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Old 01-30-2011, 10:27 AM   #41
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And that is the 800 pound gorilla in the room which, if addressed, would make all the other related issues much easier to fix.

No "reform" will make the system sustainable, accessible and somewhat affordable if health care costs keep rising 3-4 times the rate of inflation and wage growth.
Yep. And putting more money into any system is unlikely to result in lower prices.
Some reforms of the (various) health care delivery mechanisms would, in themselves, lower prices. No one talks about needing some sort of big special mechanism to lower food prices, or to mandate lower costs for houses, or to lower life insurance rates.
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Old 01-30-2011, 10:34 AM   #42
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I have this sneaking suspicion that any attempt at changes oriented toward cost containment will immediately result in shrieks of "Rationing!", "They wanna kill Grandma!", "Socialism!", and the other usual noises.

Gosh, sometimes this looks like there is a Grass Roots Movement (TM) to protect the profits of the medical industry. I'm sure that would never ever happen, though, in such a pure free market economy as health care operates within.

I don't know how to fix it, so here's a bunny with a pancake on its head:
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Old 01-30-2011, 12:58 PM   #43
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No one talks about needing some sort of big special mechanism to lower food prices, or to mandate lower costs for houses, or to lower life insurance rates.
But then no one is prevented from buying any of those things because of pre-existing conditions.

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Old 01-30-2011, 01:04 PM   #44
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I have this sneaking suspicion that any attempt at changes oriented toward cost containment will immediately result in shrieks of "Rationing!", "They wanna kill Grandma!", "Socialism!", and the other usual noises.
No need to be suspicious, sneaking or otherwise, because that is already part of the historic record.

The people who generally complain about lack of cost containment ex-post are the very same people who were screaming complaining about cost containment efforts ex-ante. Jeeze, it was only three months ago that one of our grand political parties was running non-stop campaign commercials accusing the other side of passing health reform legislation that cut Medicare spending.

Disingenuous? You betcha!

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I don't know how to fix it, so here's a bunny with a pancake on its head:
One of the ways things might get "fixed" is if folks like GOP Presidential Candidate Mitt Romney would come forward and support the health care legislation that he signed into law as governor, or if any Republican would step forward and support the health care legislation that they put forward as an alternative to "Hillarycare" in 1993. Because that is basically the law of the land now.

Congratulations, it may have taken 17 years, but the GOP finally got their health reform passed. You'd think they'd be more pleased.
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Old 01-30-2011, 02:54 PM   #45
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One of the ways things might get "fixed" is if folks like GOP Presidential Candidate Mitt Romney would come forward and support the health care legislation that he signed into law as governor, or if any Republican would step forward and support the health care legislation that they put forward as an alternative to "Hillarycare" in 1993. Because that is basically the law of the land now.

Congratulations, it may have taken 17 years, but the GOP finally got their health reform passed. You'd think they'd be more pleased.
There were just 19 Republican senators who co-sponsored that bill (less than half of the GOP senators), it was hardly a unified GOP position. And, it stunk, badly (akin to the recently passed legislation). Employment linked to health care--dumb. I guess we'll be stuck with that as long as people believe they are getting their health care "for free". In 2008 one of the presidential candidates proposed breaking that link, but the other candidate used the issue effectively to bludgeon him in the campaign. At least the 1993 bill had tort/malpractice reforms stronger than the current plan.

And, would you like some quotes from leading Democrats concerning what they thought of that 1993 bill? To turn your question around: If that 1993 proposal was nearly the same as the one just passed, why didn't Democrats vote for it then, once the wheels came off "Hillarycare"? They were in the majority in both the House and Senate, and with some Republicans going along, they could easily have passed this law. Really, I hope you'll agree there's plenty of hypocrisy and "plasticity of position" on both sides. If not, how did a very similar proposal go from "unacceptable" to "a great achievement"?

In retrospect, how much better if they'd passed that mess back then. We could have been well on our way to health care nirvana 17 years ago! We'd have seen exactly where the train was going, suffered the government cost escalation and the inevitable waiting lists, and maybe reformed the thing into a market-based system by now. Instead, we have to suffer all that with an economy that is on its back.

