Hers's a question

[Cheeseburger_in_paradise]

If the Republicans want something done about medical malpractice litigation, isn't that about insurance? I mean, isn't much of this whole confugulation with health care, about insurance? As a worker guy, it boggled my mind a few years ago that I was paying nearly $500 for heath insurance for my family (my employer was supposedly matching that), and it didn't cover ****. And as a family, we typically had about $300 in real bills, on average. Why would it cost $1000 a month to cover $300? And, are the same companies that are covering health insurance, also covering doctor malpractice insurance? If that is so, aren't they getting everybody coming and going?

 

I know it's more complicated than that. But any good football coach knows you have to break the game down into little pieces to figure out how to win. We have terrible coaches right now.

[Magox]

If the Republicans want something done about medical malpractice litigation, isn't that about insurance? I mean, isn't much of this whole confugulation with health care, about insurance? As a worker guy, it boggled my mind a few years ago that I was paying nearly $500 for heath insurance for my family (my employer was supposedly matching that), and it didn't cover ****. And as a family, we typically had about $300 in real bills, on average. Why would it cost $1000 a month to cover $300? And, are the same companies that are covering health insurance, also covering doctor malpractice insurance? If that is so, aren't they getting everybody coming and going?

 

I know it's more complicated than that. But any good football coach knows you have to break the game down into little pieces to figure out how to win. We have terrible coaches right now.

It's mindboggling that they won't add in TORT reform as one of the provisions to try to solve this problem, when it has been proved that it is one of the factors that are contributing to soaring medical insurance premiums.

[John Adams]

If the Republicans want something done about medical malpractice litigation, isn't that about insurance? I mean, isn't much of this whole confugulation with health care, about insurance? As a worker guy, it boggled my mind a few years ago that I was paying nearly $500 for heath insurance for my family (my employer was supposedly matching that), and it didn't cover ****. And as a family, we typically had about $300 in real bills, on average. Why would it cost $1000 a month to cover $300? And, are the same companies that are covering health insurance, also covering doctor malpractice insurance? If that is so, aren't they getting everybody coming and going?

 

I know it's more complicated than that. But any good football coach knows you have to break the game down into little pieces to figure out how to win. We have terrible coaches right now.

 

Umm. That's how insurance works. You pay more when things are going well...so that when something goes badly, there's money in the pot to cover it. (Because others are then paying more.)

[Cheeseburger_in_paradise]

Umm. That's how insurance works. You pay more when things are going well...so that when something goes badly, there's money in the pot to cover it. (Because others are then paying more.)

 

The grocery industry manages to operate on about a 1 percent profit margin. I wonder what the PM is for the insurance industry. I know it's a complicated issue as to why costs have sky rocketed. But I know that in 1982, I was paying about $10 a month (for just myself) for Blue Cross Blue Shield health insurance, through my employer. I barely missed it. Maybe it's like with my car. In the old days I'd take it to my mechanic. He'd look under the hood, he'd listen to the engine, and say "er ah, it's a yur fuel pump. That el be $45." Now I take it in, the mechanic hooks it up to a bunch of electrical devices which generate a computer print out. He gives the information to the customer service guy who tells me "er ah, it's a yur fuel pump. That el be $350." To say the least, I suspect there some inefficiencies going on, some redundancies, and more hands in the till.

[VABills]

The grocery industry manages to operate on about a 1 percent profit margin. I wonder what the PM is for the insurance industry. I know it's a complicated issue as to why costs have sky rocketed. But I know that in 1982, I was paying about $10 a month (for just myself) for Blue Cross Blue Shield health insurance, through my employer. I barely missed it. Maybe it's like with my car. In the old days I'd take it to my mechanic. He'd look under the hood, he'd listen to the engine, and say "er ah, it's a yur fuel pump. That el be $45." Now I take it in, the mechanic hooks it up to a bunch of electrical devices which generate a computer print out. He gives the information to the customer service guy who tells me "er ah, it's a yur fuel pump. That el be $350." To say the least, I suspect there some inefficiencies going on, some redundancies, and more hands in the till.

