Health Care Bill It's about Fire and Money

[ziggy29]

Quote:

Originally Posted by youbet Hopefully under our new govt plan, private supplementals (for the rich and priviliged who can afford them) will NOT be allowed.

Why do you say "hopefully"? Do you believe that people shouldn't be allowed to spend money on legal products as they see fit?

Or is the fear that if these "supplementals" are allowed, many doctors and hospitals won't take the lower government reimbursement rates and thus undermine the reforms because there isn't enough supply for those on the government plan?

Trying to understand here. Ideologically I'll admit that it would take a LOT for me to agree that people shouldn't be able to spend their money as they choose, but I'd entertain positions to the contrary with an open mind.

[youbet]

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Originally Posted by Martha Socialism is owning the means of production. .

You've said this in more than one thread now and I'd like to challenge because you're misleading by leaving out the concept of equal ownership. Citizens already substantially own the means of production in our country, but some own much more than others. In socialism, we'd share ownership equally, with political leadership/operatives having control.

In Canadian healthcare, my perception is that all Canadians "own" the health care system equally. The govt controls it.

It's certainly socialism in that sense. If you feel the USA system is laissez-faire capitalism gone amuck, then a "socialized" healthcare system (owned equally by all the citizens and controlled by the govt) would be an improvement in your view.

My own opinion is that folks in the USA with good insurance and substantial assets to fill in any holes that insurance leaves open have a better health care system than Canadians. Conversely, folks who (through their own negligence or because of the nature of the USA system) have only USA safety nets for health care coverage would benefit by being under a Canadian-like system.

It's a toss-up at our house. DW and I will likely see a degradation in health care coverage (higher cost and/or less access to or choices of services) under the latest proposals. My adult son, however, has health issues and his son has cerebral palsy. So DW and I are pulling for a plan that 100% lifts the burden of paying for their healthcare from their shoulders and onto the broader shoulders of the general public. DW and I could take a couple of fancy international vacations per year with the money we now spend making sure son and grandson get the necessary care (beyond what their private insurance will cover) and we look forward to spending that money on ourselves in retirement by sharing the cost with all our fellow citizens.

I think the outcome of "healthcare reform" will vary household to household with winners and losers. And, as stated, in our extended family, it's going to be a wash.

[youbet]

Quote:

Originally Posted by ziggy29 Why do you say "hopefully"? Do you believe that people shouldn't be allowed to spend money on legal products as they see fit? Or is the fear that if these "supplementals" are allowed, many doctors and hospitals won't take the lower government reimbursement rates and thus undermine the reforms because there isn't enough supply for those on the government plan?

I was primarily thinking of the Canadian system which does not allow private supplemental insurance. (If I misunderstand that, please correct.)

Your point that supplementals, with probably higher payment rates, will draw resources away from citizens with only the govt plan is a good one. Yep, just as many doc's no longer take Medicare patients today, I suppose many won't take "govt" insured patients in the future if middle and upperclass folks have supplemental policies that pay providers at a higher level.

In any case, I think you can be assured that under the current administration and Congress, any two-tier systems that allows one class of citizens to receive care beyond what another class receives will not exist for long.

[M Paquette]

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Originally Posted by youbet I was primarily thinking of the Canadian system which does not allow private supplemental insurance. (If I misunderstand that, please correct.)

Supplemental coverage is routinely used in Canada to cover gaps in what the various provincial programs cover. About 2/3 of canadians have supplemental coverage for things like dental work, eye care, prescription drugs, and private hospital rooms.

Canada's biggest healthcare problem is a shortage of medical people. There was a concern years ago about a possible glut of doctors, and medical school admissions were restricted. Oops. There are a bunch of interesting statistical details below it, including interesting shifts in the age and gender makeup of the physician workforce, but ultimately the provincial governments messed up in regard to medical school funding and class size estimates. (Canada had a bit of an export problem with it's doctor population starting shortly after the Canada Health Act was passed, for some reason. Oops again. It wasn't the idea of the Act, but some of the ham-handed details and implementation.)

