Canadian health leader wants Private options

[Magox]

That was more directed at the term itself. The resources that mere paperwork and red tape seems to be taking up almost has to be bad in any system.

Oh and you think that if the government steps in and negotiated prices with doctors and hospitals that the red tape will decrease?

[Gene Frenkle]

Well, I guess your 3% profit margin could be improved with some incentive then, couldn't it?

 

HuH

 

You're right, you don't understand economics.

 

Poisoning the Well argument? Hey I'm just paraphrasing what you said.

 

Don't pretend one is being freshly introduced here? Really? Nationalization of certain Banks certainly is a fresh concept for a capitalist country. Nationalization of the auto industry I think falls in that category, and all though the health insurance debate has been around for a while, it certainly doesn't fit into the way of thinking that I would want from the country I live in.

I'll spell it out: The profit margins could be improved simply by eliminating 'Administrative Costs', thereby making the system more efficient and increasing the profit margin. What am I missing Mr. Smith?

 

You were paraphrasing what I said totally off topic and out-of-context. The definition of Poisoning the Well.

 

In a related note, we're talking about health care, not banks and the auto industry. Let's stay on topic.

[Gene Frenkle]

Oh and you think that if the government steps in and negotiated prices with doctors and hospitals that the red tape will decrease?

If the private insurance companies are forced to compete with a leaner model or die, then yes. Human beings have an amazing ability to adapt to new environments, even on a short time scale.

[Magox]

I'll spell it out: The profit margins could be improved simply by eliminating 'Administrative Costs', thereby making the system more efficient and increasing the profit margin. What am I missing Mr. Smith?

 

You were paraphrasing what I said totally off topic and out-of-context. The definition of Poisoning the Well.

 

In a related note, we're talking about health care, not banks and the auto industry. Let's stay on topic.

if you increase competition how does that eliminate 'administrative costs'? I'll tell you how, It doesn't! That is a separate issue. Btw, most of those costs are from the claims processing department. Medical suits etc.

 

Let me ask you this, and think about this very clearly, take your time ok. If the government does lower the costs significantly, will that increase or decrease the quality of health insurance?

 

Assuming that you are not a total homer, and that you answer that question logically, since nearly 40% of the 'administrative' costs, I hate to call it that, because thats not what it is, but for arguments sake lets just keep it. If we decrease the quality of health care, is there a higher or lower likelyhood of there being increased medical lawsuits, claims?

 

Think about if for a second.

[Kelly the Dog]

if you increase competition how does that eliminate 'administrative costs'? I'll tell you how, It doesn't! That is a separate issue. Btw, most of those costs are from the claims processing department. Medical suits etc.

 

Let me ask you this, and think about this very clearly, take your time ok. If the government does lower the costs significantly, will that increase or decrease the quality of health insurance?

 

Assuming that you are not a total homer, and that you answer that question logically, since nearly 40% of the 'administrative' costs, I hate to call it that, because thats not what it is, but for arguments sake lets just keep it. If we decrease the quality of health care, is there a higher or lower likelyhood of there being increased medical lawsuits, claims?

 

Think about if for a second.

It takes less than a second. If you are entirely inefficient in your processing and underwriting, if you spend a grossly inordinate amount of money to marketing (to promote a false image), to lobbying, to executive pay, to shareholders, to buying up smaller companies which increases your demands to Wall Street instead of Main Street -- and the amount you used to pay to actual care for your patients was 95 cents out of the dollar 15 years ago to now 80 cents out of the dollar, people can surely get the same or better care for less money.

 

Read this interview

[IDBillzFan]

In a year we're going to know whether the economy is really on its way back or still sluggish. If it is, Obama's numbers will be way up again, if it's not they will likely be lower than they are now. That's all this is.

I agree with most everything you said, except I do not believe his current poll numbers are strictly because of the economy, but also, in large part, because of the confusion I mocked in my previous post. On the other hand, as John Madden says, winning is a great deodorant, and an improved economy alone will trigger an upward trend in poll numbers without question. (Frankly, the poll numbers are so frequently released that they seem to create their own trending.)