But more and more people are going to the docs. As the baby boomers grow older the demand fo services has gone up. Add to that the demand for lipo, etc... and there are not enough docs to go around. Thus the old supply and demand. If you think it is expensive now, add 50 million folks to an already overtaxed group of people and cost will go up a lot more. Hence the reason why you medical coverage has increased in cost, more folks in, more demand for service, not enough people providing service, more payout by the insurance company and voila, drastically increased cost.

[Magox]

The grocery industry manages to operate on about a 1 percent profit margin. I wonder what the PM is for the insurance industry. I know it's a complicated issue as to why costs have sky rocketed. But I know that in 1982, I was paying about $10 a month (for just myself) for Blue Cross Blue Shield health insurance, through my employer. I barely missed it. Maybe it's like with my car. In the old days I'd take it to my mechanic. He'd look under the hood, he'd listen to the engine, and say "er ah, it's a yur fuel pump. That el be $45." Now I take it in, the mechanic hooks it up to a bunch of electrical devices which generate a computer print out. He gives the information to the customer service guy who tells me "er ah, it's a yur fuel pump. That el be $350." To say the least, I suspect there some inefficiencies going on, some redundancies, and more hands in the till.

The PM's have been discussed at ad nauseam on this board

 

http://mjperry.blogspot.com/2009/08/health...nks-86-by.html#

 

http://biz.yahoo.com/p/522qpmd.html

[Magox]

If you want to know more where costs are going, here is a very informative report done by WellPoint before they were fully demonized by the W.H and congress

 

It's a very good read, and if you care about this subject then I'd take a look into it.

 

http://www.wellpoint.com/pdf/Premium%20Cost%20Drivers.pdf

[Boatdrinks]

If you want to know more where costs are going, here is a very informative report done by WellPoint before they were fully demonized by the W.H and congress

 

It's a very good read, and if you care about this subject then I'd take a look into it.

 

http://www.wellpoint.com/pdf/Premium%20Cost%20Drivers.pdf

 

 

Utterly bohunk. Are we to believe that the profits have "little to do" with the increase in costs? Please. Only a complete tool of the insurance industry would spread this nonsense. That is like company A saying " we unfortunately must raise the cost of item B. It has little to do with our making a profit, however. Come on, this crap isn't even believable to most morons.

[Frit0 Bandit0]

If you want to know more where costs are going, here is a very informative report done by WellPoint before they were fully demonized by the W.H and congress

 

It's a very good read, and if you care about this subject then I'd take a look into it.

 

http://www.wellpoint.com/pdf/Premium%20Cost%20Drivers.pdf

 

 

Technology drives costs higher in two ways. First, newer technologies tend to increase prices because they are generally more expensive than the older technologies they replace. While the availability of more advanced, superior technologies can yield better results for some portion of the patient population, .

 

 

That is one simple fact and the truth

 

 

these technologies and diagnostic tests can also be used inappropriately

 

Thats a shaky statement to throw out, not that it doesn't occur but maybe they should bring to light their own faulty mishandling and ever changing procedural input (huge cost?).... Insurance companies come across as crooked because of that...having said that, and with all due respect to their position in the overall management of health care, their job is not an easy one but vital

[Magox]

Utterly bohunk. Are we to believe that the profits have "little to do" with the increase in costs? Please. Only a complete tool of the insurance industry would spread this nonsense. That is like company A saying " we unfortunately must raise the cost of item B. It has little to do with our making a profit, however. Come on, this crap isn't even believable to most morons.

ummm, to answer your question yes. It's a fact, that is provable, which I have already shown you.

 

The proof lies in the profit margins. You can argue concepts, but you can't rationally argue facts.

