Off-topic: Government healthcare proposals
HW "Skip" Weldon
Healthcare discussions currently occurring in Washington - including
the political ramifications.
We have decided that since things are very quiet here, we would relax
the posting guidelines somewhat so that the issue can be discussed.
IMPORTANT: The rules on TRIMMING PREVIOUS POSTS, showing respect for
other posters, solicitations, and a ban on colorful language continue
to apply. Anyone breaking these rules will be hunt down and shot.
Other than that, have at it.
Cam
<skip5700removet...@yahoo.com> wrote:
Who should pay for health care for people who don't pay for their own?
If being able to get medical care isn't enough motivation to get a job
do these people deserve free medical care? The "truly deserving" are
never more than 10% of the "I can game the system" beneficiaries.
Perhaps each union worker should pay for one additional non-payer.
Maybe each Kaiser patient should pay for another person. Obviously
closed systems like Kaiser can offer cheaper medical care than open
systems that are forced by law to take anyone.
As to means-tested government healthcare, only hardworking, productive
savers are excluded. Are "self employed" people going to be forced to
pay any amount for required healthcare "because they can afford it"?
Governments are very good at exploiting individuals rather than
organized masses of voters, even if their only organization is being
in an entitlement group. High school drop out crack heads go to the
front of the line for free medical care. Is this really how society
is supposed to work?
Let's hear from everyone who wants to pay for others healthcare. I
sure the local hospitals can set up a fund for these people.
Avrum Lapin
Re Public Option/ Insurance pools/Assigned Risk plans
My alternative would be to allow individuals or employers join the
largest pool of insured Americans - the people who work for the Federal
government. Federal employees have the choice of a number of plans each
with slightly different coverage, premiums, deductibles and copays.
After an open enrollment period of 6 months or so outsiders would have
to sign up within say 60 days of losing or quitting their existing
health insurance plans or pay a penalty. Premiums would be the
governments cost plus say a 2% (from COBRA) fee for admin costs.
(probably about $400/mo for the 60-65 crowd) Who would lose - insurance
agents who get commissions from selling health insurance.
OR
They could sign up with Medicare. Persons without a work history (e.g
elderly immigrants can buy Medicare Part A (Hospitalization) for $460
/mo and can buy Part B (physicians and outpatient) for $96.40 (for the
lowest income tier). Since S96.40 only covers about 25% of Part B costs
a full share of cost would be overt $800/mo (pricey isn't it).
Assigned risk plans are fairly pricey - California's plan (MRMIP) has
monthly premiums of over $800/mo for a high deductible 70/30 PPO plan.
Re: Co-ordination of care etc
If co-ordination of care etc was that effective in reducing costs then
Kaiser (a non profit HMO) would have significantly lower premiums than
conventional HMOs or PPOs. Guess what - there isn't much difference.
Cost reduction
No one really knows how much care is "defensive" care against
malpractice lawsuits and how much is just racking up the meter. When I
had really good insurance from work I always wondered whether that
second doctor's visit to see if the meds worked wasn't just racking up
the meter. After my employer switched to an HMO I wondered if I was
missing something by not going back. I think we need some defined
"standard of care" and if the doctor thought that more care was needed
he would have to justify it.
When we reduce fees to the provider, the provider has to hustle more
patients through the office and we will get less face time with the
provider and more with physician's assistant. We will find "clerical
types" in white coats taking our blood pressure etc. Lower payments
far enough and we will have Russian style medicine
We need to think more about "end of life care". We might be better off
in a hospice than undergoing another round of complex surgery so that we
can squeeze another couple of weeks hooked up to machines. I hope that
when my time comes to go into a nursing home I have the strength to
reach down and unplug the machines.
Other thoughts
How much of one's income should one have to pay for health insurance.
Should you be forced to give up cable TV or pricey cell phones?
Should you be able to buy a lower level of care with the understanding
that you are on your own and would be forced into MediAid if you can pay
Bill
reason, and need healthcare pay for the healthcare of many others. If
you do not have insurance your local hospital will typically charge you
three to seven times the Medicare reimbursement rate or the insurance
contract rate for any service.
Ever need care at an emergency room? If you do you will learn that
there are two ways in. You can walk in the front door and wait hours
before you are seen by a triage nurse who will decide when and if you
get to see a physician. The other route in the door is to call 911 and
have the paramedics bring you in. In that case you will be seen by a
physician within five minutes of arrival. Why? Because we have an
idiotic law that says that any hospital that operates an emergency room
must treat anyone who walks in the door, whether they can pay or not.
So where does the money come from to pay for care for those who cannot
or will not? See paragraph one above.
Medical tort reform. What could we do with the hundreds of billions of
dollars wasted on frivolous healthcare litigation every year? One of
the most fascinating statistics I have read is that the U.S. has 5% of
the world's population and almost 75% of the world's lawyers. There is
more litigation in the U.S. than in the rest of the world combined.
Perhaps what we have could accurately be described as government of the
people, by the legal profession and for the legal profession.
The federal government already operates two large healthcare programs;
Medicare and the VA healthcare system. Medicare pays three to five
times more for everything than the VA in spite of the fact that the VA
is a much smaller operation. Why? Because Medicare is barred by law
from purchasing by competitive bid. I am a veteran and get some of my
healthcare from the VA and and my experience is that the VA provides
very good care at a far lower cost than any other organization in the
U.S. Almost all of the veterans I know feel the same way. Since we have
a working model that is very cost efficient why are we not using it as
a model for Medicare instead of operating Medicare in the most cost
inefficient manor imaginable.
Healthcare is always rationed because there is always nearly infinite
demand and limited resources. In this country we have elected to ration
healthcare based on ability to pay. Most industrialized nations have
made a concious decision as to whether medical care should be a
business, a social service or some hybrid combination and have then
made an effort to implement the system they selected in an orderly
organized way. The U.S. has not made that decision and the result is
that we have a for profit free market healthcare system that strangled
by thousands of pages of government regulations that have no common
goal and have created a dysfunctional incredibly expensive mess. We
spend more per capita on health care than any other developed nation
and anyone who believes we get the best healthcare simply has not
bothered to look at other countries.
The problem with current proposals for change is that they do not go
far enough.
That rant should start some discussion.<g>
--
.Bill.
Dave Dodson
> Under the current system those who do not have insurance, for whatever
> reason, and need healthcare pay for the healthcare of many others. If
> you do not have insurance your local hospital will typically charge you
> three to seven times the Medicare reimbursement rate or the insurance
> contract rate for any service.
Actually, the reason that for-profit hospitals charge the uninsured
higher rates is so that they can write off larger amounts of bad debt,
thus reducing their taxable income and their income taxes.
Dave
Don
> Actually, the reason that for-profit hospitals charge the uninsured
> higher rates is so that they can write off larger amounts of bad debt,
> thus reducing their taxable income and their income taxes.
That is interesting and certainly plausible. Thanks for pointing it out.
Douglas Johnson
>Actually, the reason that for-profit hospitals charge the uninsured
>higher rates is so that they can write off larger amounts of bad debt,
>thus reducing their taxable income and their income taxes.
Now that's the oddest accounting I've ever heard of. Maybe a real accountant
can jump in, but my understanding is that you can only write off a bad debt
after you've taken it as income sometime before.
For example, bill a customer (patient) $10,000 and don't get paid. You take the
$10,000 as income (accrual basis) and the bad debt as a $10,000 write off. Net
effect $0. Do the same for $20,000, the net effect is still $0.
The hospital can still write off the actual expense of providing the service,
but it doesn't matter how they bill the customer.
-- Doug
Elle
> Actually, the reason that for-profit hospitals charge the uninsured
> higher rates is so that they can write off larger amounts of bad debt,
> thus reducing their taxable income and their income taxes.
>From my reading of reports in the NY Times, medical fees are so
negotiable that I think it is very hard to say whether the uninsured
pay more or less than the insured. I suspect there is little
uniformity in charges, even within the same health care facility.
Elle
the legislation being considered, since it appears I will be required
to purchase insurance, and this will affect my financial planning. (I
currently am "self-indemnified," a delusional rationalization.) One
thing I found interesting is that government subsidies for payment of
health insurance so far seem likely for those with low enough income.
So far, assets will not be considered for such subsidies. Rather, Form
1040 AGI (or MAGI) will be the determining factor. The IRS is supposed
to assist as needed.
Avrum Lapin
<5de2c15a-be55-4246...@b15g2000yqd.googlegroups.com>,
Elle <honda....@gmail.com> wrote:
Unless you have a "special rate" (e.g. friend of the doctor) the bill is
the bill. What you pay is negotiable. Some doctors will negotiate,
others just send the bill to collections.
Bill
> From my reading of reports in the NY Times, medical fees are so
> negotiable that I think it is very hard to say whether the uninsured
> pay more or less than the insured. I suspect there is little
> uniformity in charges, even within the same health care facility.
What percentage of the uninsured would you estimate have the skills to
negotiate effectively with a hospital? Just curious.
--
.Bill.
Bill
> Actually, the reason that for-profit hospitals charge the uninsured
> higher rates is so that they can write off larger amounts of bad debt,
> thus reducing their taxable income and their income taxes.