 

Nonetheless, as the guys at MSNBC.com have pointed out today, liberal backlash has arrived. This is the chaos I was talking about before. I also heard Sebelius this morning using the "it must have been a slow news day" excuse for misinterpreting her comments this weekend. What a mess.

[Gene Frenkle]

if you increase competition how does that eliminate 'administrative costs'? I'll tell you how, It doesn't! That is a separate issue. Btw, most of those costs are from the claims processing department. Medical suits etc.

My claim (based on my understanding of how a free market works) is that increased competition (see public option) will cause these companies to become leaner and more efficient so that they can compete with said public option. There are great inefficiencies in the current private health care system that we as health care consumers are paying for now.

 

Let me ask you this, and think about this very clearly, take your time ok. If the government does lower the costs significantly, will that increase or decrease the quality of health insurance?

Who would choose the public option? Those who have no need for a pricier, deeper plan and those who cannot currently afford health care. So people who choose the (supposedly) decreased coverage and those who have no health insurance now (a.k.a. the ones who we pay for now).

 

Assuming that you are not a total homer, and that you answer that question logically, since nearly 40% of the 'administrative' costs, I hate to call it that, because thats not what it is, but for arguments sake lets just keep it. If we decrease the quality of health care, is there a higher or lower likelyhood of there being increased medical lawsuits, claims?

 

Think about if for a second.

I believe that the malpractice question needs to be addressed as well, but I remember reading that that problem is possibly overblown, at least relative to other inefficiencies in the current system. There is nothing that says that health care under a private insurer will decrease in quality. Nobody is taking your private option away.

 

Life Expectancy in Canada > Life Expectancy in America

 

While this conversation is stimulating and all, I need to get some work done. Holy crap!

[DC Tom]

I'll spell it out: The profit margins could be improved simply by eliminating 'Administrative Costs', thereby making the system more efficient and increasing the profit margin. What am I missing Mr. Smith?

 

 

That you can't eliminate administrative costs.

 

You can reduce them. Theoretically you can reduce them to the point where your business process is: accept requests for money, hand out what's asked for. And leave yourself open to potential fraud. Or you can add administrative overhead to protect against fraud...and the nature of the government is zero tolerance, to the point where it will spend $10k to prevent fifty dollars worth of fraud.

 

Until the American public is willing to accept that a certain amount of dishonesty, waste, risk, and and inefficiency is inevitable and trying to prevent all of it is in itself wasteful, administrative and overall costs of anything will only increase, be it health care, defense, education, or what have you.

[Kelly the Dog]

I agree with most everything you said, except I do not believe his current poll numbers are strictly because of the economy, but also, in large part, because of the confusion I mocked in my previous post. On the other hand, as John Madden says, winning is a great deodorant, and an improved economy alone will trigger an upward trend in poll numbers without question. (Frankly, the poll numbers are so frequently released that they seem to create their own trending.)

 

Nonetheless, as the guys at MSNBC.com have pointed out today, liberal backlash has arrived. This is the chaos I was talking about before. I also heard Sebelius this morning using the "it must have been a slow news day" excuse for misinterpreting her comments this weekend. What a mess.

This is simple conjecture but I don't find it unusual or overly troublesome, I find it just being in a tough dilemma and trying to figure out the best way to handle it. I can't say the White House has done a good job of it, but I think they are in a no win situation right now.

 

Basically, they didn't want to make the mistake the Clinton administration did by dictating to Congress what the health care bill should be, so they set parameters and let the Congressmen and Senators make their own bills. We're in the middle of that now, and what is going on there is not only not unusual but it's the way it always is.

 

The WH has basically kept to that stance, all the while working behind the scenes with both houses to get what they want in there but they are really much, much more concerned with the big picture -- there are 4-5 major issues they want addressed and they are not too concerned about how it gets there as long as the congress passes a bill Obama can sign.

