Health Care and the alternative point of view

[feh]

Thx for article, I urge others to read it and comment. I do not think the author draws good conclusions. That is not to say the article's premise is wrong, that is to say he added 1+1+1 and came to a conclusion the total was 10... which was completely out in left field relative to the points building up to argument.


examples



"and this means someone other than the patient ends up making decisions"... bad conclusion.

If we need to reform, you do not use the existing (inefficent) system, you reform by creating a new system. If the decision to what is best for patient is not being made by doctors, fix that aspect of the problem first, do not let treatment be the byproduct of the system.

I don't disagree with you, but this would be a huge change from the current system, and politically, it's a non-starter. Too many lobbyists. Too many citizens afraid of major change.

I frequent another forum where health care has been discussed in detail for months and months. One of the more conservative folks that post there, after listening to many well-reasoned thoughts from people that work in the industry, changed his point of view from "leave the system alone" to "nationalize the whole thing - single payer". But there's absolutely no way that would happen. It's too radical for most people, even without the lobbying influence.

[jIM_Ohio]

I don't disagree with you, but this would be a huge change from the current system, and politically, it's a non-starter. Too many lobbyists. Too many citizens afraid of major change.

I frequent another forum where health care has been discussed in detail for months and months. One of the more conservative folks that post there, after listening to many well-reasoned thoughts from people that work in the industry, changed his point of view from "leave the system alone" to "nationalize the whole thing - single payer". But there's absolutely no way that would happen. It's too radical for most people, even without the lobbying influence.

The politicians I will agree with are the ones which do not give MORE to the existing insurance companies- the existing insurance companies are the root cause of the financial spiral, and do not need more money.

The only one I heard give that stance was Hillary Clinton, and that was about 2 years before the election during a democratic candidate debate (I would have voted for her if she ran against anyone based on this single issue without considering to her other policies).


I am not single payer pro or con... to be its about measuring efficiency and making system more efficient, or at minimum prevent it from being less efficient.

[maat55]

Health care should not be tied to employment. Individuals should be treated the same as companies, in that if companies get a tax deduction for providing their employees health insurance, individuals should also get a tax deduction for buying health insurance on their own. Health insurance is a benefit that should be taxed, but then individuals could write off their cost. You are supposed to count bartering as income, so why not employee benefits?

Tort reform wasn't included because trial lawyers have a very powerful and competent lobbying force in Washington, and many lawmakers are themselves lawyers.

Companies cannot compete against the government on price. The government does not have to break even when looking at price vs. cost. The government can force the price to be one thing while ignoring the cost, but companies have to actually break even or make money in order to stay in business. Also, the government does not have to pay taxes and companies do, an automatic disadvantage companies have to overcome if they are allowed to compete with the government. Government should be referees, not participants.

I like HDHPs and Health Savings plans, where the person actually pays money out of pocket before the insurance portion kicks in. I dislike that these are disappearing with this new law. I do like your (someone above's) idea on 5 year out of pocket caps or lifetime oop caps.

I am worried that doctors are going to quit rather than deal with this new law and new regulations. I am already 30 miles away in two directions from the nearest hospital or doctor's office. Most hospitals out here are more like triage centers...stabilize and airlift to a big hospital 2 1/2 hours away. The nearest ob/gyn that knows anything is over an hour drive away.

I think the biggest problem is that the users of health care don't have to directly pay for anything. Even if individuals had to pay the costs up front and then submit to insurance, I think people would get a better understanding of how much these things really cost. It is like when you are a kid and your parents complain about the cost of going out to eat. You don't know how much work went into earning the money for a night in a restaurant, you just know the food tastes good and you would like that experience again.

I don't know why insurance companies can't sell across state lines, and even with that law, I don't know why states didn't set up agreements between themselves to have the same requirements so that one company could sell the same kind of policy to multiple states. The state insurance commissioners really dropped the ball on this one. If they had diluted some of their individual power by working with other states, they might have saved some power instead of losing it all to the federal government. Is there still a need for an insurance commissioner in a state? Perhaps for auto insurance and fire insurance, but won't the health insurance part of their job be gone now?

This is how the american free market system would do it. I'm still trying to figure out what happened to our country.

[feh]

This is how the american free market system would do it. I'm still trying to figure out what happened to our country.

The free market is no panacea. Look no further than the last recession, brought about by Wall Street greed.

[feh]

The politicians I will agree with are the ones which do not give MORE to the existing insurance companies- the existing insurance companies are the root cause of the financial spiral, and do not need more money.

I agree with you. But what was the alternative? Allowing people to buy into Medicare? A public option? Those were shouted down by lobbyists and Republicans in Congress.

[markusk]

Here is my wish list.
1. Single payer system
2. At the very least, insurance companies should be non-profit organizations.
3. Everyone is covered; everyone must have insurance.
4. So that no one can be turned down for pre-existing conditions
5. Electronic Medical Records
6. Give incentives to physicians for keeping people healthy, rather than "doing more proceedures."

