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Old 11-05-2009, 10:19 AM   #41
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That's not how it works with public monopolies like public utilities and transit agencies. In that economics-defying world, revenue shortfalls caused by reduced demand usually lead to price increases, not decreases as would be the normal response to reduced demand.

Of course, outside the world of essential monopolies, the usual laws of economics may well apply. So maybe it's important to make sure that the delivery of health care doesn't ever resemble a public monopoly.
That just puts some smoke and mirrors to the increase in costs - the gov't pays the increase costs and wallah no increase - but eventually the 'free lunch' has a cost involved and someone pays(OPM?) -- Bottom line: increasing price to make up for a reduced demand will tend to further reduce demand and create a downward spiral. Bucking the curve has consequences. Giving 'free' health care to all(as some advocate) will substantially increase costs w/o some serious expansion of supply will lead to higher costs and greater difficulty obtaining timely treatment. Simple economics.
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Old 11-05-2009, 10:21 AM   #42
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I have never heard anyone advocate for free health care for all. Not logically possible.
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Old 11-05-2009, 10:40 AM   #43
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I have never heard anyone advocate for free health care for all. Not logically possible.
I would tend to agree on the logic, but many in favor of socialized medicine would disagree and those countries with 'free health care' usually have hefty taxes to pay the bill.

Soo anyways back to currently proposed health care legislation in this country (which is definitely NOT free health care for all), but does appear to increase demand and thus add further pressure to further increase cost.
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Old 11-05-2009, 10:41 AM   #44
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IT seems rather naive economically speaking to increase demand and expect prices to drop. Increase demand => increase price. We could use a bill to increase supply - more health care folks and facilities, perhaps some real control on malpractice costs.
Assuming everyone will have insurance, I think the expectation is that by adding in a lot of young, healthy new insureds (who are now not insured by choice), there will be a larger pool of both insureds and premiums. The pool of individual policies now would not only be people who are sick. This levels out the situation, and also allows people to seek medical care before they are extremely ill.

The premiums actually could go down in this scenario, if the legislation is done very carefully and the premiums are affordable.
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Old 11-05-2009, 10:54 AM   #45
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Side-by-Side Comparison of Health Reform Bills’ Impact on Medicare
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Old 11-05-2009, 10:57 AM   #46
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Assuming everyone will have insurance, I think the expectation is that by adding in a lot of young, healthy new insureds (who are now not insured by choice), there will be a larger pool of both insureds and premiums. The pool of individual policies now would not only be people who are sick. This levels out the situation, and also allows people to seek medical care before they are extremely ill.

The premiums actually could go down in this scenario, if the legislation is done very carefully and the premiums are affordable.
Sure sounds like smoke and mirrors, more people seeking more medical care sounds like more demand. Someone might be suggesting an once of prevention is going to be equal to pound of cure or perhaps even a ton of cure.

I doubt 'careful' will have much to do with how the bill gets done and 1900+ pages of 'careful' boggles the mind.

IF the premiums do become more 'affordable' it will either be because of gov't subsidizing them or OPM.
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Old 11-05-2009, 12:45 PM   #47
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Sure sounds like smoke and mirrors, more people seeking more medical care sounds like more demand. Someone might be suggesting an once of prevention is going to be equal to pound of cure or perhaps even a ton of cure.

I doubt 'careful' will have much to do with how the bill gets done and 1900+ pages of 'careful' boggles the mind.

IF the premiums do become more 'affordable' it will either be because of gov't subsidizing them or OPM.
I know it may sound like smoke and mirrors but it actually isn't. By increasing the pool of insureds and having a lot more of them be healthier, the increased demand doesn't exceed the increased premium pool.

How to get the costs down? I would so much prefer single payer... Even my internist would go for it (I asked him). No one except extremely highly paid specialists likes current system and its paperwork.

I work for a large healthcare system (but in IT) so I've been around this discussion for years. That doesn't make me an expert but gives me a perspective that may not be the norm.

Of course my employer is NOT for single payer and freaks out at the possibility of payments going down. I forget what the official position is, but I didn't agree with it.

I think there has been way too much consideration to the insurance companies' "plight"... There are many systems in place to cover people nationally (federal employees' insurance, Medicare, VA...). I know I'm a lone voice but why they couldn't just make the big move and expand one of those... it's so irritating.

Maybe at some point the bill(s) will be comprehensible.... Maybe...
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Old 11-05-2009, 02:24 PM   #48
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I know it may sound like smoke and mirrors but it actually isn't. By increasing the pool of insureds and having a lot more of them be healthier, the increased demand doesn't exceed the increased premium pool.
....
Maybe at some point the bill(s) will be comprehensible.... Maybe...
I think that's counter-intuitive too -- Adding more to a 1900+ page bill is more likely to lead to the incomprehensible...