One of the "benefits" of the present plan is the likely severance of the link between employment and health care. As the costs of the mandated care escalates, and if nothing changes, employers will eagerly pay the fines and turn their employees over to the exchanges to purchase their own policies. Once that process is complete, we'll have established a good foundation for an insurance marketplace without the unneeded and expensive "other participant" in the game. There are strong indications that the "divorce" is already underway. The number of waivers being requested and a quick look at the relative costs to companies/unions/public entities from both courses of action make it clear how things are going to turn out.
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Old 01-30-2011, 04:43 PM   #46
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And, would you like some quotes from leading Democrats concerning what they thought of that 1993 bill? To turn your question around: If that 1993 proposal was nearly the same as the one just passed, why didn't Democrats vote for it then, once the wheels came off "Hillarycare"? They were in the majority in both the House and Senate, and with some Republicans going along, they could easily have passed this law. Really, I hope you'll agree there's plenty of hypocrisy and "plasticity of position" on both sides. If not, how did a very similar proposal go from "unacceptable" to "a great achievement"?
Ooooh! Ooooh! Ooooh! I know! I know!

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Old 01-30-2011, 05:45 PM   #47
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I don't know how to fix it, so here's a bunny with a pancake on its head:
If pets had health coverage, you can bet that poor Lepus with the pancake appendage would have been through two MRIs and a Kitty scan by now.
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Old 01-30-2011, 06:24 PM   #48
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Health care subsidies may become very important to folks who will be relying on Medicare soon.

Under a proposed new Medicare plan, persons currently 54 and under would receive a fixed payment voucher at age 65 to purchase individual medical insurance in the private market. The exact amount of the voucher would depend on total current Medicare spending, and would be indexed to adjust to cost of living changes.

The Medicare payment is projected to be on average $11,000, with a possible positive adjustment based on a risk assessment from the chosen health plan. Means testing is applied, with beneficiaries with incomes over 80,000 to 200,000 receiving 50% of the standard payment, and beneficiaries with incomes over 200,000 receiving 30%.

For persons under age 55 the Medicare eligibility age will be gradually raised from the current 65 years to 69 years and 6 months.

A fail safe test is applied to government funding, such that if the percentage of funding from general revenues exceeded 45% in the prior fiscal year, then on 1 July (or 2 months after the Medicare Trustees Report on funding is released) there will be an automatic 1% reduction in payments for services provided in the Medicare fee-for-service sector, the continuation of the current plan for those currently 55 and older.

Exercise: Go forth and price non-Medicare individual insurance policies for persons 65 and older. Next, figure in an additional 10 years of medical inflation. What is the possibility that the only cat scan you'll get is from Fluffy, when you're eating her Friskies?
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Old 01-30-2011, 08:23 PM   #49
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Under a proposed new Medicare plan . . .
Wait, no scary music?

Anyway, here's a link to what Medicare's actuary said about the Ryan Roadmap plan for Medicare, and what Congressman Ryan said.

Ryan talks gooder than I write, so his words:

Quote:
“There’s only going to be so much money for health care because the economy can only support so much … So is it better spent through the person in a competitive marketplace or through the government under increasing price controls and pressure?”

“If you go through the century, these entitlements consume all money. The GAO calculation assumes Congress is going to wise up and cut back on these programs because people will decide they don’t want 100 percent of their discretionary income going to health care. They want some for food and some for shelter and some for other things. So there will be a curtailment of health care spending in the future,” Ryan said. “The question is which curtailment gets you the better results at going after the cause of health inflation: consumer pressure or government price controls.”
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Exercise: Go forth and price non-Medicare individual insurance policies for persons 65 and older. Next, figure in an additional 10 years of medical inflation.
Well, somebody is going to be paying for this care. The present system isn't doing much to control costs, and medical costs paid by Medicare are rising faster than costs paid by private medical insurers.
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What is the possibility that the only cat scan you'll get is from Fluffy, when you're eating her Friskies?
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Old 01-30-2011, 11:48 PM   #50
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Well, somebody is going to be paying for this care. The present system isn't doing much to control costs, and medical costs paid by Medicare are rising faster than costs paid by private medical insurers.
Yup. This works to reduce costs from the demand side, as in "I can't afford to see the doctor." Folks whose ER plans were to have enough to cover individual insurance, or rely on private retiree coverage to get to Medicare, and then have that pick up most of the tab may have to reconsider their plans.

