Health Care Reform - Change you can Believe in!

[finknottle]

Does it bother anyone else that Sen. Dodd took the lead in writing the Senate version of the health care reform bill - while his wife earns more than $500,000 a year sitting on the boards of several health care companies?

[Chef Jim]

Does it bother anyone else that Sen. Dodd took the lead in writing the Senate version of the health care reform bill - while his wife earns more than $500,000 a year sitting on the boards of several health care companies?

 

No, what bothers me is that we keep electing these scum balls.

[VABills]

Does it bother anyone else that Sen. Dodd took the lead in writing the Senate version of the health care reform bill - while his wife earns more than $500,000 a year sitting on the boards of several health care companies?

You mean like the messiahs wife who I believe still sits on the board of a Chicago hospital earning 350K per year?

[YellowLinesandArmadillos]

You mean like the messiahs wife who I believe still sits on the board of a Chicago hospital earning 350K per year?

 

Doubt that, conflict of interest. But you keep spreading that misinfo. She would have had to divest like everyone else. That being said, Dodd bothers me. But he along with many others who have been in DC too long on both sides no matter their rhetoric are in the pockets of the insurance companies.

 

If we are going to reform healthcare we first must make health insurance companies illegal and start from scratch on how to deal with risk pooling. Liability insurance rate then need to be heavily regulated to deal with ridiculous unfounded costs to Doctors. Lawsuits are 1/10 of 1 percent of the justified costs of liability. And then finally, we need to find a way to reign the costs of drugs and cost to drug companies for developing drugs. Not sure how to deal with this, but one way would be to cut all the federal grant funding to them unless they lowered costs. They are subsidized the hell out of by the taxpayerand to a large extent still complain about their development costs.

 

But lets start by removing the middle man from the equation, the health insurance companies.

[finknottle]

If we are going to reform healthcare we first must make health insurance companies illegal and start from scratch on how to deal with risk pooling. Liability insurance rate then need to be heavily regulated to deal with ridiculous unfounded costs to Doctors. Lawsuits are 1/10 of 1 percent of the justified costs of liability. And then finally, we need to find a way to reign the costs of drugs and cost to drug companies for developing drugs. Not sure how to deal with this, but one way would be to cut all the federal grant funding to them unless they lowered costs. They are subsidized the hell out of by the taxpayerand to a large extent still complain about their development costs.

 

But lets start by removing the middle man from the equation, the health insurance companies.

 

If I understand you correctly, you are suggesting getting the private sector out of the medical insurance business - I assume in favor of a government-controlled entity, since somebody has to do it.

 

Beyond the onbious objections about the inefficiency of the government, have you seen what happens when the government meddles in insurance? It listens to polls, not accountants. In Florida, the insurance companies decided that too many houses were getting damaged every year by hurricanes, so they raised the rates. The state stepped in and mandated that they lower them if they want to continue to do business there. So now the rates are lower than the payouts, and people keep rebuilding on the shore. The premiums are effectively subsidized by artificial increases in every other type of insurance.

 

So what happens in your scenario when the AMA or whomever lobbies congress claiming that their insurance rates are too high? Congress tells the agency/regulators top lower them, end of story. Any budgetry shortfall is somebody elses's problem.

[YellowLinesandArmadillos]

If I understand you correctly, you are suggesting getting the private sector out of the medical insurance business - I assume in favor of a government-controlled entity, since somebody has to do it.

 

I favor getting rid of the insurance industry all together private, government or otherwise. I know that won't work, but short of stringent government regulation and rate setting which I know you would oppose and would not work, there has to be another answer. The current system doesn't work, so let's scrap it and start from scratch... a little idealist I admit and politically untenable... it will never happen.

 

Beyond the onbious objections about the inefficiency of the government, have you seen what happens when the government meddles in insurance? It listens to polls, not accountants. In Florida, the insurance companies decided that too many houses were getting damaged every year by hurricanes, so they raised the rates. The state stepped in and mandated that they lower them if they want to continue to do business there. So now the rates are lower than the payouts, and people keep rebuilding on the shore. The premiums are effectively subsidized by artificial increases in every other type of insurance.