 

Instead of making blanket statements that are full of fallacies, prove it! Prove that profits are one of the primary reasons why health insurance premiums are soaring. PROVE IT!!!

 

Enough of the empty bull ****, back up your claims with facts. I backed my **** up, now it's your turn. I showed you 4 different sources listing the profit margins. Here is a FACT CHECK you moron from the AP http://www.google.com/hostednews/ap/articl...JY3SvgD9BIQPN01

 

In the health care debate, Democrats and their allies have gone after insurance companies as rapacious profiteers making "immoral" and "obscene" returns while "the bodies pile up."

 

But in pillorying insurers over profits, the critics are on shaky ground. Ledgers tell a different reality.

 

Profits barely exceeded 2 percent of revenues in the latest annual measure. This partly explains why the credit ratings of some of the largest insurers were downgraded to negative from stable heading into this year, as investors were warned of a stagnant if not shrinking market for private plans.

 

Health insurers posted a 2.2 percent profit margin last year, placing them 35th of 53 industries on the Fortune 500 list. As is typical, other health sectors did much better — drugs and medical products and services were both in the top 10.

what the Associated Press, Yahoo, WallStreet Journal, Fortune 500 are all lying too?

 

People like yourself refuse to look into the facts, and into detailed studies that show where the rising costs are coming from. Instead, you'd rather believe what these idiot, hypocritical politicians tell you. I use logic and good common sense to make my decisions, you on the other hand, can't back anything up, and just mimic what these bafoons tell us, and sadly, the herd happens to believe this bull ****.

 

So once again, PROVE TO ME that rising insurance premiums are because of these "Evil and Greedy" insurance companies pocketing profits. PROVE IT!! And don't bring me an opinion article, I want real numbers just as I have shown you.

 

I bet you didn't even read the study. If you did, tell me specifically which part you think they are misleading people. I want specifics, not just "bohunk", but specifics.

 

You see, I read up everyday, from both points of views and I try to educate myself on this topic, and I can tell you, there is not one realistic plausible solution that the W.H and Congress are providing that will bring down premiums. The only thing they have are sympathetic personal stories that just illustrate that there is a problem with rising health insurance premiums, then they throw in blanket accusations of the health insurance industry as being "greedy and evil", when in reality they can't back up those claims, other than "Health insurance premiums have skyrocketed and they are outpacing the rate of inflation".

 

Well no ****, but that's not because of higher profit margins, it's because of other medical inflationary issues, which are detailed in that report.

 

Looks like the W.H and Congress have successfully fooled another fool

[Alaska Darin]

Utterly bohunk. Are we to believe that the profits have "little to do" with the increase in costs? Please. Only a complete tool of the insurance industry would spread this nonsense. That is like company A saying " we unfortunately must raise the cost of item B. It has little to do with our making a profit, however. Come on, this crap isn't even believable to most morons.

Increased regulations=Increased costs=Higher premiums. The government that's behind this argument has more to do with increased health care costs than any other single thing (just look at Medicare/MedicAid reimbursement). Talk to your own doctor. Ask him/her what's driving up the costs - the answer won't be profit.

 

Profit is a pretty small part of the problem, though I don't believe the numbers because it's pretty easy to hide stuff accounting wise.

[GG]

Two different insurance issues. One type of insurance is what you buy to protect against health related issues. Your premium is dictated by the risk/health factors of the people in your insured group. If you work in a big company, your premium will probably be lower than for somebody who works in a small company because more people in the pool diversify the overall risk. This is the biggest problem with current health insurance scheme, as it distorts the creation of risk pools by company, not by individuals.

 

The malpractice insurance is the cost that doctors have to bear to protect against litigation. As the threat of litigation increases, doctors jack up the rates they charge to pass through the cost of that insurance, which flows down to the cost of medical insurance that you buy.

 

Both of these can and should be fixed without introducing a massive government behemoth that wouldn't fix any of the above issues.

