Health Care Reform

[Texas Proud]

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...

 

[ziggy29]

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.

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.

 

[Martha]

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."

 

[Martha]

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.

 

[lets-retire]

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.

 

[Gone4Good]

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.

 

[Martha]

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.

 

[Gone4Good]

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.

 

[ziggy29]

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.

 

[Gone4Good]

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.

 

[Gone4Good]

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.

 

[Gotadimple]

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.

-- Rita

 

[samclem]

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).

 

[kumquat]

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?

 

[Rich_by_the_Bay]

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.

 

[lets-retire]

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.

That could be, but I don't really see that argument in his statement. It also goes back to my original point, He wants the people who have paid their dues to pay more dues and pay the dues for those who refuse to pay.

I know it's going to sound mean, but I don't care, I'm not exactly the PC type. I think any tool the employers can use to lure a person to work for them is a good thing. What everyone is proposing is to give every worker in a responsible job a huge pay cut. I started with a car, five t-shirts and two pairs of jeans. My "new" clothes were anything I could scrounge out of the garbage. I worked my but off, so I could move up and provide a good standard of living for me and my family. Why should I have to take a huge pay cut because some lazy S.O.B. refuses to go out and make a better life for themselves. I know not everyone who does not have insurance is lazy. Some choose to go without, some find themselves in a position where through no fault of their own they are without a job and insurance, those are not the people I'm talking about. I'm talking about the perfectly capable person who is doing a minimum wage job, despite being in the work force for several years. I'm talking about the person who refused to acknowledge the business they were in was coming to an end and refused to upgrade their job skills. I talking about the person who would rather sit at home and play video games, watching Jerry Springer, and eating Bon Bons than go out and find work. I should not have to pay for those people. I used to work around those people and have to listen to them complain about how bad they had it. When hearing those complaints the only question I would ask is, "What are you doing to better your situation?" The question was always met with blank stares followed by "it's not my fault..."

 

[Gone4Good]

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.

This is a scheme that can potentially achieve the same objectives as a single payer system, but the hand of government is so heavy here I'm not sure there is much difference between this and just having the government run everything. It's possible that you get some benefit from competition among insurers but the scope of those benefits will be limited by how much leeway companies are given to compete on things other than price.

It also sounds a lot like what we have here in NJ, where, according to e-health insurance, a family of 4 would pay $18K per year for an HMO type of plan. The least expensive plan offered costs $8,400 per year, but it looks like the coverage for a lot of stuff is capped at $700 per year.

So my guess is we'd still need some subsidies from Uncle Sugar to make this affordable.

 

[george76]

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 can't speak for anybody else. But considering my own experience I don't think it is possible we can get any worse medicine than we have now

I had severe back pain a few years ago. The doctor prescribed a traction chair to help the back get better. Some bureaucrat at the insurance company refused to pay for it, so I could not use it. I still have back pain etc.

A friend of mine have MS. As an MS patient she needs to take a daily injection of a drug. She could not use the medication the doctor prescribed, because the insurance company refused to pay for it. Instead, she had to settle for a cheaper drug the insurance company allowed her to take. The doctor was not happy, but it was this second choice drug or nothing.

Whatever health care reform we get, I doubt it will be worse than what we have today. Furthermore, since this is an early retirement board, health care reform hopefully will also eliminate the issues with pre-existing conditions. It is tough to retire with a pre-existing condition as no insurance company will touch you.

 

[george76]

I should not have to pay for those people. I used to work around those people and have to listen to them complain about how bad they had it. When hearing those complaints the only question I would ask is, "What are you doing to better your situation?" The question was always met with blank stares followed by "it's not my fault..."

You are asking why you should have to pay for people that didn't take care of themselves. I hear you, but that has always been the case as long as we have taxes. For example, why should someone who was against the Iraq war be required to pay for it? Why should someone in Texas have to pay for the "bridge to nowhere"?

We all pay in to the system, and then we elect representatives to make the best decision possible to spend it. Survey after survey show the same thing, ie we are paying more for our health care, yet we are less healthy than other countries. Something is not working.

 

[lets-retire]

You are asking why you should have to pay for people that didn't take care of themselves. I hear you, but that has always been the case as long as we have taxes. For example, why should someone who was against the Iraq war be required to pay for it? Why should someone in Texas have to pay for the "bridge to nowhere"?

We all pay in to the system, and then we elect representatives to make the best decision possible to spend it. Survey after survey show the same thing, ie we are paying more for our health care, yet we are less healthy than other countries. Something is not working.

I agree we shouldn't have to pay for a bridge to nowhere. The people in charge who decided to build that bridge would be the same people in charge of your health care. As far as the Iraq war, getting into that discussion would hijack this thread and wind up getting it closed, so I will leave it at that.

I do realize people get sick due to circumstances outside their control. I also understand that the largest killer of people in the US is heart disease. That is one very preventable illness for most people, yet we are still the most obese country in the world. We get the least amount of exercise of any country in the industrialized in the world. Those are two areas we need to address before we throw out the current system for something else.

It doesn't matter what we do with health care, it will get more expensive, period. The baby boomers are getting old and ill. The boomer doctors are retiring. So at this time we have a decreasing number of doctors at the same time as a increased demand for health care. It has no choice but to get more expensive.

 

[Khan]

One of the reasons for high costs is that people without insurance don't get basic care, then end up in the ER when really bad stuff occurs (that probably could have been kept at a low level if they had earlier health care) and the way things are set up the ER has to accept and treat them.

Then the hospital (which has said ER) has to charge more to others to not go broke.