"Increasing the pool of insureds" by coercing those who do NOT want and hopefully(likely) will NOT need coverage is definitely using OPM (other people's money) to reduce premium costs... Using fines, taxes on cadillac plans, deficits, etc is just more of the same. It all looks smoky to me and it does no good to tell me, 'PAY NO attention to the man behind the curtains'. If you follow the yellow brick road to DC -- you'll find little magic beyond making our tax dollars disappear...
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Old 11-05-2009, 03:03 PM   #49
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"Increasing the pool of insureds" by coercing those who do NOT want and hopefully(likely) will NOT need coverage is definitely using OPM (other people's money) to reduce premium costs... Using fines, taxes on cadillac plans, deficits, etc is just more of the same. It all looks smoky to me and it does no good to tell me, 'PAY NO attention to the man behind the curtains'. If you follow the yellow brick road to DC -- you'll find little magic beyond making our tax dollars disappear...

I have no problem with a requirement to buy insurance or posting a bond or something to prove that you can be self insured. Unless you are very wealthy you cannot say that you will not needinsurance. Accidents and illness happens. Even to young people. And those uninsured young people are going to be looking for care if they get hurt or ill and someone is going to have to pay for that care. Failure to have adequate insurance doesn't just effect the person without insurance. So, OPM is already in use. (Or, you could bar them from treatment without proof of ability to pay, but we don't do that in emergency situations).

The young person says "I will take the risk" but they don't mean it. If they have a serious car accident they will expect to be treated in a hospital. If they get cancer, they will be looking for treatment.

Plus, if there is a bar on underwriting then adverse selection will occur if people are not required to buy insurance. This is what happened in states like New Jersey, making non-group insurance unaffordable for most.
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Old 11-05-2009, 03:16 PM   #50
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I think that's counter-intuitive too -- Adding more to a 1900+ page bill is more likely to lead to the incomprehensible...

"Increasing the pool of insureds" by coercing those who do NOT want and hopefully(likely) will NOT need coverage is definitely using OPM (other people's money) to reduce premium costs... Using fines, taxes on cadillac plans, deficits, etc is just more of the same. It all looks smoky to me and it does no good to tell me, 'PAY NO attention to the man behind the curtains'. If you follow the yellow brick road to DC -- you'll find little magic beyond making our tax dollars disappear...
We'll have to agree to disagree. I think everyone should have some level of health insurance, because there is no way to predict when or if a serious health problem will occur. It could be a car accident, it could be cancer.

If you don't have health insurance (these are those young healthy people?) you do one of two things: go bankrupt if you have assets, or get paid for by the government (Medicaid etc.). OR, the hospital (often) absorbs the costs, which raises their expenses and forces them to charge more for service to the paying customers.

I also think this should be a federal program paid for by taxes.

Interesting site: www.pnhp.org Physicians for a National Health Program
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Old 11-05-2009, 04:25 PM   #51
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Perhaps put the question to popular vote, should everyone be required to have health insurance or be fined for not having it?! Maybe the majority would agree - I think we should at least ask.

This bill does nothing to prevent folks w/o insurance from incurring bills for catastrophic cases and then either using bankruptcy (or death) to escape the full consequences. It just adds a fine to their already dire consequences. For the vast majority who take the risk w/o the consequences, it's just another hand in their pockets.

Even those with some coverage could be bankrupted (or dead) by your examples. SO no real change.

Let's call me skeptical that those not having a way to pay, those with minimal coverage, those with superior coverage, and those with deep pockets all receive the same quality of care now or in the future... So another consequence.

NOT having insurance is a gutsy call to say the least and my daughter has had to pay a hefty price for treatments she has received and paid out of pocket. Still she is unable to find what she considers affordable health care. An optimist might suggest this bill would give her that opportunity. A pessimist sees an added cost and continued risk with no guarantees... Call me optimistically-pessimistic, I think it could actually be worse than that!
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Old 11-05-2009, 05:58 PM   #52
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I read an article not too long ago where the author interviewed common people and asked for their opinion about the cost of health care and health insurance. One woman stated health care was too expensive and she had to think hard about going to the doctor. Her health insurance was completely provided by her employer, she paid no premiums. She had a very good policy that required her to pay a co-pay somewhere between $20-30. She complained that if she became sick she might have to pay a couple hindered dollars for the doctor's visit and medications. I would love that policy, I pay a couple hindered dollars per month, even if no one in my family goes to the doctor, which is still less than some people pay.