[OCinBuffalo]

Since I do this for a living...and just got off a conference call with a major hospital group in the south discussing this very issue....allow me to take a whack.

 

1. The #1 issue has nothing to do with price. Price is an effect, not a cause. The fundamental issue here is: health care providers cannot tell you what their real cost of doing business is, on a per patient, or per patient profile basis. Instead, they do what's known as financial allocation(top down) a la "if I ordered and used 80% of 2 pallets of milk cartons, I take the number of patients in the house and divide that into the # of used milk = each patient used 1.4 cartons of milk today". Clearly this is not accurate, and is merely a rough example of the fundamental flaw of using this method to determine cost per patient.

 

2. The #2 issue is: health care provider organizations are doomed to never having real organizational knowledge. Most health care workers, in any discipline, know what they do each day. However, they cannot see how that effects cost, or, how it effects others, or others' costs. Metaphorically, they are doomed therefore to having the organizational memory and knowledge of single cell bacteria. Lots of bacteria grows wherever it can, but not because that was the plan. Instead, each cell is doing what it needs to...and each cell knows how to do it's job, but, not how to do it better, so that all the bacteria uses the resources they consume as efficiently as possible.

 

3. Insurance companies/health care providers are therefore locked into an eternal struggle over what things should(there's that word again) cost, instead of operating with the data that tells them exactly what things DO/and therefore WILL cost.

 

4. Health care providers cannot measure the work they do, therefore they have no hope of truly managing it. Worse, if you cannot manage your planned work properly, you are absolutely screwed when it comes to unplanned work. Since an emergency room's business process, as one example, is almost 100% comprised of unplanned work, they have no REAL way to set up an ACCURATE cost model. Yeah, yeah, we can do the business intelligence thing...but that's only as good as the raw data we collect, so spare me.

 

5. Add in the fact that by and large, health care providers:

a. think they are absolved of proper management techniques....because they "save lives", and how dare anyone question their methods? (Hint: questioning your methods '= questioning your motives, or how hard you work, there, you insecure tools)

b. due to a, go out of their way to say "we aren't an 'industry', and therefore not subject to the same management performance indicators everybody else is", they have set up no possible way to solve the problems described in 1-4, without having them freak out....therefore any improvement to their business process becomes like handling Maria Carey.

 

6. Add in all the crap we know that Insurance Companies like to pull....as has been stated here ad nauseum

 

7. Add in the fact that doctors/CEOs aren't willing to deal with their informatics properly. Largely because they have been sold, and burned, 3-4 times on crappy software that does their regulatory crap, or handles billing and accounting, but doesn't help them with their REAL operations. (Any fool can make appointment scheduling software)

 

8. Nurses/middle managers/CEOs/Administrators catch hell from all sides, making it near impossible for them to make large, meaningful strides in the improvement of care delivery. For example, the average Director of Nursing lasts 3 years at their job before quitting or being fired. Same thing with Administrators. Other than in IT, what job do you know of that has such high turnover? This turnover has created the famous "nursing shortage", which is not real. In fact there are plenty of trained nurses. However, only so many that are willing to deal with the BS. Many, many nurses leave the profession altogether, or, keep job jumping, hoping to hit it right. This mass turnover costs us billions, yet, NOTHING is being done to fix it. One major consequence of this is that nursing unions have sprung up, that now make it even harder to control cost properly. Another major consequence has been that nurses/admins/CEOs have become extremely jaded, and resistant to anything that even has the slightest risk, no matter it's potential reward. After getting burned so many times, wouldn't you be?

 

9. Patients think "health care is free, cause my boss/the government pays for most of it, so it's OK if I treat my body like an amusement park". Unlike buying auto insurance, there is no consequence cost to the patient for poor behavior. The insurance companies are RIGHT when they point this out.