That sounds like a nice win-win scenario where Uncle Sam (i.e. you and
I) pick up the tab but if and only if the patient is indigent. When you
consider the case of a person who has a job and has some assets and
cannot get insurance due to a pre-existing condition it is a bit
different because the hospital sues to collect the debt and can easily
force the patient into bankruptcy.
There was a case several years ago where I live of a man taken to the
emergency room who required surgery to save his life. If I remember the
numbers correctly the Medicare reimbursement would have been $40K, the
average insurance contract reimbursement would have been a little under
$60K and the hospital billed and sued for over $250k. A tax write-off
was not the motivation in that case and that is not an uncommon
occurrence.
I have a relatively small circle of friends and out of that group I
know two who could afford medical insurance even if they had to pay
double the normal premium yet they can not get it at any price.
Something very few people realize is several states already run
insurance plans for the uninsurable but due to budget limitations there
is frequently a waiting list that is years long to get coverage. So, we
are already paying to subsidize coverage for some of the uninsurable
who can afford to pay for coverage. Why not simply make all health
insurance plans guaranteed issue? Even if we allow insurers to charge
higher premiums (within reason) for those with pre-exiting conditions
we, as a whole, would be much better off economically than we are with
our current system which adds the cost of litigation, bankruptcy and
the fallout costs of that foolishness to the cost of healthcare.
--
.Bill.
Elle
I would estimate the number to be about the same as the percentage of
bills to the uninsured that goes to collections. Then by my
understanding the collections people and process automatically involve
negotiating. This is in no small part because collections reps
understands that the fees are designed to be negotiable. Just an
impression.
Avrum, I see your point as a distinction without a difference, given
how common the knowledge is that a medical bill is highly malleable.
Bill
> I would estimate the number to be about the same as the percentage of
> bills to the uninsured that goes to collections. Then by my
Please be assured that I do not mean this comment to be offensive in
any way but I think are suffering from the mirror effect. In other
words, you tend to view other people as having the same knowledge,
attitudes, skills, etc. that you have. The fact that you are here on
this forum means that you are far above the average person in this
country in education and financial and business acumen. The next time
you get a chance to talk to the person behind the counter in a gas
station, a bank teller, a farm worker, a machinist in a small
manuafacturing facility or any one in a similar occupation ask them if
they think medical bills are negotialble and how they would go about
negotiating them.
> understanding the collections people and process automatically involve
> negotiating. This is in no small part because collections reps
> understands that the fees are designed to be negotiable. Just an
> impression.
Collection agents are paid a percentage of _the amount they actually
collect_. The very last thing any collection agent will do is negotiate
the amount because it costs them money.
If you are going to negotiate your chance of getting a significant
reduction is much greater if you do it before the bill goes to a
collection agency. If you are dealing with a hospital where the amount
is fairly significant, say a couple of thousand dollars or more, the
single most effective technique I have heard of is a credible threat of
going to the press with a human interest story about how Maxi Mega
Hospital is screwing this poor uninsured person by charging five times
the Medicare reimbusement rate. I know of a couple of cases where that
has worked very well.
--
.Bill.
Don
> The fact that you are here on
> this forum means that you are far above the average person in this
> country in education and financial and business acumen. The next time
> you get a chance to talk to the person behind the counter in a gas
> station, a bank teller, a farm worker, a machinist in a small
> manuafacturing facility or any one in a similar occupation ask them if
> they think medical bills are negotialble and how they would go about
> negotiating them.
It seems to me that a lot of the advice given by experts falls into the
same category. For example, in the area of financial planning, you
often hear someone say: "Do your homework" or "Do your research before
you invest." That advice appears sensible at first glance. But,
realistically, how many farm workers, machinists, etc., are able to go
to the library or use the internet to find out all about the past
performance or the future prospects about a particular company's stock
or a mutual fund? And another thing that is relevant to a person's
financial health: How many of those farm workers realize that it is
possible to negotiate with banks, mortgage brokers, real estate agents,
lawyers, etc. about the cost of various fees and services involved in
financial planning?
I apologize if the above remarks are off-topic. (Perhaps this is a case
of something that is off-topic of an off-topic issue being on-topic of
the original topic.)
Bill
> I apologize if the above remarks are off-topic.
I don't think your remarks are off topic regarding the healthcare
debate. The single most important factor in designing any system
designed to serve people, whether it is a government program or a
commercial offering, is will the target audience be able to understand,
use and derive maximum benefit from the system. When the designers have
masters or doctoral degrees or equivalent and the users of the system
are the average worker there is a huge risk that the designers will
view the target audience as a mirror image of themselves and get the
design very very wrong. A healthcare system has to work for all
Americans, not just the people represented by the participants on this
forum.
--
.Bill.
rick++
http://thomas.loc.gov/cgi-bin/query/D?c111:2:./temp/~c111goVxfz::
I looked at the Oct 29 version mostly and the Nov 7 (passage) version
has just been loaded to the web. The table-of-contents prints out
at 15 pages. You then can follow links to the deep text.
About a quarter of the bill deals with topics discussed in the press.
The remaining parts deal will micromanaging costs such as
medicare, physician training and indian affairs.
I was looking for sections that could facilitate early retirement,
say age 50-65 before medicare kicks in. The bill specifically says
that companies have to honor retirement medical promises.
But its unclear how they can enforce this.
Alternatively the public option looks promising. But that doesnt
phase in until 2013, four years from now.
I also poked around for pork, especially of the last-minute kind.
I did not see a whole lot, unlike the stimulus bill. Some "pet"
diseases like autism are specifically funded. I also saw funding
for a class of drugs called biosimilars which probably benefts a few
companies.
I saw something bor biofuels snuck in.
The bill add some taxes. People making over %500K will have a 5% tax
surcharge.
There is a 2.5% additional tax on medical equipment.
People not signing up for health insurance will have 2.5% tax penalty.
Bill Woessner
won't prevent me from writing. I'll limit myself to 3 issues.
I think my biggest concern with the current efforts to overhaul the
health care system is the unspoken requirement to maintain the current
employer-based system. Why is that so important? Doesn't the
employer-based system suck? Isn't that what got us where we are,
today? If we constrain ourselves to leave the employer-based health
care system mostly in tact, we severely limit the scope of any
potential reform.
At the same time, that's the appeal of maintaining the employer-based
system. It makes healthcare reform more politically palatable. If
roughly 60% of the population isn't directly affected by healthcare
reform, they might find it easier to swallow. Of course, that's just
a political ruse. Directly or indirectly, everyone will be affected
by healthcare reform.
My second concern is the notion of "controlling costs" (they really
mean lowering costs; I don't know why they don't just come out and say
that). There is no mechanism for lowering costs. The government can
shift costs, but that's not lowering costs. This is true at every
level of the health care industry. If you show up in the emergency
room, they have to treat you. If you can't afford it, the cost is
shifted to everyone else. Medicare and Medicaid are often hailed as
champions of cost control. Their method of controlling costs is
paying providers less than cost. You're deluding yourself if you
think providers just eat that loss. Of course they pass those costs
along to everyone else.
The best example of failed cost control is prescription drugs. We
look at other industrialized nations and wonder why they pay so much
less for their prescription drugs than we do. Obviously, their
policies have been extremely effective at controlling the cost of
prescription drugs, right? No. They haven't controlled costs at
all. All they've succeeded in doing is shifting the cost of
prescription drugs. And to whom have they shifted the cost? To us,
of course.
In fact, simple supply and demand dictate that the current health care
reform proposals will actually raise costs. The proposals all focus
on increasing access (i.e. demand) for health care. Is anyone
addressing increasing the supply of health care? We already have a
doctor shortage in the United States, which is predicted to get worse
in the future. If demand goes up but supply remains the same, costs
go up. Every economics 101 student can tell you that.
Honestly, I would much prefer nationalized health care to the current
batch of proposals. And I say that as a pretty hard-core
libertarian. Sure, we would have to essentially double taxes and we'd
have the whole host of problems that every other country with
nationalized health care has. At least with nationalized health care,
everyone would know where they stand. There wouldn't be separate
rules for seniors, large employers, small employers, self-employers,
unemployeds, families, singles...
I believe real leadership is being able to craft one set of rules that
applies to everyone, not repeatedly subdividing the population until
you can orthogonally pander to each group. That's just American-style
politics at its finest.
--Bill
Elle
> Elle wrote:
> > I would estimate the number to be about the same as the percentage of
> > bills to the uninsured that goes to collections. Then by my
>
> Please be assured that I do not mean this comment to be offensive in
I routinely quote how less than 30% of the age-eligible population has
a bachelor's degree. So I am well aware of how uninformed the general
population is. To elaborate on my meaning above, my understanding is
medical bill collectors are prepared to ask the client about their
income and assets and adjust the bill accordingly. You may want to
counter that then the client is not actually negotiating with skill.
But the effect I originally cited is nonetheless in place.
> Collection agents are paid a percentage of _the amount they actually
> collect_. The very last thing any collection agent will do is negotiate
> the amount because it costs them money.
My reading indicates that medical bill collectors seek to get
something rather than nothing from the client.
I am not splitting hairs over collection agencies vs. medical clinic
billing departments, by the way. My point is that medical bills are
bogus, and many reports are that those doing the billing are well
prepared to reduce the bill.
