Healthcare reform update

[Martha]

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Originally Posted by NW Landlady One of the major differences between the US & other countries is the Tort Liability System. Much of the cost of Healthcare is the cost of Malpractice & liability insurance built into it. We are talking really large sums of money here. Many doctors & facilities cannot afford it or build it into the cost of medical services. The new HC Bill does very little to reduce the cost of medical services, (there is a small sure-to-fail-pittance given to the states for Tort Reform which is doomed IMO given the funds/strength of the BAR & such). Drugs & medical devices are expensive in the US for the same reason. The US is flooded with ambulance chasing attorneys encourage potential litigants to sue for "bad" drugs, etc.

Before you blow a gasket at the evils of the BAR, step back and look at the data. Here is a study which shows that about 2.4% of our healthcare costs is due to malpractice related items: National Costs Of The Medical Liability System -- Mello et al. 29 (9): 1569 -- Health Affairs. Most is defensive medicine and that may not disappear if malpractice is dealt with differently.

There are states, like Wisconsin, where malpractice insurance costs are low in part due to caps and due to a compensation fund. Health care still costs a lot in Wisconsin.

(I find it interesting that we want to cap malpractice for doctors and we have short statutes of limitations for the claims. But legal malpractice claims get no caps and long statutes of limitation for malpractice. I guess we like the medical profession and not the legal? )

[RonBoyd]

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Originally Posted by Emeritus I'm not sure if Americans are not just mentally defective or simply so stupid and greedy that they cannot figure it out

Are you thinking of the Metric System proposal?

[MichaelB]

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Originally Posted by ERD50 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

They don't get sick as often. When they do, more of the care is provided by the family doctor.

[ziggy29]

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Originally Posted by M Paquette Tort reform would be a good thing, but it's not going to have a significant impact on the costs of health care on it's own.

I think there are a lot of things which make relatively minor differences on their own, but collectively make a big difference. The problem is that half of these things are opposed by one side of the public policy debate, and the other half of these things are opposed by the other side.

And since the tendency is for neither side to give the other what they want (that would be defeat -- or worse, compromise) -- we get little of the things that will really matter in terms of cost control.

[teejayevans]

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Originally Posted by FinanceDude If unemployment was not almost 10%, that number would drop...........not many folks in America who are unemployed can afford insurance........

The meat of this bill doesn't take affect until 2014, in the what have you done for me lately, this bill is a total bust.
TJ

[NW Landlady]

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Originally Posted by Martha Before you blow a gasket at the evils of the BAR, step back and look at the data. Here is a study which shows that about 2.4% of our healthcare costs is due to malpractice related items: National Costs Of The Medical Liability System -- Mello et al. 29 (9): 1569 -- Health Affairs. Most is defensive medicine and that may not disappear if malpractice is dealt with differently. There are states, like Wisconsin, where malpractice insurance costs are low in part due to caps and due to a compensation fund. Health care still costs a lot in Wisconsin. (I find it interesting that we want to cap malpractice for doctors and we have short statutes of limitations for the claims. But legal malpractice claims get no caps and long statutes of limitation for malpractice. I guess we like the medical profession and not the legal? )

Your link does not say more than a paragraph & a statement, not criticizing, just curious as to what the other 97.6% of the costs are attributed to. Does anyone know?

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 |

[Rich_by_the_Bay]

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Originally Posted by NW Landlady just curious as to what the other 97.6% of the costs are attributed to. Does anyone know?

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.

[REWahoo]

I think someone struck a nerve... but that's only a non-medical opinion.

[M Paquette]

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Originally Posted by teejayevans The meat of this bill doesn't take affect until 2014, in the what have you done for me lately, this bill is a total bust. TJ

The Swiss system didn't go fully into effect until five years after the bill was passed. They had to go through a similar series of transitions. Some of the changes were significantly larger, such as the basic care insurance being forced to become organized as a non-profit. (Optional care packages and various add-ons continue to operate as for-profit insurance sales.)

When Switzerland relied on U.S.-style for-profit health insurance, many people were denied coverage altogether. Many others had to fight constant battles with insurers to get their bills paid. In the new Swiss system, essentially everybody has insurance, and the companies are not allowed to deny a claim. (In fact, they generally pay all claims within five days.) The Swiss people are happier with this system than with what they had before.

The trick in the US will be to somehow force failure early in the transition process, before benefits of any changes are seen by most folks, so as to convince the populace that 'change is bad.' Toward that end, we have actions such as several large insurers are taking today. If we allow the US transition to proceed to the point where people see the benefits, and the fringe fears (death panels, soylent green, etc) fail to be realized, then it will be much more difficult to undo the changes.

[travelover]

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Originally Posted by Rich_in_Tampa ....... aggressive end-of-life care for elderly or chronically ill patients with no meaningful hope for recovery in any event; .............

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

[dex]

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Originally Posted by travelover See? I told ya they were gonna kill my grandmother!

How it will end?

http://www.youtube.com/watch?v=4WUUnc1M0TA

&

http://www.youtube.com/watch?v=SVpN312hYgU

[Emeritus]

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Originally Posted by Martha 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]

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Originally Posted by Rich_in_Tampa 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]

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Originally Posted by M Paquette 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]

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Originally Posted by NW Landlady 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]

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Originally Posted by ERD50 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]

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Originally Posted by DallasGuy 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]

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Originally Posted by lets-retire 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]

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Originally Posted by Gotadimple 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.