 

10. Lawyers add no value, as usual, and while they are not Problem #1, they are Catalyst #1 in terms of increasing cost. IF we solved problem #1, then we could tell lawyers to blow it out their asses. Why? Because if I know, down to the second, what is happening in my health care providing facility, and something bad happens, and I immediately take the proper steps to correct it....how the f am I being "negligent"? I'm not. IF you take away the ability to prove negligence, you take away the ability for lawyers to sue, and then you take away about 80% of the lawsuits. Forget the legal minutia. Good business process tracking and thoughtful and immediate intervention OWNS all lawyers and their menagerie of BS.

 

Take 1-10 and a few other things, and this is why costs keep going up. It's really that simple. We can character assassinate each group all we want, but the fact is EVERYONE is to blame in some form or another. Anybody who says otherwise, is usually partial to one side or the other. It is my job to see problems OBJECTIVELY, and this is what I see right now. As always, there's much more to learn. But, if we can get after 1-10, we will be well on our way to controlling health care cost.

[Magox]

Two different insurance issues. One type of insurance is what you buy to protect against health related issues. Your premium is dictated by the risk/health factors of the people in your insured group. If you work in a big company, your premium will probably be lower than for somebody who works in a small company because more people in the pool diversify the overall risk. This is the biggest problem with current health insurance scheme, as it distorts the creation of risk pools by company, not by individuals.

 

The malpractice insurance is the cost that doctors have to bear to protect against litigation. As the threat of litigation increases, doctors jack up the rates they charge to pass through the cost of that insurance, which flows down to the cost of medical insurance that you buy.

 

Both of these can and should be fixed without introducing a massive government behemoth that wouldn't fix any of the above issues.

This supports your argument GG, which is also mentioned in that WellPoint Study.

 

http://voices.washingtonpost.com/ezra-klei...ml?hpid=topnews

 

http://www.politico.com/livepulse/1009/CBO...vate_plans.html

 

CBO: Public option premiums higher than private plans

 

The public insurance option would typically charge higher premiums than private plans available in the exchange, according to the Congressional Budget Office analysis of the House bill.

 

That surprising conclusion raises doubts about Democratic promises that a government-run insurance plan would provide a lower-cost alternative to consumers. At the same time, it calls into question Republican charges that the plan amounts to government takeover of health insurance -- because only 6 million people would enroll in the plan, according to the CBO.

 

Here's the key passage from page 6:

 

Roughly one-fifth of the people purchasing coverage through the exchanges would enroll in the public plan, meaning that total enrollment in that plan would be about 6 million.

 

That estimate of enrollment reflects CBO’s assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges. The rates the public plan pays to providers would, on average, probably be comparable to the rates paid by private insurers participating in the exchanges. The public plan would have lower administrative costs than those private plans but would probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees. (The effects of that “adverse selection” on the public plan’s premiums would be only partially offset by the “risk adjustment” procedures that would apply to all plans operating in the exchanges.)

 

Read it Boatdrinks

[drnykterstein]

It's mindboggling that they won't add in TORT reform as one of the provisions to try to solve this problem, when it has been proved that it is one of the factors that are contributing to soaring medical insurance premiums.

 

tort reform will get passed, but it's a different issue altogether and a different bill. the cbo did the numbers on the savings and it wasn't a lot anyways. like .5% healthcare savings, if 30% of lawsuits cut down.

 

"it has been proved that it is one of the factors that are contributing to soaring medical insurance premiums" it really hasn't. but if you have (credible) reports on that .. do link to them.

[Magox]

tort reform will get passed, but it's a different issue altogether and a different bill. the cbo did the numbers on the savings and it wasn't a lot anyways. like .5% healthcare savings, if 30% of lawsuits cut down.

 

"it has been proved that it is one of the factors that are contributing to soaring medical insurance premiums" it really hasn't. but if you have (credible) reports on that .. do link to them.

http://voices.washingtonpost.com/capitol-b...ice_reform.html

 

CBO: Medical Malpractice Reforms Could Save Up to $54 Billion

 

Lawmakers could save as much as $54 billion over the next decade by imposing an array of new limits on medical malpractice lawsuits, congressional budget analysts said today -- a substantial sum that could help cover the cost of President Obama's overhaul of the nation's health system.