 

1] They want everyone (95%-97%) covered by mandate.

2] They want no one to be denied coverage based on previous conditions, and no one to be able to be dropped if you get sick and require more care by law.

3] They want caps on how much out of pocket consumers can be charged by law.

4] They want the exchange created so individuals can group together to get the same better rates that major companies get, and can comparison shop for better deals.

5] They want competition for the private insurers to lower costs through a public plan.

 

Those are the major changes that the White House wants, and they already have the top four done. There are also a number of major elements of the bill that doesn't change things but keeps them the same.

 

1] They want people to be able to keep their insurance if they want and grandfather in all the plans people have now (although, yes, employers could choose to change it and they would have no choice)

2] They want no changes to Medicare benefits so the elderly doesn't freak out.

3] They want to be able to say that it is deficit neutral through specific savings (especially fraud and in Medicare) which is 400-500 billion, as well as a plan for taxes to pay for the rest that doesn't tax the middle class.

 

There are all kinds of other elements but IMO that is what they want. And they are allowing the Congress to provide it for them.

 

But they also want to try to get 60 votes in the Senate and the only way to get that is to woo the Blue Dog Dems and a couple Republicans. That is the sole cause, IMO, for all the confusion. The WH simply won't take a hardline stand right now because they don't have to, and they still want Obama to appear to be above the fray and working with the other side. And he is. That's the sole reason for keeping the co-op deal option open. But when the press jumps all over something like they did, the progressives in the party feel like they have to take their stand.

 

If anything, from Pelosi's and others response to this, it should reinforce the WH thinking not to try to dictate too much policy because these azzholes are powerful, too.

 

As I said yesterday and all along, all the WH wants to do is get a bill out of the Senate Finance Committee so they can get all the Senate working together on their bill and the House working on their bill, so they can be joined as one. That is how this works. But the WH can't get a bill out of the Finance Committee that has a public plan element to it. So they are saying, rightfully, that it doesn't need one and they are open to a co-op. But the progressives don't want that to dominate the news and lose their big want, the public plan.

 

That's why there is so much apparent chaos. But it's all just posturing.

[GG]

It takes less than a second. If you are entirely inefficient in your processing and underwriting, if you spend a grossly inordinate amount of money to marketing (to promote a false image), to lobbying, to executive pay, to shareholders, to buying up smaller companies which increases your demands to Wall Street instead of Main Street -- and the amount you used to pay to actual care for your patients was 95 cents out of the dollar 15 years ago to now 80 cents out of the dollar, people can surely get the same or better care for less money.

 

Read this interview

 

I just scanned it. It made me laugh, because all the warts that Potter is exposing of the private insurers will be magnified in a government plan. If he became disillusioned when the industry went from managed-care to consumer driven care, then he's a Pollyanna, because it was consumers themselves who moved the industry in that direction.

 

Remember the move a decade ago where you needed your primary doctor to give a referral to the specialist? I do. That was managed care and my recollection is that people puked at it. So I'm sorry that I don't feel bad that a company discontinued offering a product that its customers didn't want.

 

But this is a key point: "But I also saw how—you know, the things that they do to maximize their profit, which really boils down to dumping the sick."

 

A private insurance company needs to make a profit. So, on to his explanation:

Two different ways that they do this. In the individual insurance market, we’ve seen quite a bit of news coverage, especially in California. When insurance companies who are active in the individual market—and this means when you don’t get your insurance coverage through your workplace, about the only option you have is to buy it directly from an insurance company, and usually it’s much more costly than it is through—if you buy it or get it through your employer. Once you file a claim, if you are unfortunate enough to get very sick or have an accident and file a claim, you very often will find that your insurance company will go back and look at your application to see if there might be a chance that you either didn’t disclose something that you knew about in the past or inadvertently didn’t disclose something or might not have known about a pre-existing condition. They’ll use that as evidence that you were committing fraud, and they’ll revoke your policy, or they call it “rescinding” your policy, leaving you holding the bag, making you completely responsible for all the medical bills. That’s one way that they dump people who need insurance the most.

