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How health reform may help ... or hurt
Old 06-18-2009, 10:27 PM   #1
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How health reform may help ... or hurt

This is the best and most concise explanation I've seen regarding the economic tightrope we're walking on health care reform:

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Fixing health care has giant consequences. Here are the potential economic rewards for getting it right and the perils of getting it wrong.
Health care reform: How it could help - or hurt - economy - Jun. 18, 2009
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Old 06-19-2009, 08:37 AM   #2
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Risking being a bit political, our legislators are not so good at walking a tightrope.
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Old 06-19-2009, 08:42 AM   #3
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Risking being a bit political, our legislators are not so good at walking a tightrope.
Or even worse, both sides are too busy vilifying each other as stupid or malevolent -- and building a culture of mutual distrust and even dislike -- to craft anything that might be mutually acceptable as well as palatable for the masses.

That's why I suspect anything meaningful beyond "tinkering on the edges" may be DOA for a while.
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Old 06-19-2009, 08:44 AM   #4
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Risking being a bit political, our legislators are not so good at walking a tightrope.
Agreed. I'm of the opinion most of them need something much broader to walk - like a plank.
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Old 06-19-2009, 09:10 AM   #5
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I listened to Dr. Frist, this morning on TV. (Qualifing Dr. Frist is ex-senate majority leader Repblican, and a heart surgeon.) I thought his comments were insightful in several area. He use to practice medicin in England and commented on their system. He also commented on some of the statistics thrown around to justify how bad our health care is. He talked about life expectancy and infant mortality. and how these two things are more dependent on life style choice than quality of health care. I believe the numbers he gave out is 40% lifestyle, 30% haridity and 30% health care.

Given that we eat too much, and don't exercise enough, are we going to see a system that forces diet and exercise?

While this may seem far fetched to some, I don't think it is. We already have laws on the books that are justified by 'We all may have to pay if you are in an accident and don't have a seat belt on'. The same logic is used to support helmet laws and a slew of OSHA regulations. So it does not seem too far fetched that we will see lawmakers crafting some form of tax or law for the good of us all.

After all if you are over weight 'We all have to pay your bill'.
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Old 06-19-2009, 09:18 AM   #6
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Agreed. I'm of the opinion most of them need something much broader to walk - like a plank.
Hard to disagree with that In fact, I think the plank is too easy. Maybe they should walk the gauntlet - hands tied behind their back and legs chained.
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Old 06-19-2009, 09:24 AM   #7
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Michael, remember you pay their doctor bills. They got you coming and going!
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Old 06-19-2009, 09:27 AM   #8
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How much does a coroner charge?
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Old 06-19-2009, 09:32 AM   #9
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What Drives High US Healthcare Costs? Price or Utilization?

That article rehashes much of what has been said before and does not add new insights.


For example:
"The crux of the problem: The United States spends far more on health care than do other developed countries.
See Switz - below

"For 40 years, health care costs have grown faster than inflation and wages."
Isn't this the same for college education which plays into the cost of health ins.
Haven't new technologies been added over that time - not apples to apples.


"Lawmakers note that higher health care costs put U.S. businesses at a competitive disadvantage because they have to pay so much more to insure their employees than do their foreign competitors."
=== Competitive disadvantage (of course) yet if businesses don't pay it directly; they do through higher taxes or higher wages due to their employees paying it. - shell game

"Indeed, among developed countries, the United States is the biggest spender. It spends 52% more on heath per person than the country ranked second, which is Switzerland."

"A true comparison versus other nations would be the different price components.

E.g.
real estate costs
transaction costs - accounting
delinquency rates
personnel costs
Insurance fees

Only when that is done can we understand the differences and make an informed decision.

This is nothing different than trying to understand retirement budgets for a person living in NYC or Roswell, NM."
What Drives High US Healthcare Costs? Price or Utilization?

I would add to the above: What was the last war Switz. fought? They don't have veterans.

"The CBO told lawmakers that a 1% reduction in the growth of federal health care spending each year forthe next 20 years would pay for the cost of expanding coverage in the first decade and then provide savings that "exceed that cost in the next decade."
Have we evern know of a large government program that doesn't expand over time? Look at all the Great Society programs.

"Obama economic adviser Christina Romer estimates that if the annual growth rate in health care costs slows by 1.5 percentage points a year -- which she concedes is a high bar -- real GDP could increase by more than 2% in 2020 and by nearly 8% in 2030."
Think about that one for a second - Health cost down 1.5% + taxes up by X equals GDP growth? Only telling part of the story - I think so.

+++++

We live in a consumer society yet when it comes to health care that is forgotten. Sellers have done exhaustive studies on their buyers to find out how to get them to buy their product and price is only one factor. But when it comes to health care only price is mentioned.