 

New research shows that legal reforms would not only lower malpractice insurance premiums for medical providers, but would also spur providers to save money by ordering fewer tests and procedures aimed primarily at defending their decisions in court, Douglas Elmendorf, director of the nonpartisan Congressional Budget Office, wrote in a letter to Sen. Orrin Hatch (R-Utah).

 

The CBO report gives a political boost to Republican arguments that any health care package should include substantive limits on malpractice lawsuits, rather than the ill-defined state pilot projects Obama has championed.

 

http://health.cch.com/news/medicare/103009a.asp

 

$54 Billion is a lot of cheddar. There is no silver bullet solution as I have said many times, but it is A part of the solution.

 

Btw, did you read the CBO scoring of the Public Option? It states that Health insurance premiums will rise. What do you say about that? So you probably shouldn't be supporting it right?

[drnykterstein]

In the link you sent, it says "CBO now estimates, on the basis of an analysis incorporating the results of recent research, that if a package of proposals ... was enacted, it would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009)"

 

but like I said before, tort reform will get passed, but it will be a totally different bill. so stop bitching about it.

 

$54 Billion is a lot of cheddar. There is no silver bullet solution as I have said many times, but it is A part of the solution.

 

Btw, did you read the CBO scoring of the Public Option? It states that Health insurance premiums will rise. What do you say about that? So you probably shouldn't be supporting it right?

then the private insurers have nothing to fear. (and if they have nothing to fear ... why are they fighting it so strongly?)

[Doc]

This supports your argument GG, which is also mentioned in that WellPoint Study.

 

http://voices.washingtonpost.com/ezra-klei...ml?hpid=topnews

 

http://www.politico.com/livepulse/1009/CBO...vate_plans.html

 

CBO: Public option premiums higher than private plans

 

The public insurance option would typically charge higher premiums than private plans available in the exchange, according to the Congressional Budget Office analysis of the House bill.

 

That surprising conclusion raises doubts about Democratic promises that a government-run insurance plan would provide a lower-cost alternative to consumers. At the same time, it calls into question Republican charges that the plan amounts to government takeover of health insurance -- because only 6 million people would enroll in the plan, according to the CBO.

 

Here's the key passage from page 6:

 

Roughly one-fifth of the people purchasing coverage through the exchanges would enroll in the public plan, meaning that total enrollment in that plan would be about 6 million.

 

That estimate of enrollment reflects CBO's assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges. The rates the public plan pays to providers would, on average, probably be comparable to the rates paid by private insurers participating in the exchanges. The public plan would have lower administrative costs than those private plans but would probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees. (The effects of that "adverse selection" on the public plan's premiums would be only partially offset by the "risk adjustment" procedures that would apply to all plans operating in the exchanges.)

 

Read it Boatdrinks

How does the CBO figure that the premiums for the public plan will be higher? They're going to be subsidized by the government, meaning the taxpayers, meaning the middle class, and premiums will be low. I mean, where is all of that (fancifully underestimated) $1T going to go?

 

Another problem with their fantasy is that the fines for not having coverage are so ridiculously low that it would still make financial sense for businesses to not offer it to their employees, and for people who didn't already have coverage to continue to not buy it. And the dirty little secret is that with no pre-existing condition exclusion, one could literally buy a public plan when sick and drop it when healthy, like they do in Massachusetts.

 

Also, the Dems want to limit high-deductible plans and HSA's, which are the best way for people to self-ration their health care. And no tort reform which DOES drain health care dollars.

 

Ask yourself, does that sound like it's going to save the country money, or even break-even? Unless there are provisions for the above in those 1990 pages of legislation, if this passes, we're all screwed.