[youbet]

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Originally Posted by M Paquette Supplemental coverage is routinely used in Canada to cover gaps in what the various provincial programs cover. About 2/3 of canadians have supplemental coverage for things like dental work, eye care, prescription drugs, and private hospital rooms.

Thanks. Somehow I got the impression that Canadian healthcare coverage was provided exclusively by their national healthcare plan and individual citizens did not/could not purchase supplemental policies. Although, the coverage areas you mention aren't what I was thinking of. I meant supplemental policies that would pay for doctor or hospital charges above what the national coverage pays for or for tests or treatments not allowed by the national plan.

Kind of makes me wonder if the future USA national plan will cover dental, eye care, prescription drugs and that sort of thing........

[samclem]

Quote:

Originally Posted by M Paquette Canada's biggest healthcare problem is a shortage of medical people. There was a concern years ago about a possible glut of doctors, and medical school admissions were restricted. Oops. There are a bunch of interesting statistical details below it, including interesting shifts in the age and gender makeup of the physician workforce, but ultimately the provincial governments messed up in regard to medical school funding and class size estimates. (Canada had a bit of an export problem with it's doctor population starting shortly after the Canada Health Act was passed, for some reason. Oops again. It wasn't the idea of the Act, but some of the ham-handed details and implementation.)

I'm amazed that these central planners can't get it right--forecasting just how many doctors will be needed, etc. Who could have guessed that low reimbursement rates would lead to a shortage of people wanting to do that particular type of work in that particular place.
Once the planners start calling the shots (number of medical school slots, hourly rate of pay, appropriate workload, etc) instead of the free market, the market will be the enemy forever. Whole societies have tried the command economy approach, and it never ends well. But maybe this time everything will turn out different somehow. . because we have hope, because we want change (don't sweat the details, there's no time to read the legislation)-- and everyone wants to do the right thing.

[haha]

Here is a passionate but apparently sane argument about health care.

Diabetes Update: Who Is Really Getting Euthanized

[eridanus]

Quote:

Originally Posted by samclem I'm amazed that these central planners can't get it right--forecasting just how many doctors will be needed, etc.

Correct. The AMA does the same in the US and look at what's happened -- adequate results but for TWICE the money of other industrialized countries...including Canada.

The study mentioned in this article supports what other studies have found:

Health care's six money-wasting problems - Aug. 10, 2009


One of the biggest drains is when doctors overtest to make more money (and malpractice isn't a concern, at least in Texas, where the Brownsville v. Mayo analysis was done).

Another drain is the middleman and their squeeze on profits.

[modhatter]

Good article HaHa

In reading the blogs below it, once again I see someone make the statement "Have you read the 1118 page bill? If so you would see just how bad it is." (words to this effect anyway) Now, I have heard people say this before who are against health care reform, and I must admit I am skeptical that very many private citizens have read it. I don't imagine that it makes for a good book to curl up with. Perhaps I am wrong, but I don't think so. Can anyone on this board tell me they actually read it?

Here is link to HR bill: Health Care Bill Page 425 - The Truth

What I find most facinating is that the propaganda generated around the "End of Life Counceling" proposed to be available to all seniors every 5 years, was turned in to "would push people to undergo euthanasia".

The pages are marked, the actual wording of the bill is there in plain site for everyone to read, and there is a pole at the end asking individuals who have read the above pages from the bill if they still feel it's meaning is to push people to undergo euthanasia?

Still 34% answered Yes, I absolutely feel it's true.
15% answered Yes, I think it could be true.

Now what do you do with people who you show a picture of a horse to and keep insisting it is dog? This is the type of irrationallity I have a hard time dealing with. If you want to make an argument for or against, make it with facts, not with made up reterick that can not be substantiated.
I respect everyone has a right to their opinion and I applaud our right to freedom of speech. I just wish we could have arguments based on facts not on sillly made up interpretations. Tell me again, this is not politicallly drivern.

[MichaelB]

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Originally Posted by modhatter Now what do you do with people who you show a picture of a horse to and keep insisting it is dog? This is the type of irrationallity I have a hard time dealing with. If you want to make an argument for or against, make it with facts, not with made up reterick that can not be substantiated. I respect everyone has a right to their opinion and I applaud our right to freedom of speech. I just wish we could have arguments based on facts not on sillly made up interpretations. Tell me again, this is not politicallly drivern.