Bill
> My reading indicates that medical bill collectors seek to get
> something rather than nothing from the client.
As I said, reducing the amount is the last thing they try.<g>
>
> I am not splitting hairs over collection agencies vs. medical clinic
> billing departments, by the way. My point is that medical bills are
> bogus, and many reports are that those doing the billing are well
> prepared to reduce the bill.
Agreed. It is just a lousy and unfair system that tends to penalize
those least able to afford the penalty.
--
.Bill.
Bill
> There is no mechanism for lowering costs.
It depends on what you include in healthcare costs but I will take
issue with you on that point. Litigation costs can be dramatically
reduced. Having standarized policies, as with Medigap plans,
dramatically reduces costs in two ways. First it makes a medical
insurance policy a commodity item. You know you are getting exactly the
same product regardless of the vendor you select. That reduces the
amount spent on marketing since vendors have only two areas in which to
compete; cost and customer service. The Medigap approach saves money in
another way. Medicare determines whether a claim is covered or not. The
insurance company no longer incurs the cost of staff to review claims
and look for excuses to deny them. Medicare could save a lot if it
could purchase by competitive bidding. If you can do things more
efficiently you can save money.
I do agree with you that there is no complelling evidence at all that
the current proposal will do so.
--
.Bill.
Elle
On hospital billing departments and medical bill collection agencies:
> As I said, reducing the amount is the last thing they try.<g>
I know this may sound argumentative, but I have the impression from
reading articles over the last few years that since (1) time is money
and (2) billers (hospital billing departments or collection agencies)
know that the nominal fee listed on a bill is purposely bogus (being
way more than the usual insurance company contracted fee for one),
they reduce what they are trying to collect from the uninsured almost
instantly.
For non-medical bill collections, what you say makes sense.
Sorry, I do not want to argue. I am trying to emphasize the importance
of people with medical bills calling the billing source and asking for
a reduced bill from the get-go. It might remove a lot of stress.
> It is just a lousy and unfair system that tends to penalize
> those least able to afford the penalty.
I do not know whether it is unfair, because I remain uncertain whether
the uninsured or the insured end up paying more for the same
procedures, averaging over each group. My rough impression is that the
insured end up paying more, on average. Hospitals etc. milk the
insurance companies to the best of their ability.
Don
> It depends on what you include in healthcare costs but I will take
> issue with you on that point. Litigation costs can be dramatically
> reduced. Having standarized policies, as with Medigap plans,
> dramatically reduces costs in two ways. First it makes a medical
> insurance policy a commodity item. You know you are getting exactly the
> same product regardless of the vendor you select
One point that should be studied is why so many other industrialized
nations are able to provide universal coverage for their citizens at
considerably less cost than in the USA. It would seem reasonable to
learn from what those nations are doing right. If one corporation
discovered that a competitor was building better mousetraps for half
the cost, wouldn't that company look closely at the other's methods and
then re-design their own product?
Bill
> One point that should be studied is why so many other industrialized
> nations are able to provide universal coverage for their citizens at
> considerably less cost than in the USA. It would seem reasonable to
> learn from what those nations are doing right. If one corporation
> discovered that a competitor was building better mousetraps for half
> the cost, wouldn't that company look closely at the other's methods
> and then re-design their own product?
I agree completely. It is amazing how quickly that happens in industry
and how slowly, if ever, in government. We are not trying to solve a
problem that has never been solved.
It is the same situation as the poor U.S. performance in education
compared to other industrialized nations. When so many others have
found a way to do better and their solutions are an open book it should
not be too difficult to improve our system.
--
.Bill.
Rich Carreiro
> compared to other industrialized nations. When so many others have
> found a way to do better and their solutions are an open book it should
> not be too difficult to improve our system.
That depends.
For example, many other countries have lower prescription drug costs
than the US does. What magic, better solution do they have? Why,
capping the cost by government fiat. In other words, they are
parasitically free-riding off countries without such caps -- primarily
the US. And sure, the US could slap price controls on drugs as well,
but then I hope we're all happy with fewer new drugs, becoming
available more slowly.
--
Rich Carreiro rlc-...@rlcarr.com
Bill
> For example, many other countries have lower prescription drug costs
> than the US does. What magic, better solution do they have? Why,
> capping the cost by government fiat.
Most single payer national health plans, consider Canada as an example,
are importing virtually all of the prescription drugs used in the
country. The Canadian government has no way to impose price controls on
U.S. and European pharmaceutical manufacturers. The vendors are free to
not sell to Canada unless the Canadian government meets their price.
Why are ethical pharmaceuticals so much cheaper in Canada than in the
U.S.? Because there is a single buyer that buys in very large volume
and that negotiates vigorously and skillfully for the best deal they
can get. Why do the drug companies agree to sell to Canada at low
prices? Because they can charge anything they want in the U.S. where,
with the exception of the VA, there is essentially no competitive
purchasing at all. That means they have no problem recovering there R&D
costs plus a substantial profit here and countries like Canada are
viewed as incremental revenue. As long as they can sell to Canada at a
price that exceeds the direct cost of manufacturing they drug company
is realizes more total revenue by selling to Canada at a low price than
by not selling at all.
I wonder why no one in the U.S. government understands this? Maybe
there is no one in this country who has passed economics 101. Or,
maybe, out system of government has allowed the pharmaceutical industry
to purchase a suggicient number of congressment and senators who are
willing to close their eys and ignore the elephant stanting in the
kitchen. Naw. It couldn't be that.<g>
--
.Bill.
Don
> For example, many other countries have lower prescription drug costs
> than the US does. What magic, better solution do they have? Why,
> capping the cost by government fiat. In other words, they are
> parasitically free-riding off countries without such caps -- primarily
> the US. And sure, the US could slap price controls on drugs as well,
> but then I hope we're all happy with fewer new drugs, becoming
> available more slowly.
Maybe what is needed is a "public option" in the pharmaceutical
research business, that is, a central government funded and operated
reserch laboratory to develop and make available new drugs. A nation
that can do things so quickly in the space program and get to the moon
before anybody else should be able to do some needed pharmaceutical
research in record time.
Bill
> Maybe what is needed is a "public option" in the pharmaceutical
> research business, that is, a central government funded and operated
> reserch laboratory to develop and make available new drugs. A nation
> that can do things so quickly in the space program and get to the
> moon before anybody else should be able to do some needed
> pharmaceutical research in record time.
1) The cost of the R&D still has to be paid.
2) When congress must make a choice between funding drug research and
funding something that will buy votes in the next election which do you
think they will choose?
3) If you are unsure about the answert to 2 look at the National
Institutes of Health and see how well it is funded.
--
.Bill.
Don
> 1) The cost of the R&D still has to be paid.
>
> 2) When congress must make a choice between funding drug research and
> funding something that will buy votes in the next election which do you
> think they will choose?
>
> 3) If you are unsure about the answert to 2 look at the National
> Institutes of Health and see how well it is funded.
Yes, that is true. So I guess the problem is getting people to realize
that finding new drugs for the sake of people's health has the same
urgency as getting to the moon or fighting a war somewhere (and to vote
accordingly). Certainly there has been government funding of many kinds
of medical research. It seems to me that investigation and development
of specific drugs to better combat illeness is not something that
should be left entirely to the research labs of corporations with an
eye on profits.
Bill
> It seems to me that investigation and development of specific drugs
> to better combat illeness is not something that should be left
> entirely to the research labs of corporations with an eye on profits.
I don't disagree with that at all. The point of my questions was that I
think your suggestion to let the government do it all may be a bit
simplistic. In the U.S. today drug research is done by the government,
private enterprise and universities. I think we need a major effort to
understand how to direct the applied research to provide the most
benefit (as opposed to applied research by drug companies whose goal is
to generate the most revenue) while at the same time ensuring that
basic research gets enough funding to keep the pipline full.
The space program is a great example of our ability as a nation to
apply existing knowledge to a acomplish a specific goal. Another
example, that is more impressive in some ways is the Manhattan Project.
Those two examples alone are convincing evidence that if we can decide
what we want to accomplish we can do it.
--
.Bill.
dapperdobbs
> Bill Woessner wrote:
> > There is no mechanism for lowering costs.
>
> issue with you on that point. Litigation costs can be dramatically
> reduced.
> I do agree with you that there is no complelling evidence at all that
> the current proposal will do so.
>
> --
> .Bill.
Why not enact tort reform / medical malpractice reform, first? See if
that doesn't lower costs by 50% and increase supply and quality of
medical services?
What most frightens me is the Command Economy aspect of these
"healthcare reform" proposals. I submit that our thoughts, our
integrity, our morals and even taste, are all deteriorating. It is not
all "government". When we stop thinking clearly, talking freely, when
we stop protesting genuine wrongs, when we become afraid of life and
of each other, when we stop seeing a happiness to pursue and a
reasonable means to achieve it, then we die as free people and become
a nation of dependent psychology.
I say we return to a free market medical services sector. I feel very
sorry for the poor guy who cannot afford a house in Montecito, I
really do. It would extend his life by five years at least. Me, I
can't afford one either, but as long as I live in a free country, I'm
not unhappy. Taking away the free country I live in, by bits and
pieces, that's killing me. It really is.
