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Old 07-29-2007, 03:54 PM   #201
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One reason social security is so popular because it is not a program for the poor. There is no shame in collecting social security. There is shame in participating in a welfare program. People who feel shame at participating in a program are going to be poor lobbyists for that program and will suffer quietly when their program is cut.
Is shame a force for social good or social ill? I think it is appropriate for people to do what they can to take responsibility for themselves. They should be proud of being independent, they should dread the thought of falling into dependency, and should be ashamed when they are on the dole when it is within their power to avoid it. Obviously, life sometimes deals people a bad hand and they aren't physically/mentally able to be independent, and that's what charity (and public assistance, which is a different thing) is for.
I don't know why people who receive their medical care at my expense (through public assistance) should be entitled to the same quality of care I get if I have provided for my own medical needs (as part of the pay my employer gives me, through direct payment from my pocket, etc.) This would be like saying Section 8 housing should be as good as every other house in the community.
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Old 07-29-2007, 04:32 PM   #202
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Is shame a force for social good or social ill? I think it is appropriate for people to do what they can to take responsibility for themselves. They should be proud of being independent, they should dread the thought of falling into dependency, and should be ashamed when they are on the dole when it is within their power to avoid it. Obviously, life sometimes deals people a bad hand and they aren't physically/mentally able to be independent, and that's what charity (and public assistance, which is a different thing) is for.
Who doesn't dread dependency? I don't think shame is an especially good motivator. I think it tends to cause a lot of people to give up, to not believe in themselves. Instead, I want to see people get good educations, get enough to eat, live in a safe place and get their health taken care of so they can be productive members of society. A taste of success is the best motivator. So I support public education, I support national health care, I support student loans and grants for college. But I also support coming down hard on petty crime, neighborhood police initiatives, evictions from public housing if you are deal drugs out of your home and the like.


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I don't know why people who receive their medical care at my expense (through public assistance) should be entitled to the same quality of care I get if I have provided for my own medical needs (as part of the pay my employer gives me, through direct payment from my pocket, etc.) This would be like saying Section 8 housing should be as good as every other house in the community.
Apples and oranges. Section 8 housing doesn't need to be fancy. But it still needs to be safe. That is why we have housing regulations. "Fancy" healthcare is cosmetic surgery. Everyone pays that out of pocket. Otherwise, second tier healthcare is what? Where the providers are overworked and underpaid, where getting treatment is hit or miss? What good is that? Healthy people are productive people. Also, my values say that we are a rich enough country to provide necessary health care for everyone and that is the right thing to do.
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Old 07-29-2007, 05:28 PM   #203
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Old 07-29-2007, 05:40 PM   #204
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"Fancy" healthcare is cosmetic surgery. Everyone pays that out of pocket. Otherwise, second tier healthcare is what? Where the providers are overworked and underpaid, where getting treatment is hit or miss?
I would see the public safety net health care as being no frills, and the private system as providing whatever the patient is willing to pay for (directly, or through payment by his/her insurer, which the patient obviously pays for indirectly). In the public safety net care you would expect to see:
-- Wards with 4-6 patients per room. This was the standard in years past, it's not clear why patients today have a greater requirement for privacy than our grandparents did. This is common in military health care, does not seem to adversely affect treatment.
-- Physicians/providers who are government employees, or directly contracted by the government at a fixed wage. (Reduced incentive for unnecessary procedures. This is also common in military health care, does not appear to adversely affect treatment). This step alone would likely cut costs a lot.
-- Treatment of some types is not available. This would include :
---Cosmetic surgery (restorative, post traumatic injury treament would be covered).
--- Fertility treatment
--- There would be age-based and expected-outcome-based limits on expensive care. A 90+ year old would not get $250,000 of cutting-edge inpatient oncology treatment at taxpayer expense. A 30 year old in good health otherwise might get this care. In a ward.