 

Another is, if you are employed, particularly with a small business, and your insurance—your employer gets his or her insurance through one of the large insurers, and if just one person in your company files a claim that the underwriters think is too high, if it skews what they think is the appropriate medical experience or claim experience, when that business comes up for renewal, they very likely will jack up the rates so much that your employer has no alternative but to leave and leave you and all of your coworkers without insurance. Either that or they may cut benefits or try to shop for coverage somewhere else. But the end result is, you may find yourself dumped into the rolls and the ranks of the uninsured.

 

Nothing outrageous there. It's called managing the risk and we've discussed it in other threads. Your policy premium is based on the expected risk profile of your class/risk pool. If you buy a policy and your risk pool is very small, one big claim will tilt the future premium. Yes, it sounds outrageous, but that's how you manage the risk.

 

As to the industry fighting the proposals, they are public companies and have a responsibility to their shareholders. Even if the public plan doesn't put them out of business, it will hurt revenue and profitability. They have a duty to the shareholders to protect that.

 

The big problem that I see is that while you criticize others for missing the point, you continue to harp on administrative costs and profits as the evils of a private insurance model, yet do not talk about the absolute cost of medical care. That is the elephant in the room, and that is the main worrying item that should be talked about.

 

Healthcare costs are exploding because people have no idea of what healthcare actually costs, because for insured people and for the poor, the cost is virtually free. By expanding the public option without reforming the lack of transparency in total costs will add 20 million free riders to the system, without an effective means to pay for the exploding costs.

 

That should be the worry of every single taxpayer, not whether insurance companies are using scare tactics to block this plan or the next

[Kelly the Dog]

A private insurance company needs to make a profit. So, on to his explanation:

 

Nothing outrageous there. It's called managing the risk and we've discussed it in other threads. Your policy premium is based on the expected risk profile of your class/risk pool. If you buy a policy and your risk pool is very small, one big claim will tilt the future premium. Yes, it sounds outrageous, but that's how you manage the risk.

 

As to the industry fighting the proposals, they are public companies and have a responsibility to their shareholders. Even if the public plan doesn't put them out of business, it will hurt revenue and profitability. They have a duty to the shareholders to protect that.

 

The big problem that I see is that while you criticize others for missing the point, you continue to harp on administrative costs and profits as the evils of a private insurance model, yet do not talk about the absolute cost of medical care. That is the elephant in the room, and that is the main worrying item that should be talked about.

 

Healthcare costs are exploding because people have no idea of what healthcare actually costs, because for insured people and for the poor, the cost is virtually free. By expanding the public option without reforming the lack of transparency in total costs will add 20 million free riders to the system, without an effective means to pay for the exploding costs.

 

That should be the worry of every single taxpayer, not whether insurance companies are using scare tactics to block this plan or the next

I agree totally that as big a problem or a bigger problem is the absolute cost of Health Care. But no one seems to want to listen to that when the Democrats or Obama describes that and what they want to do about it. He talks about it every single day. But to me it is just a huge problem that this particular health care bill is only going to start to address. But believe me, there are dozens and dozens of models and programs and pilot programs to try to get right at that hard cost already in the bills being discussed.

 

One of them is the death panel where all the Democrats are trying to kill gramma. That provision could save up to 70 billion over ten years in hard cost from tens if not hundreds of thousands of patients 50+ that are getting procedures and treatment and care they don't even want at the end of their life, or are spending their last few days in the hospital instead of at home with their loved ones or in hospice where they would prefer to be if you asked them.

 

There are all kinds of provisions in the reform bill to try to battle obesity and smoking and other ailments that drive up the hard costs. There are all kinds of provisions to try to cut down on fraud and unnecessary tax breaks to insurers and providers. There are all kinds of provisions for programs in companies like Safeway that incentivize wellness in their employees that cut down on their health costs. And systems like Mayo and Cleveland clinic that cut down on costs and have better care. They're in there already but no one wants to talk about them because the government is taking over health care and gramma's plug is being pulled.

