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Old 06-03-2009, 02:37 PM   #21
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This thread has not popped up lately... so I read a few of the posts back a way...

Tell me this.... if, as a country, we are paying to much for healthcare (as the politicians continue to point out all the time)... then how is a government system that will cost the taxpayers trillions of dollars over the next few decades supposed to 'fix' things?

Where are the savings going to come from? And if we have those savings, then why is it so much more expensive?

BTW, one of the ways that at least one other country spends less in medical costs is they don't pay the doctors much. When I was in the UK, one of the guy's wife was a doctor... I said something about her making more than him... he said she made about half of what he made... and he was not highly paid...
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Old 06-03-2009, 02:56 PM   #22
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This thread has not popped up lately... so I read a few of the posts back a way...

Tell me this.... if, as a country, we are paying to much for healthcare (as the politicians continue to point out all the time)... then how is a government system that will cost the taxpayers trillions of dollars over the next few decades supposed to 'fix' things?

Where are the savings going to come from? And if we have those savings, then why is it so much more expensive?
I think the reasoning is that we spend a lot on healthcare but we don't get good value for our money. The care is gold-plated, there is too much high-technology, and especially the funding system (through private insurers) is "leaky" and causes a lot of trouble/costs for health care providers. If we had a single payer system then there would be rational, centralized decisions on what would be covered, and the overhead costs of providing the funding would be reduced. So, taxes would go up, but what we spend (on average) would go down. Everyone would be covered on at least the basic level.

Kinda like food, another necessity. Our food production, delivery, and funding mechanism is terribly inefficient and irrational. Nobody tells farmers what to grow, they just have to figure it out. Does that make any sense? The money we waste on food, as a nation, is INCREDIBLE-- much higher than what we spend on health care. Do you know that the raw materials for the food accounts for less than 20% of the average restaurant bill? The rest is just overhead and waste. The system is crazy. Look at the things people buy in the grocery store--wasting money on beer and soda with almost no nutritional value. And look at the size of those people--talk about the need for some rationing! In my view, this whole food funding and delivery system should be the government's first priority--it's more basic than health care, and some of the benefits will spill over. When the government takes it over, we'll get our dehydrated nutripatty every day and our liter of fiberslush. It turns out that 90% of Americans have NO food coverage, a scandal in the richest nation on earth. This modest program will significantly enhance the overall nutrition ingested by Americans. We'll save money overall, everyone gets food coverage at a basic level, and we are healthier as a people. It's hard to argue with that.

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Old 06-03-2009, 03:18 PM   #23
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Where are the savings going to come from? And if we have those savings, then why is it so much more expensive?
I see quite a few potential places to find savings, but very few (if any) that both sides of the aisle would agree on. Any such low-hanging fruit would probably already be picked where that was concerned.

Here are a few possibilities, most of which would be anathema to one side of the lawmaking aisle or the other: eliminating the overhead of private insurance and underwriting, allowing the government to negotiate drug prices, tort reform which would result in less "defensive medicine" costs, more transparency in pricing to allow an informed market-based decision in consuming health care, eliminating the link between employment and health insurance and a few other things.

Each of these has the legitimate potential of resulting in some cost savings. Some of them do have side effects, though, and most of these are "poison" for one ideology or the other.
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Old 06-03-2009, 03:25 PM   #24
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The other "saving" from the POV of an insured patient is the amount of money I am paying for those who do not pay for the services they receive because they do not have insurance or the ability to pay for the cost of services.
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Old 06-03-2009, 03:36 PM   #25
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Correct the Byzantine reimbursement systems, and you might eliminate the $80 tylenol tablet, which the hospital has to charge because it didn't get paid for the coronary bypass operation on that Medicaid or uninsured patient who wandered into the emergency room that week.

Or the $1000 emergency room cost for the visit for a common cold, high because among other things ERs have to maintain a high and expensive state of readiness for the "real" emergencies.

Or the futile use of ventilators, central lines, and drastic therapy for chronically demented or ill 90 year old patients in the ICU who lack a health care surrogate, or have one who can't or won't discontinue care.

Or the absurd multimillion dollar settlements for legitimate but exaggerated malpractice (if only I were worth as much...).
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Old 06-03-2009, 03:50 PM   #26
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I see quite a few potential places to find savings, but very few (if any) that both sides of the aisle would agree on. Any such low-hanging fruit would probably already be picked where that was concerned.

Here are a few possibilities, most of which would be anathema to one side of the lawmaking aisle or the other: eliminating the overhead of private insurance and underwriting, allowing the government to negotiate drug prices, tort reform which would result in less "defensive medicine" costs, more transparency in pricing to allow an informed market-based decision in consuming health care, eliminating the link between employment and health insurance and a few other things.