It's possible that the poll outcome you mention is not the result of irrationality but instead reflects a mistrust of politicians and government.

A very dear friend - a well educated Brit - once remarked (after consuming copious amounts of distilled beverages) that the big mistake the English made, when at the peak of their empire, was not understanding that other people as rational as them could see things so differently. He then expressed hope that us "yanks" would not suffer from the same lack of vision, else our empire should follow the same course. I didn't express much hope then and have even less now.

[youbet]

Nicely put MichaelB.

It does indeed seem that the truly irrational are those who can't see that rational people can see things very differently.

[youbet]

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Originally Posted by eridanus Correct. The AMA does the same in the US and look at what's happened .

Yes, it does seem that associations and unions have a similar effect on resource allocation efficiency as govt's. It does seem like the cost of funding medical schools and their students would be small compared to having a doctor/nurse/technician shortage. An abundant supply of highly competent and qualified medical professionals would allow market equilibrium pricing to occur as opposed to the inflated salaries that result when supply is artifically constrained by associations or govt's.

[haha]

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Originally Posted by youbet Yes, it does seem that associations and unions have a similar effect on resource allocation efficiency as govt's. It does seem like the cost of funding medical schools and their students would be small compared to having a doctor/nurse/technician shortage.

The AMA has worked for at least 50 years to keep down the supply of doctors. Medical education is very good in some ways, wasteful in others. The success of PAs and Nurse practitioners shows that much of the preclinical medical course is essentially lost on primary care oriented students. Even very scientifically motivated students who are likely a minority anyway usually can't really understand the science unless they arrived at school already knowing much of it, and they take time off for PhD study etc. It goes too rapidly, and most of the students have their minds on being sure they can handle the clinic.

The AMA is less powerful today, but there are other groups with similar agendas. However, it should be rememberd that in a managed, non-competitive market like the market for medical services, more practitioners may actually wind up costing more money rather than less, as more Docs are out there ordering tests etc. to be sure they can meet their financial obligations and Mercedes payments.

Ha

[youbet]

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Originally Posted by haha However, it should be rememberd that in a managed, non-competitive market like the market for medical services, more practitioners may actually wind up costing more money rather than less, as more Docs are out there ordering tests etc. to be sure they can meet their financial obligations and Mercedes payments.

An interesting view on that Ha!

I disagree, but I see where you're coming from. I'd tend to think that a lower patient per doc ratio would eventually result in the docs having time to analyze the patients situation more thoroughly and fine tune the tests being ordered instead of calling for "test battery #256." But I'm no medical field expert, so your view could certainly be correct!

[MichaelB]

An increase in dentists hasn't resulted in declining prices. On the contrary, like HaHa suggested, it seems they are actually costing more - as if to make up for declining patient rolls.

Note - I think this exists with both physicians and dentists, but is not across the profession. Much more individual and with some specializations.

[modhatter]

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Originally Posted by MichaelB It's possible that the poll outcome you mention is not the result of irrationality but instead reflects a mistrust of politicians and government.

Well, that's my point. I think a lot of the negative response is from people who are unhappy with Obama's performance on the economy, the bailouts, stimulouss package, mounting deficit, whatever. All very scary things, and no one knows for sure, if it was the right or wrong decision. Yes, I know about the buddy system and the ties between Wall Street and Congress. There are a lot of crooked politicians in office not acting in our best interest. But there are also good ones who are.

However bail outs (the economy issues) is not the same as Health Care Reform. No party, whether Democrtic or Republican has no good ideas.
Sometimes they get it right and sometimes they don't.

So when I talk about being irrational, I am talking about people who deliberately distort the facts. If you read the pages on the matter of "End of life Counceling", there is nothing proposed that remotely suggests euthanasia. It is about filling out forms and taking care of end of life decisions, which everyone should be doing anyway. So when people say this is euthanasia, and use this as an argument against the bill, I say their statements are irrational. (assuming they can read)

I am not stating that people who don't agree with my way of thinking are irrational. I am saying that some of the statements I have heard "opposer's" use in their argument is irrational and unfounded.