Bill
> Why not enact tort reform / medical malpractice reform, first?
6% of the U.S. workforce are lawyers. 45% of the members of congress
are lawyers. Perhaps that is a clue.<g>
--
.Bill.
Coffee's For Closers
says...
> Under the current system those who do not have insurance, for whatever
> reason, and need healthcare pay for the healthcare of many others. If
> you do not have insurance your local hospital will typically charge you
> three to seven times the Medicare reimbursement rate or the insurance
> contract rate for any service.
> Ever need care at an emergency room? If you do you will learn that
> there are two ways in. You can walk in the front door and wait hours
> before you are seen by a triage nurse who will decide when and if you
> get to see a physician. The other route in the door is to call 911 and
> have the paramedics bring you in. In that case you will be seen by a
> physician within five minutes of arrival. Why? Because we have an
> idiotic law that says that any hospital that operates an emergency room
> must treat anyone who walks in the door, whether they can pay or not.
> So where does the money come from to pay for care for those who cannot
> or will not? See paragraph one above.
I am somewhat familiar with the workings a particular Emergency
Department in a non-US country, with socialist medicine.
There, if you walk in, you can often see the triage nurse almost
immediately - less than a minute during slow periods. If it is
busy, you might have to get in line behind maybe four or five
other walk-ins. Each triage encounter is very short.
As I understand it, that nurse does NOT have the authority to
tell you that you cannot be seen. But his/her job includes
prioritising you, and, if your problem is minor, you may spend a
long time in the waiting room, partly depending on how busy it
is.
Ambulances have their own door, leading to the interior of ED.
So, yes, you get to go in immediately. And if you have a cardiac
arrest, serious trauma, etc, then you will get immediate
attention.
But, if you have vague abdominal pain, or fainted and immediately
came to, or just consumed too much alcohol, then you are in for a
serious wait. Which I guess is a bit of a let-down after the
exciting ambulance ride.
Other situations are in-between those extremes medically, and
therefore in-between in terms of waiting time. Some people seem
to think that it should be first-come-first-served, and resent
seeing a more recently arrived patient being seen sooner. They
have to have it explained to them that, this is one place where
you don't ever want to be first in line.
Nobody gets a bill for their visit. It all comes out of the
taxpayors' collective pockets. Some of the patients work and pay
taxes, and some never have. Sometimes the abdominal pain turns
out to be indigestion, and a complete waste of
time/attention/$$$. Sometimes the patient should have just gone
to a General Practitioner for an appointment. Sometimes there
are underlying poor behaviour patterns that build up to a crisis.
Sometimes there are life-shattering consequences to a fun night
out on the town, binge-drinking with friends.
There are a whole lot of tax dollars being consumed by things
that can touch my own compassion for other humans. But there is
also a whole lot of wastage of resources by irresponsible,
immature behaviour.
In a medical emergency, you cannot sort out a car accident, and
only treat the innocent victim, while tossing the drunk driver
back out the door. And you cannot reliably sort by ability to
pay, or by insurance coverage. And that doesn't matter whether
you have a socialist medicine "option" or not.
If an Emergency Department visit costs money out of pocket, then
that would be a disincentive for people to come in with sniffles,
or upset tummies. But it can also result in somebody just hoping
that a serious problem will subside, while it gets worse.
The big thing that is missing in this country, and in America,
and all over the world, is personal responsibility. If you eat
large amounts of junk food, smoke, never exercise, etc, then your
self-inflicted heart attack will often get time/attention/$$$
priority over somebody who didn't do anything wrong to cause
their problem.
But it isn't polite to include that in the current talk about how
socialist medicine serves "fairness," and other warm, fuzzy
values. A lot of people want me to work hard and pay taxes for
their medical treatment, but they would probably be quite
offended if I asserted a reciprocal demand that they put down the
doughnut and get off the couch.
--
Get Credit Where Credit Is Due
http://www.cardreport.com/
Credit Tools, Reference, and Forum
Xho Jingleheimerschmidt
>
> Actually, the reason that for-profit hospitals charge the uninsured
> higher rates is so that they can write off larger amounts of bad debt,
> thus reducing their taxable income and their income taxes.
Then wouldn't the amount they write off as bad debt be exactly matching
the amount they "wrote on" to their AR in the first place? How does
doing the hokey poky change taxable income?
Xho
Bill
> Then wouldn't the amount they write off as bad debt be exactly
> matching the amount they "wrote on" to their AR in the first place?
I am not an accountant but I believe the transactions would be:
Debit Accounts Receivable Credit Sales at the time of the sale.
Debit Bad Dept Expense Credit Accounts Receivable at the time of the
writeoff.
This leaves a credit in Sales and an offsetting debit in Bad Dept
Expense so the net effect on income is zero. This assumes that the
business does not maintain a reserve for bad debts.
--
.Bill.
Bill
--
.Bill.
Bill Woessner
> Maybe what is needed is a "public option" in the pharmaceutical
> research business, that is, a central government funded and operated
> reserch laboratory to develop and make available new drugs.
Correct me if I'm wrong, but I believe a significant amount of
pharmaceutical research is already funded by the government. I
suspect it's probably as much as 50%. There was some discussion a
while ago about shortening drug patents proportional to how much
public funding went in to developing the drug. Seemed like a
reasonable thing to do.
I think this points to a deeper issue with the pharmaceutical
industry. It's not a competitive industry in the usual sense. It
takes millions of dollars and years of R&D to develop a single
pharmaceutical product. The probability of failure is tremendous.
This situation doesn't exactly promote innovative startups that
provide healthy competition.
--Bill
Rich Carreiro
> Correct me if I'm wrong, but I believe a significant amount of
> pharmaceutical research is already funded by the government. I
> suspect it's probably as much as 50%.
If you narrowly limit it to "research" (i.e. finding the magic
molecule), you might be right (though I doubt it). But there's a lot
more expense in bringing the drug to market than "research". Clinical
trials, figuring out how to mass produce it, etc. comes out of the
company's budget, not the government's.
> while ago about shortening drug patents proportional to how much
> public funding went in to developing the drug. Seemed like a
> reasonable thing to do.
Sounds like a great way to stop new drugs from being developed.
--
Rich Carreiro rlc-...@rlcarr.com
Bill Woessner
> Why not enact tort reform / medical malpractice reform, first?
Actually, the House bill goes much farther than not enacting tort
reform. The House bill actually punishes states which enact tort
reform. There was an opinion piece on CNN.com last week about this:
http://www.cnn.com/2009/OPINION/11/09/frum.trial.lawyers.victory/index.html
Personally, I don't think tort reform would save a whole lot of
money. The CBO says malpractice reform would save $54 billion over 10
years (and that's 10 times more than previously estimated):
http://www.washingtonpost.com/wp-dyn/content/article/2009/10/09/AR2009100904271.html
Assuming medical spending is $3 trillion per year, that's about 0.2%
of total spending. Don't get me wrong, I'm completely in favor of
it. I think our culture of "sue first, ask questions later" is
absurd. I just don't think tort reform is the magic bullet.
But your point is well-taken. If there's money for the taking, why
not take it? They say we can cut $500 billion from Medicare over the
next decade without reducing services. Great, let's do it! And how
about today's report of $98 billion in improper payments in FY 2009:
http://www.cnn.com/2009/POLITICS/11/18/government.improper.payments/index.html
It seems to me the goal here is not to save money; it's to buy votes.
But I guess that's always been the goal.
--Bill
Bill
> Correct me if I'm wrong, but I believe a significant amount of
> pharmaceutical research is already funded by the government. I
> suspect it's probably as much as 50%.
FWIW I did a little quick research and found that, according to a 2001
CRS report the pharmaceutical industry spent $22.4 billion on R&D in
the U.S. in 2000. R&D in this case includes all of the costs of
developing a drug through and including stage III clinical trials. This
was a 10% increase from 1999 to 2000 so the figure today is probably
around $30 billion.
Essentially all of the federally funded drug research not done by NIH
itself is funded by NIH grants. The 2010 NIH budget is just over $30
billion and a bit over 50%, or roughly $16 billion is devoted to
research grants. Thus it appears that total drug R&D expenditures are
about $46 billion with the federal government providing just over one
third. If you add the cost of in-house research at NIH the federal
contribution will be a bit higher.
Although it can vary widely a rough estimate of the R&D cost for a new
drug, according to the 2001 CRS report, is $500 million and the total
time is roughly 15 years. That first pill is indeed expensive.
--
.Bill.
Bill
was $20.31 billion, about 60% of which goes for basic research and most
of the remainder for clinical research.
--
.Bill.
Don
> Correct me if I'm wrong, but I believe a significant amount of
> pharmaceutical research is already funded by the government. I
> suspect it's probably as much as 50%. There was some discussion a
> while ago about shortening drug patents proportional to how much
> public funding went in to developing the drug. Seemed like a
> reasonable thing to do.
You are probably right. At least the government provides grants to
universities for basic research. As I understand it, a problem with the
drug companies is that they do not research drugs for rare and
little-publicized conditions and diseases that are not likely be in
demand and be big money makers. I guess an analogue of the "public
option" insurance idea would be an entire government-operated drug
company that competes with the private companies in not only finding
the drugs but also distributing them and getting them to market.