Each of these has the legitimate potential of resulting in some cost savings. Some of them do have side effects, though, and most of these are "poison" for one ideology or the other.

The drug price thing would be something that would be difficult... but I think they SHOULD be able to negotiate for anything they pay in medicaire or medicaid...

They did do tort reform here in Texas... not much happened to lower the costs of medicine... we just went to the emergency room for a dog bit and the total cost was about $1700... I paid $150 plus $35 for drugs... they did very little....


But you did not address my main question, why would the government have to shell out so much money? I would not think that 'we' would have our costs go down so much that the overall cost of medicine would decline when you consider the estimated cost to the government... and I would think we would get worse medicine...
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Old 06-03-2009, 04:09 PM   #27
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we just went to the emergency room for a dog bit and the total cost was about $1700... I paid $150 plus $35 for drugs... they did very little....
Curious: I assume $1700 was the fully billed amount? Did you see how much insurance would pay of that at negotiated rates?

About five years ago, my wife went to the ER with an acute attack of kidney stones. They took a couple of images for which the bill was $3,400. Blue Cross only allowed about $380 of those billed items, and we paid $50.

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But you did not address my main question, why would the government have to shell out so much money? I would not think that 'we' would have our costs go down so much that the overall cost of medicine would decline when you consider the estimated cost to the government... and I would think we would get worse medicine...
I've tried to stay out of the ideological government versus private sector debate. I know it's relevant; I just don't feel like diving into the mosh pit.
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Old 06-03-2009, 04:15 PM   #28
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Is a "pranayam" like a sweet potato? And, is this paranayam yoga the kind with the fruit at the bottom, or is it all mixed in? I like to mix it myself, it is good exercise. Do you do any exercise--like calisthenics?
Something I know! Prana is life force, or breath. Ayama is to restrain or suspend. The combination of the words, pranayama or pranayam is yogic breathing "excercises."
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Old 06-03-2009, 04:19 PM   #29
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Malpractice insurance costs, while high in parts of the country and for some specialties, is not a large part of medical costs. Defensive medicine is a bit harder to measure. Sorry, forgot the percentages and don't feel like looking it up.

Admin costs are very high in the US as compared to single payer countries. Too many insurance companies all with their own requirements. Other near garbage paperwork as well. The privacy part of HIPAA is a failure in my mind.
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Old 06-04-2009, 07:39 AM   #30
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I read a news article within the last few days, but it was a right leaning publication, so take it for what it's worth. "(Max) Baucus says the tax-free benefit packages Americans now enjoy are a big factor in the high costs of the country's health care system, because they provide workers free or low-cost access to too many health care services." Granted this was from a right leaning publication. To me that says either he wants the people who have worked hard and paid their dues to pay more for their own coverage and for those who haven't or he wants to limit access to health care.
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Old 06-06-2009, 02:51 PM   #31
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Tell me this.... if, as a country, we are paying to much for healthcare (as the politicians continue to point out all the time)... then how is a government system that will cost the taxpayers trillions of dollars over the next few decades supposed to 'fix' things?
I don't think that you necessarily arrive at a single payer "solution" if your primary concern is cost. After all, a truly free market for products and services is generally a more efficient mechanism for allocating resources than any centrally planned system. (BTW, we don't have anything remotely like a free market for health care in the U.S.).

However, if your primary concern is universal access to affordable health care, you almost invariably arrive at a single payer "solution" as the only option. The reason being, a free market will only offer health insurance to a very sick person at a price that exceeds his cost of care. Nearly no family can afford that, so you end up with a system where only healthy people, or very rich people, can get affordable health insurance. Attempts to rectify this always lead to increasing government involvement in the market to the point where a single payer system ends up being the logical conclusion.
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Old 06-06-2009, 02:58 PM   #32
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I don't think that you necessarily arrive at a single payer "solution" if your primary concern is cost. After all, a truly free market for products and services is generally a more efficient mechanism for allocating resources than any centrally planned system. (BTW, we don't have anything remotely like a free market for health care in the U.S.).

