Healthcare reform update

[dex]

See? I told ya they were gonna kill my grandmother!

How it will end?

&

 

[Emeritus]

Or care is forgone.

Nearly 45,000 annual deaths are associated with lack of health insurance, according to a 2009 study published by the American Journal of Public Health. That figure is us considerably from the 18,000 shown in a 2002 study, which I reported on before.

The study found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.
New study finds 45,000 deaths annually linked to lack of health coverage | HarvardScience

Actually its a little more complicated. you have to include the people who die because they have health insurance who would not have died if they had stayed away from doctors.
Iatrogenic Disease: The 3rd Most Fatal Disease in the USA

 

[DblDoc]

Unnecessary or unproven high tech imaging and testing, aggressive end-of-life care for elderly or chroniically ill patients with no meaningful hope for recovery in any event; tens of millions of uninsured or underinsured who uses the hospital ER for primary care, pandemic obesity; untreated hypertension, diabetes and other diseases with effective treatment available; pharmaceutical abuses and numerous "me-too" drugs of no added value to old stand-by drugs; a 25-30% administrative cost on every dollar of services; neglected prenatal care; rampant violence in certain locations requiring massive trauma care; lack of primary care physicians who can deflect a reflex referral to subspecialists (who often a buck-stops-here approach which is costly and is sometimes avoidable with no adverse consequences.

I'm just getting warmed up, but I'll give it a rest.

I'll pick up the baton...

Advertising dollars promoting medications/treatments/my clinic is better than your clinic. Defensive medicine (the hidden cost of malpractice). Skewed compensation for procedures over prevention. The sense of entitlement of patients - I want this and I want it now!

DD

 

[obgyn65]

For those who are interested, here is the full timeline of changes thanks to the Affordable Care Act:

What?s Changing and When - Timeline: What's Changing and When | Understand the New Law | HealthCare.gov

 

[lets-retire]

That's just the opening. In California, one of the affected states, there is already a bill on the Governor's desk to require that any firm selling that lucrative individual medical insurance in the state also sell individual policies for children.

Call and raise...

What's to keep the insurance companies from selling the child policies but at say $10 or $20K per year and still complying with the law?

 

[lets-retire]

Here is a comparison online (take it with usual grain of salt) by country. Note the $ per capita difference between US & other countries with better healthcare: Healthcare Costs Around the World |

What year is that data from? I'm not really familiar with the website you posted and it is interesting that it is very different than the data presented by the WHO.




I'm going to try to stay out of the rest of this discussion, since it normally gets me a bit irritated at the distortions and outright misinformation.

 

[DallasGuy]

Yes, I was surprised how little attention the Swiss system got in this whole debate leading up to what we got. I could be 'sold' on the Swiss system, and I'm a tough 'sell'.

Makes me wonder - how did the Swiss manage to do it?

-ERD50

Switzerland only has about 8 million people. I'm guessing that it's alot easier changing something when you're dealing with a population that small (as compared to the US with over 300 million people).

 

[ERD50]

Switzerland only has about 8 million people. I'm guessing that it's a lot easier changing something when you're dealing with a population that small (as compared to the US with over 300 million people).

That probably is a big factor. It is also why I think the statements about how we pay more and get less for our HC dollar are a bit misguided (though true). It's partially due to trying to meet the 'needs' of a very large and diverse society. I'm not sure there is anything substantive to say that changing the US system to a more public one is going to change that.

-ERD50

 

[Gotadimple]

What's to keep the insurance companies from selling the child policies but at say $10 or $20K per year and still complying with the law?

Their state insurance commissioner. Any politician running for election.

-- Rita

 

[lets-retire]

Their state insurance commissioner. Any politician running for election.

-- Rita

The same pressure can be brought to bear against the state for health insurance that can be brought to bear against the states surrounding the Gulf of Mexico. The insurance companies can just as easily say, "OK, fine we just won't offer health insurance." They typically make less than 5% on health insurance anyway. It won't kill the company to not offer insurance in a state.