Bill
> As I understand it, a problem with the drug companies is that they do
> not research drugs for rare and little-publicized conditions and
> diseases that are not likely be in demand and be big money makers.
Unfortunately that should not and probably will not change a lot. There
will always be limited resources and the resources that are available
should be applied to help the greatest number of people.
--
.Bill.
Don
> Unfortunately that should not and probably will not change a lot. There
> will always be limited resources and the resources that are available
> should be applied to help the greatest number of people.
The utilitarian concept makes good sense under the assumption of fixed
resources. But perhaps there are enough resources to help both many
people with common diseases and the few with rare diseases, provided
there is efficient allocation of those resources. For example, maybe it
is not really necessary to produce five different drugs to combat
cholesterol. Maybe one or two would be enough, and the savings could
then be applied to find something for other conditions you don't hear
much about in the news. Also, new information gained from research into
rare and unusual conditions could eventually lead to better
understanding of more common conditions.
Bill
> For example, maybe it is not really necessary to produce five
> different drugs to combat cholesterol. Maybe one or two would be
> enough, and the savings could then be applied to find something for
> other conditions you don't hear much about in the news.
Great example except... There are some people who develop severe muscle
pain caused by destruction of the muscle tissue when they take statins
and it can be a serious problem. I happen to be one of those people. My
cardiologist tried four (of the five available) statins before finding
one I could tolerate. When I was first put on statins my LDL was not
extremely high and when I developed myalgia and high CPK the solution
was to stop the statin. Eighteen months later I had a heart attack and
now have a stint in one of my coronary arteries so tatking a statin is
important to my survival. Like I said, great example. You just picked
te wrong guy to use it on.<g>
--
.Bill.
TheMightyAtlas
> The utilitarian concept makes good sense under the assumption of fixed
> resources. But perhaps there are enough resources to help both many
> people with common diseases and the few with rare diseases, provided
> there is efficient allocation of those resources. For example, maybe it
> is not really necessary to produce five different drugs to combat
> cholesterol. Maybe one or two would be enough, and the savings could
> then be applied to find something for other conditions you don't hear
> much about in the news. Also, new information gained from research into
> rare and unusual conditions could eventually lead to better
> understanding of more common conditions.
If there are tens of millions of people who have high blood pressure,
producing 15 drugs that each work a little differently, and may be
better for a few hundred thousand people each, is better than
developing a drug for a disease that affects on a few thousand people
a year globally. Twenty years ago, I could not take any of the
medications on the market without getting some pretty nasty side
effects. Now I have a couple of choices. I am sure I did a lot of
damage to my cardiovascular system during the fifteen years that I was
not treated consistently. This may or may not knock years off my life
(maybe I will be hit by a bus) but across the millions who are like
me, I am sure the newer meds are going to add millions of years of
life.
Don
> Great example except... There are some people who develop severe muscle
> pain caused by destruction of the muscle tissue when they take statins
> and it can be a serious problem. I happen to be one of those people.
Sorry about that! Lets substitute "pain relievers" for "statins" in the
example. But we could expect stil more savings if we could completely
eradicate smoking, excessive alcohol consumption, and obesity. (My
apologies in advance if you are an obese smoker and drinker.)
Come to think of it, there are a whole lot of stop-smoking remedies on
the market. Wouldn't one or two suffice? And the number of weight-loss
programs must be astronomical.
Bill
> if you are an obese smoker and drinker.)
We have a winner! I am not obese, do not drink and quit smoking 41
years ago.<g>
I agree with you whole heartedly. I recently read an artilcle that
estimated the cost of excessive salt consumption, alcohol consumption,
smoking and obesity at almost $900 million annually.
--
.Bill.
Bill
--
.Bill.
Elle
I get a kick out of this part of the thread in particular. Imagine if
the whole country could be talking the way you (and also my hero(!),
Safeway CEO Steve Burd) are here. Helping people "get" that our
national problem with health care, and people's personal problems with
it, could largely be helped by taking specific measures involving
smoking, obesity and drinking should be a national theme. Ideally I
think translating it to bucks per individual, and giving them specific
financial incentive, the way Burd does with his employees with he
reports a fabulous quantifiable return on investment dollars, would be
compelling.
I am sure it is something some lofty (and so deprived IMO) minds might
guffaw at, but to me one of the most exciting and important TV shows
on the air today is "The Biggest Loser." It is a glimpse of some of
the most downtrodden (meant a few ways) of America. It is uplifting,
too. I know the show's producers are about money. But for gosh sake,
they also seem to get that for the show to continue to be successful,
its contestants must not only lose weight, quit smoking etc., but keep
it off and never take another cigarette. There is amazing emphasis on
strategies for contestants to take the show's lessons and make them
last for the rest of their lives.
The Henchman
"Bill" <nos...@nospam.com> wrote in message
news:he454i$1j4$1...@news.america.net...
Smokers and drinkers pay taxes. Taxes are a high percentage of the cost of
alcohol and tobacco. Taxes that go to fund health care in Canada. We need
more smokers and more alcoholics to help pay for this public health system.
Unfortunately Canada has a public health insurance plan. This needs to be
paid for by tax revenue. Income and corporate taxes plus various user fees
cannot cover all the costs that government agencies are burdened by. So
taxes on smoking, gambling, alcohol, and one hopefully one day soon sex and
drugs, will go far in making sure the funds will be available to cover the
great costs associated with public health insurance.
Smokers and alcoholics die younger saving our pension systems and health
care dollars. Taxing salty and fatty snacks and restaurant foods is fine by
me. The people that consume these product choose to live shorter lives
while quite willingly choosing to pay far more in taxes.
What needs to be discussed in this thread is how much revenue health care
will be REQUIRED from smokers and salty food eaters. Healthy people don't
exactly provide a reliable tax base.
Don
> Smokers and drinkers pay taxes. Taxes are a high percentage of the
> cost of alcohol and tobacco. Taxes that go to fund health care in
> Canada. We need more smokers and more alcoholics to help pay for this
> public health system.
>
> Unfortunately Canada has a public health insurance plan. This needs to
> be paid for by tax revenue. Income and corporate taxes plus various
> user fees cannot cover all the costs that government agencies are
> burdened by. So taxes on smoking, gambling, alcohol, and one hopefully
> one day soon sex and drugs, will go far in making sure the funds will
> be available to cover the great costs associated with public health
> insurance.
I would say the health of ALL the people, including smokers, drinkers,
and obese people, comes first, and the question of how much tax revenue
is needed to provide health care and where it comes from should be
considered later. Not only Canada, but also other responsible
industrialized nations in Europe and elsewhere seem to get along quite
well with their public programs, and they don't fuss about taxes. The
people in those enlightened nations will opt for a USA-style health
care system when hell freezes over.
Bill
> Not only Canada, but also other responsible industrialized nations in
> Europe and elsewhere seem to get along quite well with their public
> programs,
I have quite a number of Canadian friends and the majority of them are
not enamoured of their health care system. A typical example of many
stories they tell is the wife of a friend of mine who herniated a
lumbar disc and was in extreme pain. The pain was so severe that it
could not be completely suppressed by narcotic pain killers. The wait
for an operating room was nine months. Fortunately, they could afford
to venue shop and by checking operating room backlogs in some smaller
communities in the prairie provinces they got the wait down to four
months. I recently had the same problem in the U.S. and the time from
onset of symptoms to surgery was four weeks.
Another friend who lives in Toronto, when told that the wait for a MRI
for his son was six weeks elected to drive to Buffalo and pay for the
procedure himself. Once he had the MRI which showed that his son's
condition was life threatening he was able to get immediate surgery in
Canada but the boy had an anyeurism and if his parents had waited for
the national health the anyeurism might have ruptured and the boy would
be dead.
Not all other industrialized nations have systems that are better than
ours in every way all though quite a few appear to be better than both
ours and Canada's. There is a lot of variety between Canada, England,
Germany and Sweden as examples. The choice is not as simple as saying,
"Everyone does it better than we do so we should just do what everyone
else does."
--
.Bill.
Don
> I have quite a number of Canadian friends and the majority of them are
> not enamoured of their health care system. A typical example of many
> stories they tell is the wife of a friend of mine who herniated a
> lumbar disc and was in extreme pain. The pain was so severe that it
> could not be completely suppressed by narcotic pain killers. The wait
> for an operating room was nine months. Fortunately, they could afford
> to venue shop and by checking operating room backlogs in some smaller
> communities in the prairie provinces they got the wait down to four
> months. I recently had the same problem in the U.S. and the time from
> onset of symptoms to surgery was four weeks.
I live in Canada and have heard similar complaints about long waits for
operations. However, I have never met a single Canadian who suggests
abandoning government insurance and changing over to an American-style
system. Serious life-threatening conditions get quick action, and the
long waits are mostly for less serious, elective procedures. I guess
there are unfortunate exceptions like the one you described, but on the
whole I think the record is good. Nobody in Canada goes bankrupt
because of illness.