That has largely been addressed by prohibiting building in very high risk areas and keeps happening, areas prone will not be insured, even so short of any insurance the people end up crying for and getting government bailouts, no matter who is in charge in DC. So at least they are paying into the system. So at least they are paying something into the system.

 

So what happens in your scenario when the AMA or whomever lobbies congress claiming that their insurance rates are too high? Congress tells the agency/regulators top lower them, end of story. Any budgetry shortfall is somebody elses's problem.

 

A comprise may be to set up risk pools a la crop insurance with three risk pools. FCIC Subsidizes premiums especially for higher risk pools and has the government be both a re-insurer and watch dog against insurers and patients committing fraud or over charging. The penalties need to be severe enough including jail time for fraud. But for those that say that the private sector is the answer. They are fooling themselves. Medicare's administrative costs sadly enough are cheaper than private health insurance. You are right, entrenched bureaucrats are not effectively motivated to provide efficient care. And finally not enough people are covered. I say if you want health benefits, you have to enroll in an insurance programs and then the program should be a private public partnership with incentives for all sides, the patients, the government and the private sector to serve a check and balance against the other side.

 

Also, increasing the size of the risk pools by requiring everyone to carry insurance, like auto insurance, will help better fund insurance and lower overall rates by reducing overall risk.

 

But this needs to be done now and saying any plan won't work or calling a government option, a government takeover is just being obstructionist and an excuse to do nothing. At least a government option is a start to providing some competition to these over bloated inefficient insurance companies that do nothing but cherry pick and deny coverage when a serious medical issue occurs. What kind of health system is that. We pay, but we get no benefits yet our tax dollars still fund this crap.... Please, the current system only benefits the rich and the poor and once again taxes the hell out the middle class with little benefit.

[pBills]

You mean like the messiahs wife who I believe still sits on the board of a Chicago hospital earning 350K per year?

 

 

Damn her. DAMNNNNNN HERRRRRR

[GG]

I favor getting rid of the insurance industry all together private, government or otherwise. I know that won't work, but short of stringent government regulation and rate setting which I know you would oppose and would not work, there has to be another answer. The current system doesn't work, so let's scrap it and start from scratch... a little idealist I admit and politically untenable... it will never happen.

 

That has largely been addressed by prohibiting building in very high risk areas and keeps happening, areas prone will not be insured, even so short of any insurance the people end up crying for and getting government bailouts, no matter who is in charge in DC. So at least they are paying into the system. So at least they are paying something into the system.

 

 

 

A comprise may be to set up risk pools a la crop insurance with three risk pools. FCIC Subsidizes premiums especially for higher risk pools and has the government be both a re-insurer and watch dog against insurers and patients committing fraud or over charging. The penalties need to be severe enough including jail time for fraud. But for those that say that the private sector is the answer. They are fooling themselves. Medicare's administrative costs sadly enough are cheaper than private health insurance. You are right, entrenched bureaucrats are not effectively motivated to provide efficient care. And finally not enough people are covered. I say if you want health benefits, you have to enroll in an insurance programs and then the program should be a private public partnership with incentives for all sides, the patients, the government and the private sector to serve a check and balance against the other side.

 

Also, increasing the size of the risk pools by requiring everyone to carry insurance, like auto insurance, will help better fund insurance and lower overall rates by reducing overall risk.

 

But this needs to be done now and saying any plan won't work or calling a government option, a government takeover is just being obstructionist and an excuse to do nothing. At least a government option is a start to providing some competition to these over bloated inefficient insurance companies that do nothing but cherry pick and deny coverage when a serious medical issue occurs. What kind of health system is that. We pay, but we get no benefits yet our tax dollars still fund this crap.... Please, the current system only benefits the rich and the poor and once again taxes the hell out the middle class with little benefit.

 

Idealistic? Naive is more like it.

 

 

Medicare & Medicaid are the examples of the system you just described. Yet there is far more fraud in that segment than in private insurance and quality of care is inferior. So, tell us why we should suspend reality and believe that a new plan, which will basically be Medicare for everyone will work better? The only reason that Medicare isn't a bigger fiasco is that the medicine industry can subsidize it out of the profits from the private part.