 

[M Paquette]

What's to keep the insurance companies from selling the child policies but at say $10 or $20K per year and still complying with the law?

Nothing. I would normally say 'competition', but that may be an alien concept to the insurers.

I suspect that rather than simply have their actuaries compute new rate tables taking the new child insurable population into consideration, which would lead to bad press for yet another rate increase, they went for the 'outrage' option, with the largest insurers opting to drop the policies and point to the PPACA as the cause.

 

[lets-retire]

Nothing. I would normally say 'competition', but that may be an alien concept to the insurers.

Competition works well for controlling prices, if the seller actually wants to sell. The insurance companies would be forced to provide a product they don't want to provide, so I don't think any amount of competition will help. It will be interesting to see how the government handles that issue.

 

[FinanceDude]

I for one am waiting to see what the Supreme Court rules in regards to the constitutionailty of the HealthCare bill........apparently there are several cases working their way up the appellate court side at this time.

 

[ziggy29]

I for one am waiting to see what the Supreme Court rules in regards to the constitutionailty of the HealthCare bill........apparently there are several cases working their way up the appellate court side at this time.

If they can rule that corporations and unions have Constitutional rights and that private property can seized by eminent domain for private redevelopment projects benefiting developers, it appears that anything goes. And I'll leave it at that lest it get political.

 

[Bestwifeever]

Health care anecdotes that prove nothing:

At a medical center last week, I overheard a superelderly woman in a wheelchair talking loudly about her angiogram and other tests. I turned to my daughter and said, "Promise me you won't let anyone do an angiogram on me if I live that long."

On the news discussion re the health care, an anchor asked if prices would go up and the reporter excitedly said yes, but you'll have so much more coverage!

Read a story in the local metro paper quoting people who said the new insurance programs will be great because pre-existing conditions will be covered, so they won't even need to get insurance until they need medical care.

Finally, my family members (see grifting thread) who don't have health insurance will never get health insurance, no matter how cheap or expensive. They just don't want to pay for it.

 

[huusom]

Let just have universal healthcare and end this controversy. I don't hear any countries that have universal healthcare talk about their healthcare problems and try to repeal their healthcare system and replace it with employer provided private insurance.

 

[dex]

Let just have universal healthcare and end this controversy. I don't hear any countries that have universal healthcare talk about their healthcare problems and try to repeal their healthcare system and replace it with employer provided private insurance.

Try google

Sentenced to death on the NHS - Telegraph

 

[ERD50]

Let just have universal healthcare and end this controversy. I don't hear any countries that have universal healthcare talk about their healthcare problems and try to repeal their healthcare system and replace it with employer provided private insurance.

Of course not - why would we want 'employer provided private insurance'? That's a big part of the mess we are in. We should get away from that, which can be done any number of ways.

-ERD50

 

[MichaelB]

Of course not - why would we want 'employer provided private insurance'? That's a big part of the mess we are in. We should get away from that, which can be done any number of ways.

-ERD50

Agree

 

[WanderALot]

I for one am waiting to see what the Supreme Court rules in regards to the constitutionailty of the HealthCare bill........apparently there are several cases working their way up the appellate court side at this time.

I keep hearing this, but how is the healthcare bill mandating the purchase of insurance different than Medicare being mandated? I can't opt out of paying for Medicare during my working-years.

The other question that I have is why is this healthcare bill keep compared with Canada/UK, instead of a more apples-to-apples comparison with the Swiss or the Dutch models?

 

[Martha]

Political positions aside, the arguments for it being unconstitutional are a major stretch and are inconsistent with precedent. The lawsuits are mostly posturing. It isn't even a good law school exam question.