TheMightyAtlas
>
> I live in Canada and have heard similar complaints about long waits for
> operations. However, I have never met a single Canadian who suggests
> abandoning government insurance and changing over to an American-style
> system. Serious life-threatening conditions get quick action, and the
> long waits are mostly for less serious, elective procedures. I guess
> there are unfortunate exceptions like the one you described, but on the
> whole I think the record is good. Nobody in Canada goes bankrupt
> because of illness. �
Most of my family lives in Canada, including two doctors. We talk
about this ad nauseum when we have family gatherings. We also have two
doctors on the US side.
There are some things we all seem to agree on:
- Everyday care (doctors visits for minor issues, annual physicals
etc.) are about the same between the two countries, if you have
insurance in the US.
- Severe life threatening issues get treated in both countries, but
even with insurance can be financially ruinous in the US.
- Chronic conditions are very expensive in the US, because of high
drug costs.
- Specialists are a lot easier to get to see in the US.
- Things that are considered "not urgent" are massively more difficult
to get treated in Canada. This includes things like slow growing
tumors, chronically painful but not life threatening issues (knee
surgery, hip replacement).
- Doctors, especially specialists, make a lot more money in the US. A
lot more, like three or four times more. GPs are highly variable,
depending on the kind of practice. Canadian doctors are kind of upper
middle class for the most part. US doctors are rich.
Bill
> abandoning government insurance and changing over to an
> American-style system.
I certainly did not mean to imply that the Canadians I know would like
to abandon the national healthcare system, particularly for what we
have. I do know many who would like to see some things about the system
changed.
The point I was trying to make is that there are not just two systems,
the U.S. and the rest of the industrialized world. There are
differences country to country and they all have positive benefits and
limitations. The decision that the U.S. has to make is more complex
(even ignoring the political issues) than just deciding whether or not
to go to "the system" used by the rest of the industrialized world
which is the way I interpreted your message.
One thing that I do not understand here in the U.S. is why most people
seem to be unable to grasp the idea that when it comes to healthcare
demand will always exceed supply. Therefore, there will always be some
form of rationing. The trick is to design a system that rations
healthcare in a way that is least onerous to the citizens.
--
.Bill.
Bill
--
.Bill.
Bill
of the physicians I have seen in the last 15 years went to medical
school at McGill.<g>
--
.Bill.
Don
> I certainly did not mean to imply that the Canadians I know would like
> to abandon the national healthcare system, particularly for what we
> have. I do know many who would like to see some things about the system
> changed.
>
> The point I was trying to make is that there are not just two systems,
> the U.S. and the rest of the industrialized world. There are
> differences country to country and they all have positive benefits and
> limitations.
Yes, I agree completely. Many Canadians complain and want a better
system, but what they usually have in mind are systems like those in
places like France, Britain, or Australia, certainly not the USA.
Don
> Most of my family lives in Canada, including two doctors. We talk
> about this ad nauseum when we have family gatherings. We also have two
> doctors on the US side.
>
> There are some things we all seem to agree on:
>
> - Everyday care (doctors visits for minor issues, annual physicals
> etc.) are about the same between the two countries, if you have
> insurance in the US.
> - Severe life threatening issues get treated in both countries, but
Agreement here too. Another interesting comparison could be made
between medical education in the two countries. This is just a personal
impression, but it seems to me that medical schools are more selective
and more rigorous in their training in the USA than in Canada. Some
people get through in Canada who wouldn't make it in the USA.
Furthermore, for the very reasons you mention about earnings and
wealth, a lot of Canadian doctors find their way South of the border.
Despite these diffefences, it is still true that most people needing
health care are better off North of the border.
jIM
which RECEIVE the healthcare.
Level playing field needs to happen in many ways, on many fronts.
Examples:
1) You and I need access to the same insurance plan with the same
coverage regardless of employer or pre-existing conditions
2) If you or I go to same city/region to have a given procedure done,
that cost must be the same with minor exceptions
meaning my MRI costs the same as your MRI. Exceptions could be that
if you are a hospital, there might be an additional fee for the
orderly or nurse which wheeled you into room. But the most important
thing is that if both you and I had the same MRI done at same
location, it cost the same whether you or I had insurance, or what
insurance we had (standard pricing).
3) I think 60 minutes did something a few months back on areas with
high populations and high cost of health care per person did not have
lower mortality rates than locations which spent less money per
person. This probably gets aligned with some "end of life care"
issues, but the point is spending more per person is not the answer,
so the "costs of care/ treatment" need to be in line with a level
playing field- everyone needing a given service in a pre-defined area
should be paying the same cost.
**The point of level playing field is to get "true costs" disclosed
and then let free markets take control of pricing. Right now, most
people could not tell you how much a given service really costs
because of markup before insurance companies mark prices down.**
Point #2 for me is that people should expect to pay for the health
care they receive. Treating people for free is just bad economics.
My personal example is that my wife was pregnant slightly more than 24
months ago. In Feb of 2008 she was admitted to hospital, and in March
of 2008 I had twin boys which were born 3 months early. One spent 11
weeks and one spent 13 weeks in one hospital or another. We could
tell that about 1/3 to 1/2 of the beds (space) in the NICU were people
which probably could not pay for their coverage. Our insurance paid
everything after $150 and $50 payments (Wife and each kid paid $50 for
admittance to hospital A and baby C paid another $50 when transferred
to hospital B). The total "Bill" for all 3 was well in excess of $1 M
(400k, 300k, 500k I think for wife, baby R and baby C). Best guess is
the hospital has to "mark up" our beds to pay for the free beds we saw
in the NICU.
Point #3 if a person cannot pay for the health care they receive,
there should NOT be markup for services I receive because I can afford
to pay. I think this is the million dollar question (how is this
solved?), but bottom line is this for me
1) level playing field for obtaining insurance- allow it to be sold
like life insurance or similar, and the insurance must be just as good
as that I can get from my employer. How this is done does not matter,
but level the playing field for how insurance is obtained so everyone
can get access to it.
2) If you receive health care, the expectation is you pay for it.
Every american tax payer should be expected to pay $X per year in
health coverage (like an HDHP or similar). $X might be $2000, $5000
or $10,000. The government should come up with a number, give tax
credits to low income people if the money is spent, and similar
incentives in this regard, but the expectation should be you pay for
health care, then resolve your tax return to possibly get refunded for
money spent.
3) It is not up to the people which can afford to pay to pay more to
subsidize the people which refuse to pay.
My rant
will read beyond first page of posts now.
jIM
>
> My second concern is the notion of "controlling costs" (they really
> mean lowering costs; I don't know why they don't just come out and say
> that). �There is no mechanism for lowering costs. �The government can
> shift costs, but that's not lowering costs. �This is true at every
> level of the health care industry. �If you show up in the emergency
> room, they have to treat you. �If you can't afford it, the cost is
> shifted to everyone else. �Medicare and Medicaid are often hailed as
> champions of cost control. �Their method of controlling costs is
> paying providers less than cost. �You're deluding yourself if you
> think providers just eat that loss. �Of course they pass those costs
> along to everyone else.
>
>
> --Bill
Bill- a well thought out post
Cost control
could be cost reduction
it could also be cost elimination
it could come in different forms as well
Costs can be eliminated. Transportation fees, lab fees, billing
fees... the doctor's offices create fees to bill insurance companies
for, so they have more billing codes and because the fees are small,
they will not get the attention from the insurance company that "large
claims" get. My MIL works in large claims at a health insurance
company- her job is to track the high cost patients and the bills they
receive, and work to pay less on these large claims. Small claims
have similar markups, but because its OK for you and me to each pay an
extra $35 for this, or $75 fot that, those costs do not get removed or
eliminated, where as if the bill is large, those costs are often
removed.
In a similar example, In my experience, I had health coverage with an
employer in 2007. Call it company A. In 2008 company A was bought
by company B and new health care was provided. In 2009 I received a
Bill for services which were incurred in 2007. The fees totaled about
$500. The insurance decided to change what was covered in 2007 2
years later. This is after my company let all its benefits people go
when the 2008 buyout happened- I had no where to go but pay the extra
$500 in fees which were covered on the original Bill, but the
insurance company audit close to 18 months later decided we had to pay
the fees. That type of insurance company bullying needs to stop as a
way to eliminate or control costs.
jIM
My opinion would be let free market drive how many treatments exist
for something. There are numerous antihistamines. Allegra works best
for me, but I stopped using it because my insurance would not cover
it, and they told me to use claritin or similar instead. To this day
I have yet to find an antihistamine which works better for me than
allegra.
Bill had a point which debated this too, and my take is remove the
insurance companies from telling me what drug to use for a given
problem- let my body and free market decide which treatments work best
and determine the costs of the treatment too.
Elle
> Point #3 if a person cannot pay for the health care they receive,
> there should NOT be markup for services I receive because I can afford
> to pay. �I think this is the million dollar question (how is this
> solved?), but bottom line is this for me
Similarly, for those without insurance who pay cash, there should be a
discount from your aforementioned 'set price,' because the billing
source does not have to spend time on the administration of insurance
company policies, insurance company billing procedures, etc. A few
years ago my local paper reported that the local university hospital
charged those without insurance, whether they paid in cash or not, a
premium of some 30%.