 

Remove the profit opportunity, and you'll end up in a far worse place. Will more people be covered? Yes. Will quality be better and will it be financially sustainable - No and No.

[YellowLinesandArmadillos]

Idealistic? Naive is more like it.

 

 

Medicare & Medicaid are the examples of the system you just described. Yet there is far more fraud in that segment than in private insurance and quality of care is inferior. So, tell us why we should suspend reality and believe that a new plan, which will basically be Medicare for everyone will work better? The only reason that Medicare isn't a bigger fiasco is that the medicine industry can subsidize it out of the profits from the private part.

 

Remove the profit opportunity, and you'll end up in a far worse place. Will more people be covered? Yes. Will quality be better and will it be financially sustainable - No and No.

 

 

Not true one the fraud count.. and the administrative costs of private insurance cos are much higher than public insurance. So there has to some sort of law or rule that requires administrative costs to be equal. Then I would agree private is better than public... but not in the current structure of this portion of the insurance market.

 

Hence why I would advocate the crop insurance model where the govt is the re-insurer, but that everyone is required to participate. But apparently you didn't bother reading my whole post before taking shots.

[GG]

Not true one the fraud count.. and the administrative costs of private insurance cos are much higher than public insurance. So there has to some sort of law or rule that requires administrative costs to be equal. Then I would agree private is better than public... but not in the current structure of this portion of the insurance market.

 

Hence why I would advocate the crop insurance model where the govt is the re-insurer, but that everyone is required to participate. But apparently you didn't bother reading my whole post before taking shots.

 

I did read the whole post, just highlighted the main area of naivete.

 

There is far more fraud in Medicare, because no one cares about the enforcement, while the system is set up on reimbursements, which leads providers to maximize volume. I have a hard time believing that there's more fraud in private insurance than there is in Medicare/Medicaid simply that the inherent design of the two systems make it much harder to cheat on the private side.

 

I also wish that people would stop parroting the ridiculous administrative cost argument. The biggest cost of healthcare is the actual care itself, not the administrative side. The reason that Medicare is 'cheaper' is that it piggy backs on the systems that were created by the private sector. If you eliminate the private sector insurance the public sector picks up the entire admin cost. Care to guess whether a gov't run system will then be as cost-effective as a private one?

[YellowLinesandArmadillos]

I did read the whole post, just highlighted the main area of naivete.

 

There is far more fraud in Medicare, because no one cares about the enforcement, while the system is set up on reimbursements, which leads providers to maximize volume. I have a hard time believing that there's more fraud in private insurance than there is in Medicare/Medicaid simply that the inherent design of the two systems make it much harder to cheat on the private side.

 

I also wish that people would stop parroting the ridiculous administrative cost argument. The biggest cost of healthcare is the actual care itself, not the administrative side. The reason that Medicare is 'cheaper' is that it piggy backs on the systems that were created by the private sector. If you eliminate the private sector insurance the public sector picks up the entire admin cost. Care to guess whether a gov't run system will then be as cost-effective as a private one?

 

 

Okay, so you pan that part of my argument... fine. But what do you think about the crop insurance model of re-insurance, risk pooling and premium subsidy as well as an independent counsel to investigate fraud model?

[YellowLinesandArmadillos]

I did read the whole post, just highlighted the main area of naivete.

 

There is far more fraud in Medicare, because no one cares about the enforcement, while the system is set up on reimbursements, which leads providers to maximize volume. I have a hard time believing that there's more fraud in private insurance than there is in Medicare/Medicaid simply that the inherent design of the two systems make it much harder to cheat on the private side.

 

I also wish that people would stop parroting the ridiculous administrative cost argument. The biggest cost of healthcare is the actual care itself, not the administrative side. The reason that Medicare is 'cheaper' is that it piggy backs on the systems that were created by the private sector. If you eliminate the private sector insurance the public sector picks up the entire admin cost. Care to guess whether a gov't run system will then be as cost-effective as a private one?

 

 

If fraud or price fixing were not true, why are costs going up so high or are they. It isn't lawsuits or settlements insureres like to trot out as the reason, they area only a small portion of the over cost issue. In fact health insurance is one of the most profitable industries to be in even right now and yet fees and premiums are going up over 9%. Maybe government should institute price controls... not, but seriously our insurance has a cartel that is better functioning then OPEC as far as cornering the market.