I think if we studied the reasons why people don't have health ins. we would find a whole range of answers.
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Old 06-19-2009, 09:34 AM   #10
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REW, good idea, but just a pine box would do. We know why they died! However, my prediction is next election we will return the majority of them to their offices in Washington.
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Old 06-19-2009, 09:39 AM   #11
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Originally Posted by Rustic23 View Post
I listened to Dr. Frist, this morning on TV. (Qualifing Dr. Frist is ex-senate majority leader Repblican, and a heart surgeon.) I thought his comments were insightful in several area. He use to practice medicin in England and commented on their system. He also commented on some of the statistics thrown around to justify how bad our health care is. He talked about life expectancy and infant mortality. and how these two things are more dependent on life style choice than quality of health care. I believe the numbers he gave out is 40% lifestyle, 30% haridity and 30% health care.

Given that we eat too much, and don't exercise enough, are we going to see a system that forces diet and exercise?

Eliminating these negative lifestyle choices would be the greatest factor in reducing health costs



While this may seem far fetched to some, I don't think it is. We already have laws on the books that are justified by 'We all may have to pay if you are in an accident and don't have a seat belt on'. The same logic is used to support helmet laws and a slew of OSHA regulations. So it does not seem too far fetched that we will see lawmakers crafting some form of tax or law for the good of us all.

After all if you are over weight 'We all have to pay your bill'.

Eliminating these negative lifestyle choices would be the greatest factor in reducing health costs
Safeway Health Plan Reduces Company Costs, Promotes Preventive Health

Safeway CEO Steve Burd, who has spoken about the plan to more than 300 executives during the past three months, said, "What is the revelation Safeway had two years ago that completely transformed our thinking? That 50 [%] to 60% of all health care costs are driven by behavior," adding, "If you design a health care plan that rewards good behavior, you will drive costs down."
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Old 06-19-2009, 09:44 AM   #12
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"If you design a health care plan that rewards good behavior, you will drive costs down."
Maybe so, but how do you handle the tough cases? There is some evidence of a genetic link to things like obesity, for example. These are usually considered "bad lifestyle choices" when it comes to health and the cost of health care. But if these things are at least partially genetic, if some people are born predisposed to these things regardless of their actual lifestyles, do they get penalized? Or is there a way to only "penalize" those who actually engage in the behavior?

I know people who can eat like a horse and stay slim. I know people who, no matter what they do in terms of diet, can't lose weight. It's not ALL lifestyle. It's not all *choosing* to be unfit.

Is that $2.99 bag of Doritos about to become $4.70 with the "lifestyle tax" slapped on it? Do we slap everyone with a $200 "unfit tax" each month on which they can have $20 rebated every time they go to the gym for at least a half hour?
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Old 06-19-2009, 09:54 AM   #13
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"To Holtz-Eakin, who advised John McCain in last year's presidential race,failed health reform wouldmean that "everyone gets coverage but we don't change the underlying cost dynamics. Health care spending goes up and we haven't solved our deficit problem."


The above is from the article.... and the biggest problem I see with all the talk... they are focusing on the payment side and not the service side... if we do not fix HOW medicine is provided, we can not fix the cost... and from what I see, they want to have a single payor who will then say "this is all you get, just don't give out health care after you reach this point"... which is not a fix even though it will reduce the monitary cost of health care... the social cost will increase, but who cares..
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Old 06-19-2009, 10:04 AM   #14
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Ziggy,
I have heard the statement before, that there are people that can't loose weight. However, I have never seen a picture of a fat prisoner coming from WWII concentration camps or Japanese Prisoner of War Camps. My mother use to say she could not use weight. However, she would then say 'Unless I get my diet below a 1,000 calories a day, and you can't live on that.' She died at 80 over weight but happy. She would have a bowl of ice cream and say 'This is how I keep my girlish figure'. She was 5'2" and well over 200lbs. She would have given up Medicare before she gave up that ice cream!
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Old 06-19-2009, 10:05 AM   #15
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Wouldn't it cost a ton of $$$ to monitor people's lifestyles to determine how to allocate any incentive/tax for lifestyle issues? Not to mention the privacy issues.
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Old 06-19-2009, 10:07 AM   #16
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Ziggy,
I have heard the statement before, that there are people that can't loose weight. However, I have never seen a picture of a fat prisoner coming from WWII concentration camps or Japanese Prisoner of War Camps.
Seems like a slightly excessive example of how to deal with the "obesity epidemic," but maybe that's just me...
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Old 06-19-2009, 10:07 AM   #17
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Rustic, did your mother have health issues from her weight? (My mother with her perfectly healthy lifestyle died at 50 at 5'6" and 135 lbs.)
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Old 06-19-2009, 10:08 AM   #18
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Wouldn't it cost a ton of $$$ to monitor people's lifestyles to determine how to allocate any incentive/tax for lifestyle issues? Not to mention the privacy issues.
That's the can o' worms, I think. The more and more "taxpayer money" gets involved, the more and more people are going to demand their "right as a taxpayer" to regulate and control the lifestyle decisions of other people.