That $11,000 doesn't cover a high deductible/HSA non-Medicare individual plan for a 65 year old in most parts of the US today. For example, the cheapest non-Medicare Kaiser Permanente plan for a 65 year old here is $12,672 annually, with $30 copay after a $2,700 deductible, 30% copay on hospital and emergency services, $5,200 annual out of pocket maximum.

I don't see anything coming up that will make such plans much cheaper in 10 years. Conservative planning for retirement suggests that this change in expenses, if the changes do go through, should be taken into consideration.
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Old 01-31-2011, 05:30 AM   #51
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Conservative planning for retirement suggests that this change in expenses, if the changes do go through, should be taken into consideration.
"This change in expenses"?
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The amount of the voucher would be based on total current Medicare spending and indexed to grow year by year thereafter.
House GOP considers privatizing Medicare | The Daily Caller - Breaking News, Opinion, Research, and Entertainment
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Old 01-31-2011, 01:18 PM   #52
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"This change in expenses"?
Yup. The voucher amount will be indexed at a rate that represents the average of the cost of living index used for Social Security, and a medical expense index. Based on past history, this will adjust the voucher amount upward by less than the actual change in the cost of the private individual insurance proposed to replace the current Medicare program.

Further, the non-Medicare insurance policies I can find currently all cost more than the voucher, and have much higher deductibles and copayments. That will be an additional expense for the retiree under the proposed plan.

For example, the cheapest non-Medicare Kaiser Permanente plan for a 65 year old in my region is $12,672 annually, with $30 copay after a $2,700 deductible, 30% copay on hospital and emergency services, $5,200 annual out of pocket maximum. This represents a higher net annual expense than similar Medicare Advantage or Medicare plus supplemental coverage would have.

A person aged 54 or younger should be prepared for somewhat higher medical expenses under Medicare than current programs allow, if this proposal goes through.

Note that I'm not against the proposal. I think that in the long run it may be an important step in containing the projected rise in Medicare costs to the federal government and the taxpayer base. However, this change does not come without some impact on those who will retire to the proposed new plan.
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What's the value added for private insurance companies?
Old 02-19-2011, 09:10 AM   #53
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What's the value added for private insurance companies?

THe private insurance companies do nothing in the equation for health care but add a costly middleman. (Do any of you really think they add value? ) If the majority of people (including our congressmen) had to obtain their health insurance through a private individual plan there would be no debate.

For the first time in my life I have been trying to find decent private insurance for my husband and I to replace COBRA. We are both 55, have no pre-existing conditions that we know of, don't take any prescriptions and are in our "normal" weight category. We are looking at a $10,000 HD HSA account to get the premiums down to a reasonable amount. We still feel like we have been "raped" in the process and we haven't even turned in the application yet!

I can get more reliable information about a used car than I can on these insurance policies. TAlk about a racket. One agent for UHC told me he didn't have anything in writing about my issue but he knew what the policy covered because "he was trained". He connected me with customer service who told me the agent was mistaken. The latest is UHC will charge us $120 a year ($10 a month) if we don't let them automatically withdraw the premiums from our checking account. We would go with BCBS but they aren't portable and we would like to relocate.

I can go on and on about how the high cost of health care/insurance in this country is contributing to the high unemployment rate, etc. but what's the point. I'm sure anyone reading this thread already agrees.

THank you for "listening" to my ranting. I have to go fill out that application and at least now I feel a little better so I can tackle it. I need a clear head to remember that 10 years worth of medical history they require
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Old 02-19-2011, 10:34 AM   #54
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After working as an advanced practice registered nurse (RN with master's degree in nursing) for over 25 years, it is my opinion the the current healthcare system in the United States is corrupt. It's not just broken, or unorganized, or anything else that can appease our senses and allow some trust....it is as corrupt as any mafia organization ever was or could be.