[GG]

Okay, so you pan that part of my argument... fine. But what do you think about the crop insurance model of re-insurance, risk pooling and premium subsidy as well as an independent counsel to investigate fraud model?

 

Because it's not the right model for this kind of insurance. Crop insurance is more closely related to property/casualty risks, while health insurance isn't so much of event based risk management, but a transfer of payments from the healthy to the sick. So, yes if you are going to socialize healthcare, you absolutely have to mandate coverage. In effect it's a tax on the young to pay the old folks' health costs.

 

The reason I'm down on its is mistrust that the new government behemoth will be effective, and that it will accomplish even a fraction of its costs. Government has been horrendous in cost management and there's nothing that will make me believe that this is not going to be another run away money train. Add the highly politicized nature of healthcare, which will give aspiring politicians another platform to sharpen their populist credentials, the possibility of unsustainable cost of the program increases dramatically. Name one candidate who will run on a platform "I will reduce your health benefits."

 

If fraud or price fixing were not true, why are costs going up so high or are they. It isn't lawsuits or settlements insureres like to trot out as the reason, they area only a small portion of the over cost issue. In fact health insurance is one of the most profitable industries to be in even right now and yet fees and premiums are going up over 9%. Maybe government should institute price controls... not, but seriously our insurance has a cartel that is better functioning then OPEC as far as cornering the market.

 

Insurance is not a cartel, but it is difficult for small companies to get in the game, because the costs are too high. Healthcare costs are high because of the way people use healthcare in this country. Because the way that healthcare is priced and sold (do you know your healthcare premium?) in the US, there's no incentive to rationalize the cost from anyone's side. For the consumer with insurance, healthcare is free, so most people ignore problems because they're confident they can be fixed. People without insurance put off ailments as far as possible until they're really sick. In both cases, the primary first destination for health services are the emergency rooms, which are the most expensive form of care. There are very few interim clinics out there, because there is little incentive in building them because few people use them.

 

McCain's call to eliminate the tax deduction on health benefits was a correct one, because people would finally see how much healthcare is costing them, and you would force them into more prudent behavior.

[finknottle]

If fraud or price fixing were not true, why are costs going up so high or are they. It isn't lawsuits or settlements insureres like to trot out as the reason, they area only a small portion of the over cost issue. In fact health insurance is one of the most profitable industries to be in even right now and yet fees and premiums are going up over 9%. Maybe government should institute price controls... not, but seriously our insurance has a cartel that is better functioning then OPEC as far as cornering the market.

 

Hospitals are obligated to provide emergency care to anyone, regardless of whether they can pay for it. Those costs are real - the money must come from somewhere. The way the hospitals recoup the money is by raising their rates to the insurance companies and to those who actually pay for service. In turn the insurance companies raise the premiums to you. In other words, the premiums you are paying now are not calculated to cover your expected needs, but rather your needs plus a portion of those who cannot pay.

 

The big problem is the danger of it spiraling out of control. The more the uninsured use emergancy services, the higher the rates go for the insured. This causes some to drop insurance entirely and join the uninsured, driving rates up even higher. You have a smaller and smaller portion of the public subsidizing an ever-growing pool of uninsured, with predicatable results.

 

So unless you want to see rates continue to rise, the key issue in health care reform is that you either mandate that everybody purchase some kind of coverage, or else you no longer require that hospitals treat anybody who shows up in the emergancy room.

[YellowLinesandArmadillos]

Hospitals are obligated to provide emergency care to anyone, regardless of whether they can pay for it. Those costs are real - the money must come from somewhere. The way the hospitals recoup the money is by raising their rates to the insurance companies and to those who actually pay for service. In turn the insurance companies raise the premiums to you. In other words, the premiums you are paying now are not calculated to cover your expected needs, but rather your needs plus a portion of those who cannot pay.

 

The big problem is the danger of it spiraling out of control. The more the uninsured use emergancy services, the higher the rates go for the insured. This causes some to drop insurance entirely and join the uninsured, driving rates up even higher. You have a smaller and smaller portion of the public subsidizing an ever-growing pool of uninsured, with predicatable results.