We are already paying for the care of these people, we just don't think about it.

 

[samclem]

I can't speak for anybody else. But considering my own experience I don't think it is possible we can get any worse medicine than we have now

I had severe back pain a few years ago. The doctor prescribed a traction chair to help the back get better. Some bureaucrat at the insurance company refused to pay for it, so I could not use it. I still have back pain etc.

And you believe that a government health-care plan will do a good job of paying for medical devices? Here's a little recent story about their effective system for paying for something as simple as a wheelchair.

A friend of mine have MS. As an MS patient she needs to take a daily injection of a drug. She could not use the medication the doctor prescribed, because the insurance company refused to pay for it. Instead, she had to settle for a cheaper drug the insurance company allowed her to take. The doctor was not happy, but it was this second choice drug or nothing.

And you believe that the government health care plan will give patients access to expensive new drugs? I wonder how the VA, Medicare, and Medicaid formularies compare to private insurance formularies. I really don't know. I do know that if the government agrees to prescribe new drugs as they are developed, the cost of this program will escalate.

As they say, "If you think medical care is expensive now, just wait until it is free."

 

[lets-retire]

Khan--I understand your point. Unfortunately most people can afford to go it alone with the routine care they neglect that you describe. They just don't know any better because the media and government wonks keep telling them health care is too expensive. A routine doctor's office visit will cost less than a couple hundred dollars, but people believe it will cost hundreds or thousands of dollars more. Many of the people who can't afford health care are eligible for Medicaid or some other form of government health care, but don't apply for the programs.

The area I grew up had a hospital ran by a charitable organization. The bill was issued based on the earnings of the patient. If you made at least 30k you paid full fare, 20k you paid a small percentage, and under 15k your treatment was free. These figures are a bit old and approximate as the last time I went there was in the early 90's.

Care in the ER is more expensive, but I have seen an $8000 ER bill dropped to $2000 and routinely see $5000 ER bills dropped to below $2000. The norm for the hospital bills I see is any where from 1/4 to 1/2 of the original charge. These are charges I have seen from several hospitals in Florida, and Mississippi and one hospital so far in Alabama, but number two is coming up next month.

George--Just wondering what insurance company(ies) were involved? I have found in my case that as long as the doctor can justify why something needs to be done and it is not an experimental procedure/treatment the insurance does not have any problem paying for it.

 

[JOHNNIE36]

I can't speak for anybody else. But considering my own experience I don't think it is possible we can get any worse medicine than we have now

I had severe back pain a few years ago. The doctor prescribed a traction chair to help the back get better. Some bureaucrat at the insurance company refused to pay for it, so I could not use it. I still have back pain etc.

A friend of mine have MS. As an MS patient she needs to take a daily injection of a drug. She could not use the medication the doctor prescribed, because the insurance company refused to pay for it. Instead, she had to settle for a cheaper drug the insurance company allowed her to take. The doctor was not happy, but it was this second choice drug or nothing.

Whatever health care reform we get, I doubt it will be worse than what we have today. Furthermore, since this is an early retirement board, health care reform hopefully will also eliminate the issues with pre-existing conditions. It is tough to retire with a pre-existing condition as no insurance company will touch you.

The systems out there today works OK for us. We had Medicare and a supplemental policy with Blue Cross/Blue Shield through my former employer, GM. When we lost all our health care coverage with GM on
1-1-09 we had to search out something new. Somebody clued us in that if we kept Medicare and opted for another supplemental secondary, we could be denied because of preexisting conditions of both my wife and myself. However, if we dropped Medicare and bought a Medicare Advantage plan, there are no questions asked. That's what we did. The plan doesn't cost us anymore that our Medicare premium. Medicare still takes the premium, sends it to the Advantage plan provider and that plan covers us. Includes prescription drugs, and minimal dental and vision. It has a maximum out of pocket of $3400 each per year. So far so good.

 

[atlas888]

Democrats Weigh Health Mandate as Obama Urges Taxing Wealthy - Bloomberg.com

Where will the government get the money to pay for Universal Health Care and the massive deficits? Oh yes! Tax the rich!. The solution to everything is "Tax the Rich". But even after they take away every last dime from everyone the politicians consider rich, there will still not be enough to go around. It reminds me about the that song by Ten Years After:Tax the rich, feed the poor, until there is no rich no more. (and not there is no poor no more.)

I read somewhere that if we were to take all the world's wealth , national and personal. and divide the whole sum among every one on earth, each person will get about 2 thousand dollars one time, and that will be it.

Politicians invent more and more entitlement programs and hand out goodies after goodies to buy votes for their continuing reelections. There are now more and more takers in the society in proportion to people who are working and forced to support this game. If they hold a person up at knife-point at the ATM, it is a crime. If they use the intermediary of politicians to rob you, it is called Democracy.

If the Health Care system in the US is so bad, you will not have so many people coming to the US from Canada, Asia, South America and the Middle East to get medical care. Perhaps it is not fair because the rich will have it better. They also have better houses, better wardrobes, better cars, better schools, but mostly they work hard in life so they can pay for those advantages. There should be equality of opportunity but equality of outcome should not be society's goal. You want to be rich, work towards that. This doe not appear to be the thinking of a lot of the populace now. Class envy is more and more the norm. The productive segment of the society is not only having the pocket picked, but it is being denigrated as selfish and greedy at the same time. Punishing people through the system, when they are more successful on life than you are, is a good way for a lot of people to deal with the frustration of their own failure. I wonder how long before the "rich" will go John Galt on the system.