Actually, I am very interested in hearing why people are opposed to it. I just would like to hear some real facts, or peoples fears whatever they may be. I am fundamentally in favor of reform, but I am open to hearing peoples concerns. I always like to keep an open mind to both sides. I might learn something that way.

[crazy connie]

One thing that really impresses me are numbers.

U.S. National Debt Clock : Real Time

[M Paquette]

Quote:

Originally Posted by modhatter So when I talk about being irrational, I am talking about people who deliberately distort the facts. If you read the pages on the matter of "End of life Counceling", there is nothing proposed that remotely suggests euthanasia. It is about filling out forms and taking care of end of life decisions, which everyone should be doing anyway. So when people say this is euthanasia, and use this as an argument against the bill, I say their statements are irrational. (assuming they can read)

Even better, this counseling is already part of the Medicare services. Starting this year (2009) during the 'Welcome to Medicare" physical exam within the first 12 months on Part B, besides the usual screenings, the doctor should talk with the patient about end-of-life planning, including advance directives.

The provision in the House bill from Rep. Earl Blumenauer, D-Ore. adds funding to repeat the end of life planning every five years. The largest cost will be for the short chat in the doctor's office, and the printing cost of additional brochures discussing advance directives.

In my current HMO a nurse does this discussion with every patient in pre-op, and every patient over 50 seeing a doctor. It must last all of a whole minute. Nobody's offered to send me off to watch the nature film in the little room above the Soylent Green factory yet.

[ERD50]

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Originally Posted by modhatter So when I talk about being irrational, I am talking about people who deliberately distort the facts.

I agree with you. This HC issue is especially emotional and potentially extremely far-reaching, so the fervor level is high. And there are groups (on both sides of most issues) that set out to deliberately (or ignorantly/innocently) distort the facts. That's an ugly side of a democracy. But try to control it and you will face cries of "free speech!".

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However bail outs (the economy issues) is not the same as Health Care Reform.

They are not the same, but they have similarities. And since we can see how the C4C bill went, it can be used for some insight. Not exactly apples-to-apples, but it should not be ignored.

1) Big bills.

2) (Attempted) Rushed through.

3) No thorough analysis, or even fully read.

4) No measure of success, so how do we evaluate it?

So when C4C threatens to run out of money 20x faster than expected, I think it is reasonable for people to think that Congress didn't do their homework. That scares me on all the bills in front of them.

Quote:

No party, whether Democrtic or Republican has no good ideas. Sometimes they get it right and sometimes they don't.

OK, I'm an independent, no tie to either party. I am having trouble remembering the last time Congress passed a good bill. Maybe this should be a separate thread, but I can't think of one.

The "Do Not Call List" came close - that was wildly supported by the public. But Congress played politics with it and exempted themselves. What better way to tell us that they are "above the law", than by making lawmakers exempt from a law?

-ERD50

[ziggy29]

Quote:

Originally Posted by modhatter So when I talk about being irrational, I am talking about people who deliberately distort the facts. If you read the pages on the matter of "End of life Counceling", there is nothing proposed that remotely suggests euthanasia. It is about filling out forms and taking care of end of life decisions, which everyone should be doing anyway. So when people say this is euthanasia, and use this as an argument against the bill, I say their statements are irrational. (assuming they can read)

This is all fine and good if the sick and dying person already has an advanced directive of their own. When my dad had terminal cancer he had an advanced directive that indicated DNR and no heroic measures to prolong life -- just medications to make him more comfortable. That's fine and good when it's patient-driven.

The problem is, in the absence of such directives, someone other than the patient has to make these decisions, and if the government is involved in the decision there will be a vested financial interest in choosing to let the patient die -- not just in terms of saving health care costs but other things as well -- Social Security, public pensions, et cetera. I'm not saying it's a bad thing to forego "heroic" measures with relatively low chances of a positive outcome, but to me it's a little scary to think the government has a vested interest in letting you die.