 

So unless you want to see rates continue to rise, the key issue in health care reform is that you either mandate that everybody purchase some kind of coverage, or else you no longer require that hospitals treat anybody who shows up in the emergancy room.

There is no requirement for private hospitals to treat the uninsured and in fact they are turning folks away. Public hospitals don't have that option. Interesting to see if the for profit model works and if it controls costs any better. I have heard any recent stats on them and maybe there are too few. The other problem with the turn away model is the hypocratic oath that Doctors take. But of course we are subsidizing the old folks who use services more. ? Can we better serve them and provide them with more cost effective services as well?

[VABills]

There is no requirement for private hospitals to treat the uninsured and in fact they are turning folks away. Public hospitals don't have that option. Interesting to see if the for profit model works and if it controls costs any better. I have heard any recent stats on them and maybe there are too few. The other problem with the turn away model is the hypocratic oath that Doctors take. But of course we are subsidizing the old folks who use services more. ? Can we better serve them and provide them with more cost effective services as well?

Any hospital private or public is required to treat any insured person if they have tax exempt status. My wife works at a private hospital as a senior person, and yes they do have to provide care. You have no clue WTF you are talking about. BTW, the vast majority of hospitals want and get tax exempt status.

[finknottle]

Any hospital private or public is required to treat any insured person if they have tax exempt status. My wife works at a private hospital as a senior person, and yes they do have to provide care. You have no clue WTF you are talking about. BTW, the vast majority of hospitals want and get tax exempt status.

 

I don't know this for sure and please correct me, but I believe the key issue is not private v public, but rather whether or not there is an emergancy room (in some regulatory sense). If there is, you cannot turn anyone away, insured or not. If there isn't, and it is a private hospital, you can do anything you like - think clinic, or a practice.

 

Tax status makes sense, but I hadn't heard that angle before.

[VABills]

I don't know this for sure and please correct me, but I believe the key issue is not private v public, but rather whether or not there is an emergancy room (in some regulatory sense). If there is, you cannot turn anyone away, insured or not. If there isn't, and it is a private hospital, you can do anything you like - think clinic, or a practice.

 

Tax status makes sense, but I hadn't heard that angle before.

Nope, not true. It is the tax exempt status. A private hospital with an emergency and no tax exempt status can turn away whomever they want.

[VABills]

BTW , just because the hospital is tax exempt and required to provide care, doesn't mean they do it for free. They are allowed to run credit checks, review a patients income, savings, etc... there are guidelines for how much they can still charge and collect for servcies. Charity cases of the really poor are the only ones who really get free medical from the tax exempt hospitals.

[finknottle]

BTW , just because the hospital is tax exempt and required to provide care, doesn't mean they do it for free. They are allowed to run credit checks, review a patients income, savings, etc... there are guidelines for how much they can still charge and collect for servcies. Charity cases of the really poor are the only ones who really get free medical from the tax exempt hospitals.

 

I don't know about the guidelines...

 

In my experience, they set the list prices absurdly high as a sort of opening bid. Then, following the review you describe, they provide charity to reduce the bill to the most they think the patient will pay rather than stiff the hospital or declare bankruptcy. So if you are genuinely poor, or an illegal immigrant likely to disappear, you generally pay nothing - it's not worth the effort trying to collect.

 

The real victims are those who are uninsured but have the ability to pay. By way of example, I had an emergancy gall bladder removal. No advanced warning, no opportunity to shop around... Actual price of the proceedure and two-day stay? About $4,000, according to the medical tourism sites. List price as billed? ~$30,000. Amount I had to pay after the bargaining? ~$22,000. It was an outrage, but - having a house and savings for my retirement - I was a sitting duck. They figured, probably rightly, that any more than that and I would have declared bankruptcy out of spite. And what are they doing with the extra money? Using it to subsidize those they can't collect from.

 

(Btw, if you ever find yourself in this position, treat it like buying a car. Negotiate with the hospital - they do the actual assessment of your ability to pay. Cite the discount they give you to the various specialists you also receive bills from for the proceedure, and they will generally follow suit.)