--- The 9+ month wait for knee replacements experienced in other countries? Our safety-net care might have similar waits.

- The government-supplied would include mandatory vaccinations and healthy-living counseling. It might also include mandatory drug testing (I realize this is controversial. But, drug use definitely is a risk factor for all kinds of medical conditions, and if taxpayers are footing the bill, then it is not unreasonable to ask some questions that are directly pertinent. It's only mandatory if you want somebody else to pay for your care.)

To say we are a "rich nation" and that we should provide certain things for everyone blurs a couple of points that are significant, I think.
-- The individuals in our nation are prosperous. The government is broke. To provide these benefits requires taking something from individuals against their will.
-- Our people are prosperous because our system is designed to reward initiative and hard work. Other systems have been tried, they do not result in prosperity. To the degree that our system continues to allow individuals to prosper from their efforts, we'll continue to prosper as a nation. To the degree we disincentivize hard work (e.g. through increased taxes) and provide the same services to everyone (e.g. health care that is the same, by law, no matter how productive you have been), we should expect our prosperity as a people to decline.
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Old 07-29-2007, 05:45 PM   #205
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Martha for president...

Seriously, all of the thoughtful, smart, caring people i know wouldn't run for office because of the smarmy factor and nature of politics in today's world...so the slimy, smarms continue to run the show...
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Old 07-29-2007, 10:51 PM   #206
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Otherwise, second tier healthcare is what?
Maybe Dr. Nick from the Simpsons Dr. Nick Riviera - Wikipedia, the free encyclopedia
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Old 07-29-2007, 10:51 PM   #207
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Otherwise, second tier healthcare is what? Where the providers are overworked and underpaid, where getting treatment is hit or miss? What good is that?
IMO, in a single-payor system where the gov't is the single payor, healthcare, in general, would be a system where providers are overworked and underpaid! That's just my belief....and if they aren't overworked, then there isn't enough supply to take care of everyone in a timely manner.

I really am curious as to why you would think the second tier in a two-tiered system would be any different than the first tier in a single-payor, one-tiered, system
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Old 07-29-2007, 10:58 PM   #208
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Are you aware that for 40 years, the United States has had a universal single-payer healthcare system that allows every participant to choose their own doctor, its administrative cost is one-tenth the cost of private insurance and people do everything possible to get into the system (i.e., live to 65). It is Medicare, and no one calls it socialized medicine.

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Old 07-29-2007, 11:58 PM   #209
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Or maybe Dr Dogg! Rex the Runt - Wikipedia, the free encyclopedia
- "How much will that cost?"
- "Ten quid"
(everything is ten quid.)
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Old 07-30-2007, 08:06 AM   #210
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Are you aware that for 40 years, the United States has had a universal single-payer healthcare system that allows every participant to choose their own doctor, its administrative cost is one-tenth the cost of private insurance and people do everything possible to get into the system (i.e., live to 65). It is Medicare, and no one calls it socialized medicine.

Peace
It is a wonderful system and needed, no doubt! Unfortunately, it pays doctors only about 25 cents for every dollar billed. We haven't started experiencing shortages of doctors yet, because doctors have had the private market to fall back on for lost profits. No doctor would be able to afford to keep their doors open on a "Medicare only" salary. Martha suggests eliminating private or "first tier" coverage. Where will doctors go for lost income when that option goes away?
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Old 07-30-2007, 10:07 AM   #211
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It is a wonderful system and needed, no doubt! Unfortunately, it pays doctors only about 25 cents for every dollar billed. We haven't started experiencing shortages of doctors yet, because doctors have had the private market to fall back on for lost profits. No doctor would be able to afford to keep their doors open on a "Medicare only" salary. Martha suggests eliminating private or "first tier" coverage. Where will doctors go for lost income when that option goes away?
LOL - MKLD you crack me up!! You are concerned that doctors will not making enough money via Medicare but you don't seem to have a problem paying "negotiated rates" via insurance companies?? What is the difference?