Then too those with insurance are far less likely to question the
prescription of ineffective procedures and drugs. Many with insurance
have the attitude that they should get back what they pay for, and
that more is always better in medicine. (Not so.) What this does is
push up prices for all.
My point is there is justified disgruntlement on the sides of those
without insurance as well. In fact I think our problems today are due
mostly to consumers with insurance.
Lastly, with all due respect, I am doubtful that a level playing field
and free market can go hand-in-hand in the ways you suggest. That is,
you seem to be suggesting cost controls, which would be socialized
medicine and not a free market.
Bill
> Bill had a point which debated this too, and my take is remove the
> insurance companies from telling me what drug to use for a given
> problem- let my body and free market decide which treatments work best
> and determine the costs of the treatment too.
If I understand you correctly you are advocating a system where your
insurer must pay any claim for any treatment regardless or price. That
is going to remove the microscopic amount of cost control that exists
in the system now and increase the cost of insurance. The result of
that will be fewer people with insurance.
Remember that both private insurance companies, drug companies,
privately owned hospitals, etc. are for profit businesses. The sole
purpose of any business is to increase the wealth of its owner(s) and
all business will act in a way that management believes will further
that goal.
It is a given that demand for healthcare will always exceed supply.
Therefore, healthcare will always be rationed in some way just as it
is now. If you espouse a free market approach what you are saying is
that you favor a system where access to healthcare is rationed based on
ability to pay. If that is really the kind of system you want to see in
this country that's fine as long as you clearly understand all of the
implications of the system you advocate.
--
.Bill.
jIM
Level playing field relates primarily to how people obtain insurance.
Meaning you have the "right" or ability to get the same insurance I
do, and have that insurance cover the same things for the same price.
That environment does not exist today.
The "free market" is about obtaining insurance- make sure BCBS
competes with medicare and competes with UHC and all other insurance
providers compete for my insurance dollar.
I believe if this happens, the inefficiencies of costs can be squeezed
out of the system.
I am not suggesting the cost of an MRI be fixed, I am suggesting it be
the same for all who want to get an MRI. You without insurance should
pay the same as me with insurance (you should not get a discount).
The anti thesis to your comment is that the insurance cost should be
lower because they negotiated a bulk group rate. Your thesis was your
rate without insurance should be lower because its less paperwork. My
thought is the price for a given service should be the same (remove
the inefficiency and just list a standard price which all pay like a
restaurant menu). I don't care if the doctor sets the price, the
government does, the insurance companies do, but my point is the price
for a given service needs to be equal, to extent that if I find out my
Dr charged you less, I have the right to sue or recover the difference
in treatment costs.
jIM
> jIM wrote:
> > Bill had a point which debated this too, and my take is remove the
> > insurance companies from telling me what drug to use for a given
> > problem- let my body and free market decide which treatments work best
> > and determine the costs of the treatment too.
>
> If I understand you correctly you are advocating a system where your
> insurer must pay any claim for any treatment regardless or price. That
> is going to remove the microscopic amount of cost control that exists
> in the system now and increase the cost of insurance. The result of
> that will be fewer people with insurance.
>
Bill- My point is a level playing field on price. I am not advocating
price controls. I am suggesting if you get an MRI and I show up later
that day, I pay the same amount for an MRI as you do.
I have NO IDEA how to set the price, or who "controls" or "makes sure"
we set the price. Kind of like going to a restaurant and ordering
from a menu- the price for a given procedure is listed on a menu, and
all people at that location pay the same amount for the same service.
My logic behind this is the basic premise that
"everyone wants good healthcare, no one wants to pay for good
healthcare".
At minimum my reform wishlist is that we all start paying the same
price for things. Level that, fix that, and see where it takes us
(change in baby steps in better than complete reform IMO).
What I would "expect" to see is people now understanding that to get
an MRI it costs about $500 for the MRI tech and similar to get that
done. If a doctor orders an MRI, they could then logically ask "do I
need that test"?
Meaning if we saw the price, we could either
a) shop around for a lower price (and then free market might change
how much an MRI costs)
b) opt to not have the test
c) get the MRI done because it is needed and needed now
The list price for the MRI might be $500 as I suggested
if we have the same insurance, we should pay the same amount (whether
a 20% copay, the whole $500 or something else). If you choose to not
have insurance, then you pay the full $500, but you know the "end
result" is that the office received the same revenue from me as it did
from you.
This is the only form of cost control I am suggesting- menu pricing so
to speak.
Avrum Lapin
wrote:
> jIM wrote:
.......snip
> Remember that both private insurance companies, drug companies,
> privately owned hospitals, etc. are for profit businesses. The sole
> purpose of any business is to increase the wealth of its owner(s) and
> all business will act in a way that management believes will further
> that goal.
>
......snip
Non -profits are also in the business of making money so that they can
expand, have fancier rooms, subsidize the poor etc. They also must
compete for doctors, patients etc.
Bill
> Bill- My point is a level playing field on price. I am not advocating
> price controls. I am suggesting if you get an MRI and I show up later
> that day, I pay the same amount for an MRI as you do.
I agree. This is part of the larger issue of transparency. The consumer
needs to understand not only pricing but all other aspects of how the
system works in order to make good decisions.
>
> What I would "expect" to see is people now understanding that to get
> an MRI it costs about $500 for the MRI tech and similar to get that
> done. If a doctor orders an MRI, they could then logically ask "do I
> need that test"?
Only true if the consumer has to pay part of the cost directly from
his/her pocket. For those that have first dollar coverage (for example,
myself on traditional medicare with a medigape policy) there is no
incentive whatever to conserve resources. Any plan that offers first
dollar coverage will be abused and is a bad idea because resources will
be wasted that could be used to server others.
>
> Meaning if we saw the price, we could either
> a) shop around for a lower price (and then free market might change
> how much an MRI costs)
> b) opt to not have the test
> c) get the MRI done because it is needed and needed now
Again, I agree but it will only work if, as Warren Buffedt says, the
consumer has some skin in the game.
--
.Bill.
Bill
> Non -profits are also in the business of making money so that they
> can expand, have fancier rooms, subsidize the poor etc. They also
> must compete for doctors, patients etc.
I agree that non-profits need money to operate but making as much money
as possible is not usually their primary stated goal.
--
.Bill.
Bill
> I am not suggesting the cost of an MRI be fixed, I am suggesting it be
> the same for all who want to get an MRI.
I don't think you meant what you said. I think your intent is that any
single provider or MRI exams much charge the same price to all
regardless of whether or not they have insurance or what insurance they
have. If provider A charges everyone $500 and provider B can provide
the same service charging everyone $450 that is fine.
--
.Bill.
Bill
--
.Bill.
Elle
> I am not suggesting the cost of an MRI be fixed, I am suggesting it be
> the same for all who want to get an MRI. �You without insurance should
> pay the same as me with insurance (you should not get a discount).
The above is not what I call a free market.
> The anti thesis to your comment is that the insurance cost should be
> lower because they negotiated a bulk group rate. �Your thesis was your
> rate without insurance should be lower because its less paperwork. �
My thesis is that when it comes to assigning blame for health care
costs, the insured are as much at fault as the uninsured.
> My
> thought is the price for a given service should be the same (remove
> the inefficiency and just list a standard price which all pay like a
> restaurant menu). �I don't care if the doctor sets the price, the
> government does, the insurance companies do, but my point is the price
> for a given service needs to be equal, to extent that if I find out my
> Dr charged you less, I have the right to sue or recover the difference
> in treatment costs.
I am not seeing it. Bargaining is usual for many products outside of
health care. For example, should we have a standard price for new
cars?
My objection is your claim that what you are proposing goes toward a
'free market.' I think what you are proposing is in some respects a
freer market, but in other respects it is a less free market.
jIM
My thought is I need to see the cost of the procedure before the
procedure and everyone getting a procedure from the same location be
charged the same amount (transparency). You are correct in stating if
the office down the road wants to charge $50 less, they should be
allowed to do so.
As long as all costs are known for a given procedure ahead of time.
Lowrie
It has to be said that along with the transparency in amounts there
needs to be transparency as to quality and safeguards. Not all MRIs
or Radiologists are of the same quality. It is sometimes the case
where
serious problems are not apparent on imaging but discovered later with
a different radiologist or different type of machine. It could be
strictly a matter of quality or, perhaps, of payment but these more
sophisticated areas of health care difficulties have to be worked out
also.
======================================= MODERATOR'S COMMENT:
Please trim the post to which you respond. "Trim" means that except for some brief material to provide context for your remarks, the previous post is deleted. Thank you.
HW "Skip" Weldon
whatever national health insurance passes is by cutting Medicare. Does
anyone know the specifics of the cuts?
Avrum Lapin
Exactly what will happen won't be known until they are done but the DEMs
plan to do one or more of the following
a) reduce fees to providers especially the higher paid specialists -
more providers will stop taking MediCare
b) reduce payments to Medicare Advantage (HMO, PPO) plans which surely
will result in fewer benefits, higher premiums, deductibles and or
co-pays
c) wishfully think that electronic records etc will result in greater
efficiency and thus lower costs
d) Tax insurers which will result in premiums
e) continue to believe that there is a free lunch
Don
> e) continue to believe that there is a free lunch
A good plan would be to look closely at how some of the other nations
around the world manage to pay for it. The economies of England,
France, Canada, Germany, etc. have not collapsed as a result of
universal health care.