Single payer system would make things more efficient. In California there are somewhere between 10-12 major insurance companies (perhaps more, I am not sure), each with its own set of inpatient/outpatient/pharmacy/PT/OT/Rehab plans/rules, forms, proceedures for getting things done, etc, etc. As a healthcare provider, you must have a full time staff, or a team of them, just to deal with these issues (who provide zero patient care).

I am not sure allowing insurance companies to cross state lines or setting up "exchanges" will really work. California, which is a large state, already has alot of insurance companies "competing" on cost, quality, etc and we are in no better shape than the rest of the country. In fact, adding more insurance companies into the mix means more complicated and confusing paper work for the healthcare provider.

[cptacek]

The free market is no panacea. Look no further than the last recession, brought about by Wall Street greed.

I thought a lot of the cause of the last recession was the government forcing banks to give mortgages to people who couldn't pay them back?

[cptacek]

LOL
I do not agree with this point you made. Saturn did this with GM, and last I checked GM just went bankrupt. The government cannot use the attitude that it can force price. If this is what health care reform is, then I want nothing to do with it. Saturn used fixed pricing from its suppliers... meaning if an axle cost $20, Saturn would say it would pay only $12 for the part. Take it or leave it... if the supplier backed out, GM would pull ALL its business from the supplier, so the supplier lost money on the GM parts, but you know they overcharged on the other GM parts (for Buick, chevy etc...) to cover the lost profits from saturn.

I'm a little confused as to why you don't agree with my point. I'm saying that the federal government can't go bankrupt (or, if it does, the last thing we will be worrying about health insurance) but companies can. The government doesn't pay taxes (including capital gains taxes and property taxes), and companies have to. How is this a level playing field?

[cptacek]

I did not know HDHPs were going away, as I think these are smart plans to use for everyone except those with chronic conditions.

HSA's are going down to $2500 and are indexed for inflation. This starts in 2011.

Nothing is explicitly saying HDHPs are illegal now, but I am pretty sure they won't meet the guidelines set for acceptable policies.

[jIM_Ohio]

I'm a little confused as to why you don't agree with my point. I'm saying that the federal government can't go bankrupt (or, if it does, the last thing we will be worrying about health insurance) but companies can. The government doesn't pay taxes (including capital gains taxes and property taxes), and companies have to. How is this a level playing field?

The federal government can go bankrupt... it has happened to other countries, and it can happen here... could be higher than expected inflation, or something else, but the government is not immune to going bankrupt.

[cptacek]

Agree. Greece is going through that now, aren't they? But if that does happen, I think we will have more problems than if we can see the doctor next week.

[markusk]

Here is an excerpt from a thoughtful article "Why We Must Ration Health Care" that was posted several months ago from the New York Times. Hopefully it will make you think and add to the discussion.

http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?_r=1&pagewanted=1&em

You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much? If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

[jIM_Ohio]

Here is an excerpt from a thoughtful article "Why We Must Ration Health Care" that was posted several months ago from the New York Times. Hopefully it will make you think and add to the discussion.
http://www.nytimes.com/2009/07/19/ma...agewanted=1&em

good article
this got a good laugh out of me...

Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. “So,” he says, “would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the price.” The man’s response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it’s immoral to apply monetary considerations to saving lives — but is that stance tenable?

and a decent conclusion

Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won’t be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money. The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?

I think the reasoning for rationing should start with the point I concluded with.

[feh]

I thought a lot of the cause of the last recession was the government forcing banks to give mortgages to people who couldn't pay them back?

The primary cause of the mortgage meltdown was lenders getting too loose w/ their eligibility requirements (no money down, interest only loans, no documentation of income, etc), people buying more house than they could afford (enabled by the loose/non-existent loan requirements), and then Wall Street firms repackaging and selling those mortgages in such a way that nobody understood what they were or how risky they were, aka Collateralized Debt Obligations.

[dfeucht]

I agree seeing the math behind this would be helpful

I see this as a bandaid (combining people to get lower prices). The real problem is the pricing model and how that pricing model is funded and money is distributed.

If I had a choice, reform would be changing the pricing model, not pooling more money together.

an MRI should cost about the same whether done at a hospital, testing facility across the street, or at one 30 minutes away in a suburb. The only variables which change would be the real estate cost, and possibly an orderly wheeling a hospital patient from one floor to the next for test if done at a hospital... until that level of efficiency in pricing is reached, most other fixes are band aids and not treating root cause.

Not sure on the rules in this forum about posting links, but search Google for "milliman hospital and physician cost shift" and the first link shows a study done shows cost shifting between Medicare, Medicaid, and commercial. It also gets into hospital operating margins for each population type. It was comissioned by plans and hospitals, but is pretty interesting. I am fairly certain that it isn't just the buying power of the government but the legislative power of government.

One other thing on spiraling costs - we have to figure out a way to stop subsidizing research and development for prescription drugs for the rest of the world. Every other country legislates price controls on drugs leaving all research costs on the U.S. We as a nation need to figure out how to stop that from happening.