However, if your primary concern is universal access to affordable health care, you almost invariably arrive at a single payer "solution" as the only option. The reason being, a free market will only offer health insurance to a very sick person at a price that exceeds his cost of care. Nearly no family can afford that, so you end up with a system where only healthy people, or very rich people, can get affordable health insurance. Attempts to rectify this always lead to increasing government involvement in the market to the point where a single payer system ends up being the logical conclusion.
Absolutely agree. But as we cannot stomach single payer maybe instead we end up with insurance companies so highly regulated that they end up simply being processors of claims and competing for price on processing.
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Old 06-06-2009, 02:59 PM   #33
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Baucus says the tax-free benefit packages Americans now enjoy are a big factor in the high costs of the country's health care system, because they provide workers free or low-cost access to too many health care services." Granted this was from a right leaning publication. To me that says either he wants the people who have worked hard and paid their dues to pay more for their own coverage and for those who haven't or he wants to limit access to health care.
I think the argument is that employer deductability of health insurance distorts the market. It's better to give individuals the deduction, or tax credit, and let them choose the policy that fits their needs, rather than have employers use gold plated health care benefits as a recruiting tool.
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Old 06-06-2009, 03:03 PM   #34
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I think the argument is that employer deductability of health insurance distorts the market. It's better to give individuals the deduction, or tax credit, and let them choose the policy that fits their needs, rather than have employers use gold plated health care benefits as a recruiting tool.
The deduction would have to be above-the-line (directly deductible from income without itemizing), I think, or else it would be the equivalent of a large tax increase for people who aren't even close to being able to itemize.
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Old 06-06-2009, 03:06 PM   #35
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Absolutely agree. But as we cannot stomach single payer maybe instead we end up with insurance companies so highly regulated that they end up simply being processors of claims and competing for price on processing.
These politicians are a sneaky lot. If you can't get what you want through the front door, see if you can sneak it in the back way. That's what I think the they're trying with the proposal for a "government health insurance option". You leave the current system in place, but put company's in the position of having to compete with the government. No company can compete with an entity who doesn't have to turn a profit and whose pockets are trillions of dollars deep. Eventually the government "option" becomes the only option . . . presto, a single payer system.
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Old 06-06-2009, 03:08 PM   #36
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The deduction would have to be above-the-line (directly deductible from income without itemizing), I think, or else it would be the equivalent of a large tax increase for people who aren't even close to being able to itemize.
I think that is the idea.
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Old 06-06-2009, 07:30 PM   #37
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Absolutely agree. But as we cannot stomach single payer maybe instead we end up with insurance companies so highly regulated that they end up simply being processors of claims and competing for price on processing.
Actually, this is the model for traditional Medicare. The insurance companies are the claims processors and customer service front-end for the government. There is no profit in it for them, and very few make any money at all. But they get exclusive territories to service, the claim materials use their envelopes, and the local media contacts them for information to be used in news articles. All of this equals free advertising.

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Old 06-06-2009, 07:45 PM   #38
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However, if your primary concern is universal access to affordable health care, you almost invariably arrive at a single payer "solution" as the only option. The reason being, a free market will only offer health insurance to a very sick person at a price that exceeds his cost of care.
I'm not sure this is necessarily true. Imagine this:
- Anyone who sells health plans in a region must take all who apply (no underwriting--same price for each policy type (see below) for everyone regardless of age, sex, or medical condition)
- Government mandate: Everyone must buy health insurance (therefore, no adverse selection). The poor get a voucher on a sliding scale.
- A fixed number (4? 6?) of government-defined policy types with varying co-pays and features. All have basic preventative care (to reduce overall costs to the system) and an annual cap on co-pays (income based? Asset-based?). All policies have very high limits on coverage. Standardized policy types=more efficient price competition.

Now, there can be free market competition between insurers within that environment. The insurance companies get a guaranteed market of 100% of the legal citizens. The taxpayers are only paying for medical care for the needy. By selecting between the 4-6 plan types, people have some say in how much insurance they buy (within limits--these limits are in place because we, as a society, now believe people should not be free to choose to go without insurance as, in the end, other taxpayers end up paying the bill. Like it or not, that's where we are). Co-pays increase customer cost-consciousness.

More from a previous post (along with rebuttals)

I like this more. I want to be able to change insurers. I want to be able to go to a different doctor. And I want the government to regulate insurers, not become one (subject to no higher independent oversight).
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Old 06-06-2009, 09:35 PM   #39
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Or the absurd multimillion dollar settlements for legitimate but exaggerated malpractice (if only I were worth as much...).
I'm Canadian and try not to get involved in other country's troubles. OK, I'll chime in. Feel free to flame me.

I've always thought that the problem in the US is not with the medical system but with the legal system. Many years ago an oncologist friend moved from Canada to Miami. He told me his malpractice insurance premium in Miami would exceed his gross income in Canada (he was salaried). His comment was "and my patients are expected to die".

If the thread of suit was removed, and a doctor could follow a treatment plan that (s)he thought best and agreed on with the patient, what would be the effect on costs?
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Old 06-06-2009, 10:58 PM   #40
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Actually, this is the model for traditional Medicare. The insurance companies are the claims processors and customer service front-end for the government. There is no profit in it for them, and very few make any money at all. But they get exclusive territories to service, the claim materials use their envelopes, and the local media contacts them for information to be used in news articles. All of this equals free advertising.
Yep, the term is "third party administrator" and many insurers such as Blue Cross/Blue Shield do that for Medicare as well as large otherwise self-insured groups, such as governmental employees. It is already a big business.
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