Why is there so much anxiety in the USA about how to pay for it?
Perhaps because too many people in the USA indeed believe in a "free
lunch" -- that is, big, free, forever continuing profits for medical
specialists, pharmaceutical companies, HMO's, and insurance companies.
Avrum Lapin
Don <dwz...@telus.net> wrote:
Response:
Your e-mail address says that you are a Canadian
a) we are aware of long waiting times be it for CT or MRI scans, hip or
knee surgery or to get into see a specialist. My late father lived in
Montreal, my brother lives in Edmonton. I do scan the Montreal Gazette
and the BBC on line
b) taxes in both the UK and in Canada are much higher than they are in
the states.
c) the 85% of Americans who have health insurance are worried that once
the government gets into the act fear that their access to and the
quality of health care will decline. They look at the Post Office, the
Dept of Motor Vehicles, public schools etc as samples of government
run enterprises.
d) Medical Specialists, Insurance companies and Drug Manufacturers make
large donations to politicians.
Don
> Your e-mail address says that you are a Canadian
>
> a) we are aware of long waiting times be it for CT or MRI scans, hip or
> knee surgery or to get into see a specialist. My late father lived in
> Montreal, my brother lives in Edmonton. I do scan the Montreal Gazette
> and the BBC on line
My experience has been that waiting times in Canada are longer for many
things, but serious medical issues are treated without delay.
> b) taxes in both the UK and in Canada are much higher than they are in
> the states.
I would say it is more accurate to say that taxes are slightly higher
in Canada. I have business in both Canada and the USA, and I file tax
returns in both countries. There is not a huge difference in rates, and
because of tax credits, the total I pay is not a lot different from
what it would be if all my income were from one country or the other.
> c) the 85% of Americans who have health insurance are worried that once
> the government gets into the act fear that their access to and the
> quality of health care will decline. They look at the Post Office, the
> Dept of Motor Vehicles, public schools etc as samples of government
> run enterprises.
The "quality" of medical care is not a big issue for people who get no
medical care at all!
High tech methods are great for a small number of people who can afford
them, but the main problem is getting some basic care to the vast
number of people who have no insurance and limited access to any kind
of care.
rick++
that would be helpful to the 50-65 age group have been mostly
removed. These include the public option, medicare buy-in,
and federal employee plan buy-in.
I dont not know if the clause restricting the maximum
premium to be 5x the minimum premium is still in the bill.
Just having a no-refusal clause for private plans may help a lot.
Though it may cost a fortune.
Elle
> Your e-mail address says that you are a Canadian
>
> a) we are aware of long waiting times be it for CT or MRI scans, hip or
> knee surgery or to get into see a specialist. �My late father lived in
> Montreal, my brother lives in Edmonton. �I do scan the Montreal Gazette
> and the BBC on line
Are you not aware of the typically long waiting times to see a
specialist or even general MD pracitioner in the U.S.? Are you unaware
that CT and MRI scans are overprescribed in the U.S.?
> b) taxes in both the UK and in Canada are much higher than they are in
> the states.
I doubt it is much higher, once one adjusts for what one gets in the
UK and Canada.
> c) the 85% of Americans who have health insurance are worried that once
> the government gets into the act fear that their access to and the
> quality of health care will decline. �
First, one does not see people fighting to get rid of Medicare, for
one. Second, I believe the typical American confuses "quality" with
overprescription of services. That is, the typical American thinks
"more is better" when it comes to medical services. Study after study
shows this to be nonsense. "Medical services" are not to be confused
with "medical care."
Don
> I doubt it is much higher, once one adjusts for what one gets in the
> UK and Canada.
True, and people who compare two countries are often selective to the
USA's advantage. That is, they compare the medical care the more
affluent Americans receive with what everybody in Canada receives.
Bill
> My disappointment in the past week is the clauses
> that would be helpful to the 50-65 age group have been mostly
It is interesting that those provisions were removed at the insistence
of Joe Lieberman of Connecticut, home to more insurance companies than
any other state in the U.S.
> removed. These include the public option, medicare buy-in,
> and federal employee plan buy-in.
> I dont not know if the clause restricting the maximum
> premium to be 5x the minimum premium is still in the bill.
> Just having a no-refusal clause for private plans may help a lot.
> Though it may cost a fortune.
I don't think that making all insurance plans guaranteed issue will
increase premiums much. All group plans for employers with over 10 to
15 employees are guaranteed issue and the premiums are lower than
individual policies for the same group of people. When you look at
adding those who can afford to buy insurance and would buy it if they
were not prevented from doing so by a pre-existing condition I think
you are looking at a very small percentage of the total number of
people now insured. It would be interesting to see some accurate
statistics on this .
--
.Bill.
Avrum Lapin
<df7d324f-5325-495d...@m3g2000yqf.googlegroups.com>,
"rick++" <ric...@hotmail.com> wrote:
It will. A PPO under the California HIPPA plan (those who use up Cobra
and can't buy insurance because of pre-existing) pay about $750/mo with
a high deductible and a 30% co-pay
Avrum Lapin
<e231ca69-1b20-438c...@m3g2000yqf.googlegroups.com>,
Elle <honda....@gmail.com> wrote:
snip
>
> Are you not aware of the typically long waiting times to see a
> specialist or even general MD pracitioner in the U.S.? Are you unaware
> that CT and MRI scans are overprescribed in the U.S.?
Recent experience (not in an HMO)
cardiologist - 1 week for treadmill
ophthalmologist - 1.5 weeks for annual retinal check
dermatologist - same week to burn off a precancerous spot
>
> > b) taxes in both the UK and in Canada are much higher than they are in
> > the states.
> I doubt it is much higher, once one adjusts for what one gets in the
> UK and Canada.
When I did my Canadian Dad's taxes (he was 90 and living on 11K +
savings) he was paying a marginal rate of 20% in Quebec after 10K and
15.5% sales tax
>
> > c) the 85% of Americans who have health insurance are worried that once
> > the government gets into the act fear that their access to and the
> > quality of health care will decline. �
>
> First, one does not see people fighting to get rid of Medicare, for
> one. Second, I believe the typical American confuses "quality" with
> overprescription of services. That is, the typical American thinks
> "more is better" when it comes to medical services. Study after study
> shows this to be nonsense. "Medical services" are not to be confused
> with "medical care."
Did you hear the flail when the experts suggested increasing the age to
start mammograms. Most Americans have bought into the medical
advertising by big pharma etc. Doctors are paid piece work and they try
to maximize the number of pieces. I agree that we are over treated and
over medicated especially in our later years
Bill Woessner
> b)taxes in both the UK and in Canada are much higher than they are in
> the states.
Everyone seems to accept that as a given, but, in the case of Canada,
I don't think it's necessarily true. Check out the latest OECD
economic outlook:
http://www.oecd.org/document/61/0,3343,en_2649_34573_2483901_1_1_1_1,00.html
Specifically, the spreadsheet on government outlays:
http://www.oecd.org/dataoecd/5/51/2483816.xls
They measure total government outlays (federal, state and local) as a
percent of GDP. Admittedly, this is a pretty crude way of measuring
"taxes". But it's probably a lot better than anecdotal evidence. In
2009, government outlays in Canada were 43.6% of GDP. In the US, it
was 41.5%. Canada is only about 5% higher than the US.
However, the UK IS significantly higher, at 52.1%. That makes me
wonder where the disparity between Canada and the UK comes from. At
first blush, I thought it was military spending (the UK has things
like nuclear weapons, ballistic missile submarines and aircraft
carriers that I don't believe the Canadians do), but that doesn't
appear to be the case. According to Wikipedia:
http://en.wikipedia.org/wiki/List_of_countries_by_military_expenditures
Canada spends 1.1% of its GDP on its military while the UK spends
2.4%. That accounts for some of the disparity, but certainly not all
of it. Maybe the UK has more non-medical social spending that
Canada? Don't know.
--Bill
Augustine
> In
> 2009, government outlays in Canada were 43.6% of GDP. �In the US, it
> was 41.5%. �Canada is only about 5% higher than the US.
This difference also agrees with the tax burden data at
http://en.wikipedia.org/wiki/List_of_countries_by_tax_revenue_as_percentage_of_GDP.
Don
> They measure total government outlays (federal, state and local) as a
> percent of GDP. Admittedly, this is a pretty crude way of measuring
> "taxes". But it's probably a lot better than anecdotal evidence. In
> 2009, government outlays in Canada were 43.6% of GDP. In the US, it
> was 41.5%. Canada is only about 5% higher than the US.
Any comparison of financial matters in the USA and Canada should take
into consideration the huge population difference between the two
countries. In some things this may not be important, and in other
things it may be. The difference would be relevant to any unusual
event, good or bad, that has a small probability of occurring anywhere.
For example, it is far more likely that a rare and unusual discovery,
say of a new and better medical treatment, or the success of a company
that invents a new product, occurs in the USA than in Canada. On the
other hand, it is also more likely that a cult of cannibalism or a
newer and more and effective ripoff scheme come from the USA. Maybe
this is relevant to a difference in tax rates, maybe not. I don't know.