[IDBillzFan]

One of them is the death panel where all the Democrats are trying to kill gramma. That provision could save up to 70 billion over ten years in hard cost from tens if not hundreds of thousands of patients 50+ that are getting procedures and treatment and care they don't even want at the end of their life, or are spending their last few days in the hospital instead of at home with their loved ones or in hospice where they would prefer to be if you asked them.

 

There are all kinds of provisions in the reform bill to try to battle obesity and smoking and other ailments that drive up the hard costs. There are all kinds of provisions to try to cut down on fraud and unnecessary tax breaks to insurers and providers. There are all kinds of provisions for programs in companies like Safeway that incentivize wellness in their employees that cut down on their health costs. And systems like Mayo and Cleveland clinic that cut down on costs and have better care. They're in there already but no one wants to talk about them because the government is taking over health care and gramma's plug is being pulled.

I don't understand how the Congress has created, based on your description, the amazingly amazing solution to fixing the health care problem in the US, and after five weeks you remain, to this day, the only person in the entire world who understands what it is, how it works, and just how glorious it is.

 

You must be one lonely mutherfkuer sometimes.

[Kelly the Dog]

I don't understand how the Congress has created, based on your description, the amazingly amazing solution to fixing the health care problem in the US, and after five weeks you remain, to this day, the only person in the entire world who understands what it is, how it works, and just how glorious it is.

 

You must be one lonely mutherfkuer sometimes.

No, I actually have a great life, I just like to listen and read and watch, when I am not working or out with friends or drinking or !@#$ing.

 

So i understand what it is, they surely aren't going to fix the health care problem. You can just hate it blindly, I don't mind.

[ThereIsNoDog]

"Moral standard?" Where is my FREE FOOD?! I think our "moral standard" should be to feed every hungry person in the U.S., before we start handing-out free health care to those who don't deserve it, because they don't take care of themselves.

[Magox]

You know things are going bad for the White house when they start complaining about media.

[IDBillzFan]

No, I actually have a great life, I just like to listen and read and watch, when I am not working or out with friends or drinking or !@#$ing.

 

So i understand what it is, they surely aren't going to fix the health care problem. You can just hate it blindly, I don't mind.

I hate anything the government does that creates greater individual depedency on the govermnent. You can love it blindly. I don't mind.

[Kelly the Dog]

I hate anything the government does that creates greater individual depedency on the govermnent. You can love it blindly. I don't mind.

Well, that's the fundamental difference between you and I. I like to help my fellow man, you like to leave them out in the cold and kill them. It's okay, that's what's great about America, it's a choice.

[Gene Frenkle]

Well, that's the fundamental difference between you and I. I like to help my fellow man, you like to leave them out in the cold and kill them. It's okay, that's what's great about America, it's a choice.

WWJD...how incredibly ironic.

[GG]

There are all kinds of provisions in the reform bill to try to battle obesity and smoking and other ailments that drive up the hard costs. There are all kinds of provisions to try to cut down on fraud and unnecessary tax breaks to insurers and providers. There are all kinds of provisions for programs in companies like Safeway that incentivize wellness in their employees that cut down on their health costs. And systems like Mayo and Cleveland clinic that cut down on costs and have better care. They're in there already but no one wants to talk about them because the government is taking over health care and gramma's plug is being pulled.

 

I admit that I never read the phantom bill, but I have a hard time believing that this would be coming out of Dem committees, since the Safeway plan rewards healthier employees by lowering their premiums. Mayo & Cleveland have also implemented programs that are an anathema to the fairness (equal premiums/no denial of service & coverage) that Dems always fight for. The two are incongruous.

[ThereIsNoDog]

WWJD...how incredibly ironic.

J can heal the sick. Maybe that's the answer: prayer!