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Old 07-30-2007, 10:48 AM   #212
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LOL - MKLD you crack me up!! You are concerned that doctors will not making enough money via Medicare but you don't seem to have a problem paying "negotiated rates" via insurance companies?? What is the difference?

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Negotiated rates paid via insurance companies are 2-3 times higher than what doctors make from Medicare.
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A math lesson
Old 07-30-2007, 11:09 AM   #213
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Negotiated rates paid via insurance companies are 2-3 times higher than what doctors make from Medicare.
The rate is dictated by the government so let's say the hospital needs $180 to pay for a procedure. They get paid the medicare rate ($80) plus 20% of the difference between it and their "regular" rate. So to get properly reimbursed, they set their regular rate at 80+ 5x100=580

So it is the $580 where insurance plans start negotiating, even though the actual cost is $180! And people with no coverage pay the $580.

And for those who have an employer pay for their insurance, the premiums are significantly higher than they need to be. Same for the individually-paid plans.
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Old 07-30-2007, 11:23 AM   #214
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Negotiated rates paid via insurance companies are 2-3 times higher than what doctors make from Medicare.
Ahh, so it's ok for the doctors to make less if it's because of what you negotiated but not if it's because of what someone else negotiated.

Brillant!
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Old 07-30-2007, 11:33 AM   #215
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Old 07-30-2007, 11:43 AM   #216
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In an effort to provide a little more cowbell, I've uploaded a picture of my dog as my avatar.
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Old 07-30-2007, 11:49 AM   #217
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The rate is dictated by the government so let's say the hospital needs $180 to pay for a procedure. They get paid the medicare rate ($80) plus 20% of the difference between it and their "regular" rate. So to get properly reimbursed, they set their regular rate at 80+ 5x100=580

So it is the $580 where insurance plans start negotiating, even though the actual cost is $180! And people with no coverage pay the $580.

And for those who have an employer pay for their insurance, the premiums are significantly higher than they need to be. Same for the individually-paid plans.
I'm not sure I completely understand your example. Insurance companies payout approx 85-95% of their income in claims, and they make profits of approx 3-5%. This is based on information I received from my husband, who has been in the industry longer than I and spends a lot of time on the financials side of things. He said he could get me some documentation later...When he gets it to me, I'll post it. The way I understand it is that Dr.s and hospitals get approx 25% of every dollar billed from the social programs, and they get about 2-3 times that much from private insurance. Private insurance rates are inflated because doctors and hospitals won't negotiate lower than what they need to remain in business. The income that doctors and hospitals don't retrieve from the social programs and the uninsured is shifted over to private payers in the form of higher premiums.

Rich - are you out there? I know you can't stand private insurance, but can you explain in better words than I, some of the actual $$ figures (or percentages) doctors and hospitals are reimbursed by Medicare & Medicaid vs. private insurance?...
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Old 07-30-2007, 12:04 PM   #218
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Old 07-30-2007, 12:15 PM   #219
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Insurance companies payout approx 85-95% of their income in claims, and they make profits of approx 3-5%. This is based on information I received from my husband, who has been in the industry longer than I and spends a lot of time on the financials side of things. He said he could get me some documentation later...When he gets it to me, I'll post it.
I would like to see this information. What I have read is that insurance companies vary widely on the amount of their premium income they return in claims. Maybe the high end is 85% and the low end around 60%, with a number falling around 80%. IIRC, Arnold's California proposal would limit overhead and profits to 15%.

Keep in mind that not only do we have insurance company admin costs and profits, we have administrative costs incurred by medical providers who have to deal with many different insurers with their differing rules. End result is that 30% of our health care dollar goes to administration.
NEJM -- Costs of Health Care Administration in the United States and Canada
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Old 07-30-2007, 12:18 PM   #220
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I would like to see this information.
So would MKLD.

The insurance industry will make over sixty billion dollars profit this year.
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