The challenge is.....the mafia makes money "illegally" so it's easier to identify and stop it. Some very powerful organizations within healthcare (insurance and drug companies and the American Medical Assoc for example) ensure that government agencies don't create oversight requirments that might limit cash flow. And since we are and want to be a capitalist society....we embrace this lack of governmental control.

Corruption is what it is. It may be legal corruption or moral corruption. Kinda sad that so many other countries less priviledged then us in the U.S.A. figured this out and stepped up on behalf of their people.
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Old 02-19-2011, 10:40 AM   #55
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Obamacare is not the optimum solution. There is a lot I do not like about it.

Hopefully Obamacare will blast the Republican's out of their stonewalling position to negotiate a more middle ground solution that actually addresses middle class issues.

IMO - [my armchair solution ] Free Riders should have rationed healthcare for non-life threatening treatment except routine health. Redlining for health problems should be outlawed (but new policies can be rated... prior coverage stands as is). State boundaries should be removed to enable private coverage to scale. Lifestyle issues (like smoking, chronic alcohol/drug abuse and obesity) should be rated (i.e., pay higher premium).


Feel free to blast my opinion...
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Old 02-19-2011, 10:43 AM   #56
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Well, somebody is going to be paying for this care. The present system isn't doing much to control costs...
Why is it when the entre developed world decides to control costs and cover everyone every age with the same plan, Americans just try to decide which group to screw?

There must be something in the water that warps judgment.

Ha
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Old 02-19-2011, 05:22 PM   #57
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Why is it when the entre developed world decides to control costs and cover everyone every age with the same plan, Americans just try to decide which group to screw?

There must be something in the water that warps judgment.

Ha
Methinks the "entire developed world" came to their present systems just as we will--with lots of wailing, goring of various oxen, and stuffing the bill in someone's pocket.

The order (first cover everyone, then address costs? Address costs before giving everyone a card?) is a nontrivial point. The new legislation has an approach that is gonna cost a lot. Open up your pocket so that bill can slip right in.
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Old 02-19-2011, 09:48 PM   #58
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Methinks the "entire developed world" came to their present systems just as we will--with lots of wailing, goring of various oxen, and stuffing the bill in someone's pocket.

The order (first cover everyone, then address costs? Address costs before giving everyone a card?) is a nontrivial point. The new legislation has an approach that is gonna cost a lot. Open up your pocket so that bill can slip right in.
I agree that the new bill is very poor, and it does not cover everyone anyway.

To anyone who would like to get some careful description of what other advanced countries have done, when, and how, a very good and also entertaining book is T.R. Reid's The Healing of America. Reid is a former Washington Post reporter who lived in several countries and participated in their health systems with his family. He also visited medical facilities in a number of other countries to write this book.

Ha
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Old 02-25-2011, 07:29 PM   #59
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After working as an advanced practice registered nurse (RN with master's degree in nursing) for over 25 years, it is my opinion the the current healthcare system in the United States is corrupt. It's not just broken, or unorganized, or anything else that can appease our senses and allow some trust....it is as corrupt as any mafia organization ever was or could be.

The challenge is.....the mafia makes money "illegally" so it's easier to identify and stop it. Some very powerful organizations within healthcare (insurance and drug companies and the American Medical Assoc for example) ensure that government agencies don't create oversight requirments that might limit cash flow. And since we are and want to be a capitalist society....we embrace this lack of governmental control.

Corruption is what it is. It may be legal corruption or moral corruption. Kinda sad that so many other countries less priviledged then us in the U.S.A. figured this out and stepped up on behalf of their people.
Well it didn't reach this condition without lobbyists buying politicians to protect or enhance their ability to squeeze the patient dry.

That and a pliable populace easily manipulated by cries of "death panels!"
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Old 02-25-2011, 10:41 PM   #60
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And as we baby boomers age, and more turn 65, the problem will get worse, especially with our medicare program. Not saying to pull the plug on granny, but these facts below are a definite financial problem with no easy solution.

Medicare, the health insurance program for the elderly, spends nearly 30 percent of its budget on beneficiaries in their final year of life. Slightly more than half of Medicare dollars are spent on patients who die within two months.
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