regular checkups, but can save money in the short term by not getting checkups, most of the working poor will not get checkups. That will lead to higher longterm costs, and if they are poor, many of them will not be able to afford those future costs, and those costs will be passed on to others. If we have a singer payer system run by the government, everyone has to pay into it based on their income, and everyone benefits from it.
| So, we get it taken care of so that those who can afford to pay for reasonably priced health care are actually able to do so. They carry insurance for major, unexpected things. At that point we can work on a plan so that all the rest of the people who cannot afford it get some sort of government assistance with it. |
This sounds good, and while I'm tempted to agree with it, I just know that people who can technically afford basic health care will often not go if they feel healthy at the time and would rather spend the money on thing that are more fun like i-pods, etc. And when people don't do the preventative care they should, in the long-term things cost more. So unless we are talking about making basic health care checkups DIRT CHEAP, I will continue to advocate for a single payer, government run system. |
"Too much certainty and clarity could lead to cruel intolerance" -Karen Armstrong
Check out my art store: http://www.marfknox.etsy.com
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| Edited by - marfknox on 05/31/2011 12:54:02 |
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Ebone4rock
SFN Regular
USA
894 Posts |
Posted - 05/31/2011 : 13:58:57 [Permalink]
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originally posted by marfknox
| Is this meant to be sarcastic? Private health insurance is more expensive than that which you get through an employer(about twice as expensive) |
Kind of. I know a lot of people who do not consider this as an option. I should have realized who I am talking to.
Actually I did quite a bit of shopping around recently because my employer sponsored insurance had a rate hike. I found quite a few policies comparable to what I currently have. The cost was anywhere from 10-20% more for some of the policies. There were some that were much more expensive but I do think that your estimate of twice as much is a bit high.
The average cost of health insurance plans is typically around $4-5K for individuals and $9-10K for families. That's a quarter of the average family's income! And that's before copays. Now add in food, housing, utilities, oh wait, stop there. We've already reached the point beyond what the average family income can afford. Gee, I wonder why we have such a historically high number of American families and individuals using social services... .
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Agreed. It's the insurance companies that created this bloat slowly over the past 20-30 years.
But I just plain do not like the system of using health insurance companies to distribute health care. As Dave pointed out, insurance works as something that everyone pays into with the idea that most people will never have to use it. That's the only way it works. I don't see how it works when everyone eventually has to use it, and when it comes to health care, everyone SHOULD be going for regular general checkups, vaccinations, eye appointments and dental cleanings, and they SHOULD be getting the treatment necessary for basic maintenance of health that prevents more serious conditions in the future.
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Oh hell no! I don't want to see the insurance companies in charge either! All health insurance companies are are overgrown, bloated accounting firms!
....and I really shouldn't be talking this way because the health insurance industry is probably the biggest employer in my area. I bet half the people I know work in the health insurance industy.
Oooh, I'm beginning to see clearly now! Health Insurance companies ARE a way to redistribute wealth. Give skilled people a complicated job, even though the job they do is completely unnecessary.
Now I'm losing my train of thought. I am off to ponder the role of the bloated health insurance industry as it pertains to job creation and wealth re-distribution.
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Haole with heart, thats all I'll ever be. I'm not a part of the North Shore society. Stuck on the shoulder, that's where you'll find me. Digging for scraps with the kooks in line. -Offspring |
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The next black president?