Congress has the power under the Commerce Clause to require people to buy health insurance. (The Supreme Court found it was legal for the feds to bar individuals from growing marijuana for their own personal medical use under the commerce clause--that is more of a stretch). Congress also has its power to tax and spend for the general welfare. (It's not like it is a crime if you don't buy insurance, you are only taxed if you don't. Since the 1930s the SC has given Congress pretty much free reign on the taxing power. The power to tax is why social security and medicare are constitutional). No individual liberties are violated--there is no right to go uninsured.

That is the short answer, if you want a long one pay me $350 an hour.

(Edited to clarify that the issue is the requirement to buy health insurance).

 

[dex]

Political positions aside, the arguments for it being unconstitutional are a major stretch and are inconsistent with precedent. The lawsuits are mostly posturing. It isn't even a good law school exam question.

Congress has the power under the Commerce Clause. (The Supreme Court found it was legal for the feds to bar individuals from growing marijuana for their own personal medical use under the commerce clause--that is more of a stretch). Congress also has its power to tax and spend for the general welfare. (It's not like it is a crime if you don't buy insurance, you are only taxed if you don't. Since the 1930s the SC has given Congress pretty much free reign on the taxing power. The power to tax is why social security and medicare are constitutional). No individual liberties are violated--there is no right to go uninsured.

That is the short answer, if you want a long one pay me $350 an hour.

I think it is the must purchase part of the bill.


The Collegian » Panelists differ on health care legislation
The most controversial provision in the bill is the mandate requiring individuals, including students not covered by their employer or family’s plan, to purchase health insurance, which also goes into effect in 2014. Individuals must provide the Internal Revenue Service (IRS) proof of health insurance when filing their income tax, or be penalized up to $2,000 for a family of four, or 2.5 percent of your income.

 

[Martha]

I think it is the must purchase part of the bill.


The Collegian » Panelists differ on health care legislation
The most controversial provision in the bill is the mandate requiring individuals, including students not covered by their employer or family’s plan, to purchase health insurance, which also goes into effect in 2014. Individuals must provide the Internal Revenue Service (IRS) proof of health insurance when filing their income tax, or be penalized up to $2,000 for a family of four, or 2.5 percent of your income.

Yes, Dex, that is the part people are saying is unconstitutional. What I am saying is that 80+ years of precedent all the way up to recent decisions support its constitutionality. Under two separate clauses of the constitution. I'll edit my prior post to make it clearer.

 

[ERD50]

Political positions aside, the arguments for it being unconstitutional are a major stretch and are inconsistent with precedent.

...

That is the short answer, if you want a long one pay me $350 an hour.

Well, since dex isn't charging, I'll follow up with him

I think it is the must purchase part of the bill.

That's how I understood it also. I'll agree with Martha (if this is indeed what she means) that it's a rather odd distinction between saying someone must buy a product (which might be considered unconstitutional), and taxing someone and then buying that product for them. But it seems to me that much of law is about these fine and sometimes odd distinctions.

I've heard that one work-around would be to go ahead and collect it as a tax. Which would be interesting as Obama chided George Stephanopoulos for calling the mandated insurance premium a 'tax' and said George was stretching to use Webster as a reference for the definition of the word 'tax'.

Google "youtube Stephanopoulos Obama tax webster" to find the interview if you wish.

-ERD50

 

[ERD50]

Yes, Dex, that is the part people are saying is unconstitutional. What I am saying is that 80+ years of precedent all the way up to recent decisions support its constitutionality. Under two separate clauses of the constitution. I'll edit my prior post to make it clearer.

We cross-posted there, but assuming dex didn't send you money in a PM , I'll ask this:

What are those precedents? I think I agree with you in concept, but I am unaware of the Federal govt requiring everyone to purchase something (as opposed to taxing them for it). The (kinda stretched, IMO) response to the States requiring people to buy car insurance is that you don't have to drive a car. So they can't 'force' you. So I consider that a stretch, but it is a legal distinction it seems.

Your thoughts?

-ERD50