That's the aspect of the debate I find scariest of all.
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"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

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Old 06-19-2009, 10:29 AM   #19
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Originally Posted by Rustic23 View Post
I listened to Dr. Frist, this morning on TV. (Qualifing Dr. Frist is ex-senate majority leader Repblican, and a heart surgeon.) I thought his comments were insightful in several area. He use to practice medicin in England and commented on their system. He also commented on some of the statistics thrown around to justify how bad our health care is. He talked about life expectancy and infant mortality. and how these two things are more dependent on life style choice than quality of health care. I believe the numbers he gave out is 40% lifestyle, 30% haridity and 30% health care.

Given that we eat too much, and don't exercise enough, are we going to see a system that forces diet and exercise?

While this may seem far fetched to some, I don't think it is. We already have laws on the books that are justified by 'We all may have to pay if you are in an accident and don't have a seat belt on'. The same logic is used to support helmet laws and a slew of OSHA regulations. So it does not seem too far fetched that we will see lawmakers crafting some form of tax or law for the good of us all.

After all if you are over weight 'We all have to pay your bill'.
One problem with his analysis is that many European countries have lifestyle issues as well (high levels of smoking is one significant example). We are far less collectivist than Europe and they don't have forced diet and exercise. I seriously doubt it will ever happen here.

I like what Meadh had to say a while back about efforts to improve population health in Canada:

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Originally Posted by Meadbh View Post
For people unfamiliar with population health, here are a few links:

Population health - Wikipedia, the free encyclopedia

Population Health - Public Health Agency of Canada

Canadian Population Health Initiative

Basically, population health aims to improve the overall health of the population, thereby reducing the need for healthcare over time. (An apple a day keeps the doctor away, hence the apple on the PHAC website). In real terms, in Canada this translates into public policy. For example, provincial governments (who fund health care organizations) usually conduct, or cause to be conducted, population health assessments every 5 years or so. This helps to determine where the needs are. They can then incorporate those needs into a set of deliverables for the organizations they fund. In recent years, rather than funding individual hospitals and clinics that may not talk to each other, governments have been amalgamating them into health regions or similar clusters. A health region will be responsible for the health and health care of its entire geographically defined population, so it's in its interest to look at the big picture. Some provincial governments have specific indicators that they require health regions to improve, e.g. the number of diabetics getting screened for eye or kidney problems or the number of kids who get their immunizations on time. Another way to address the determinants of health is to get agencies and ministries to work together (e.g. health, housing, education) on policy making and programs. Also, health systems accreditation (Accreditation Canada) incorporates population health into its standards and now has specific sets of standards aimed at specific populations (e.g. child and youth, older people, mental health population). At the frontlines, care plans designed for patients now usually incorporate secondary prevention measures; for example, a care plan for myocardial infarction may include a stop smoking program, exercise and rehabilitation, and a visit to the psychologist in case of depression; a care plan for acute asthma will include family asthma education.

One further step that I would like to see taken is that the money follows the patient. Currently it's allocated to facilities and programs.
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Old 06-19-2009, 10:31 AM   #20
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Maybe so, but how do you handle the tough cases? There is some evidence of a genetic link to things like obesity, for example. These are usually considered "bad lifestyle choices" when it comes to health and the cost of health care. But if these things are at least partially genetic, if some people are born predisposed to these things regardless of their actual lifestyles, do they get penalized? Or is there a way to only "penalize" those who actually engage in the behavior?

I know people who can eat like a horse and stay slim. I know people who, no matter what they do in terms of diet, can't lose weight. It's not ALL lifestyle. It's not all *choosing* to be unfit.

Is that $2.99 bag of Doritos about to become $4.70 with the "lifestyle tax" slapped on it? Do we slap everyone with a $200 "unfit tax" each month on which they can have $20 rebated every time they go to the gym for at least a half hour?
Agreed. I am 5'9" and 150 lbs, eat very healthy compared to most people, and yet I have to watch my cholesterol and hypertension (compliment of my dad's family). Then I see some fat blokes woofing down big macs everyday (a treat I haven't been able to enjoy in 5 years) with barely a speck of cholesterol. Genetics is a b*tch...
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