My point is some people have opinions that don't have any basis in reality.
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Old 11-05-2009, 06:19 PM   #53
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My point is some people have opinions that don't have any basis in reality.
True enough!
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Old 11-05-2009, 07:30 PM   #54
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Oh, I LOVE the thought of a COSTCO Medical Association! And why not...?
I thought that might actually be a nice outcome. The only gotcha is the association plan language talks about eligible employees and employers, or professional organizations. Us early retirees don't count, unless we've kept our professional organization memberships up. I wonder if AARP could get itself declared a professional organization?

Here's a fresh link to the Republican House plan now that it has been released:
http://rules-republicans.house.gov/M...tive3962_9.pdf

And for comparison the Democratic House plan:
http://docs.house.gov/rules/health/111_ahcaa.pdf
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Old 11-05-2009, 10:10 PM   #55
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Nothing wrong with that. Should be the same with tax exempt interest.
It is already with respect to tax exempt interest and Medicare Part B premiums. Premiums are based on AGI as adjusted (adjusted adjusted AGI- that is, AGI with muni interest added back.)

Count me as one who does see something wrong with this. One way this new program could be cheaper for an individual is if the government put price controls on doctors, hospitals and drug companies, and no one is talking about that to my knowledge.

The only other way I can think of is to rob Peter to pay for Paul; and it always works out that I am Peter, even though I live in a 500 sq ft apartment in a building built in 1927.


Ha
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Old 11-06-2009, 09:12 AM   #56
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It won't be an income tax but rather Roth withdrawals and possibly muni bond interest will count towards income for determining health care premium subsidies and that sort of thing.
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Nothing wrong with that. Should be the same with tax exempt interest.
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Count me as one who does see something wrong with this.
I second that. I consider it wrong for the government to essentially change the rules of a ROTH after the fact. I'm no lawyer, but in the private sector I think that would be called "breach of contract". So while I guess we don't technically have a "contract" with the govt, it should be treated as such. Maybe even more so, since we have no real recourse.

And collecting HC premiums to provide HC is just as much a tax as collecting my money for any other purpose our govt chooses. So if a ROTH wd affects the amount of money I pay to the govt, it is being taxed. I didn't sign up for that when I contribute to a ROTH (though I am aware they can change the rules, but I do think it is wrong and would hope that they would grandfather past contributions).

If they want to change it going forward, well, I may not like it but at least it isn't screwing the person that tried to play by the rules.

-ERD50
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Old 11-06-2009, 09:17 AM   #57
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It is already with respect to tax exempt interest and Medicare Part B premiums. Premiums are based on AGI as adjusted (adjusted adjusted AGI- that is, AGI with muni interest added back.)

Count me as one who does see something wrong with this. One way this new program could be cheaper for an individual is if the government put price controls on doctors, hospitals and drug companies, and no one is talking about that to my knowledge.

The only other way I can think of is to rob Peter to pay for Paul; and it always works out that I am Peter, even though I live in a 500 sq ft apartment in a building built in 1927.


Ha
My only point had to do with what could be counted as income. I too find fault with the proposals. I think that we need some price controls somewhere,but not everywhere. I keep thinking of the $100 MRI in Japan and Japan has no shortages of MRI machines.

On the other hand, I think that our primary care providers are underpaid so they end up having too many patients.
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Old 11-06-2009, 09:24 AM   #58
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I second that. I consider it wrong for the government to essentially change the rules of a ROTH after the fact. I'm no lawyer, but in the private sector I think that would be called "breach of contract". So while I guess we don't technically have a "contract" with the govt, it should be treated as such. Maybe even more so, since we have no real recourse.

And collecting HC premiums to provide HC is just as much a tax as collecting my money for any other purpose our govt chooses. So if a ROTH wd affects the amount of money I pay to the govt, it is being taxed. I didn't sign up for that when I contribute to a ROTH (though I am aware they can change the rules, but I do think it is wrong and would hope that they would grandfather past contributions).

If they want to change it going forward, well, I may not like it but at least it isn't screwing the person that tried to play by the rules.

-ERD50
Oh baloney.

People who have income from tax exempt interest or Roth IRAs should have that income counted when determining eligibility for a subsidy. No one ever said Roths would be sheltered from everything, it is only sheltered from income tax. That is all the law provides and that alone is huge. Roth income might be counted in determining eligibility for many benefits. It certainly is counted to see if you are impoverished enough to get medicaid to pay for your nursing home. It is not like breach of contract and is not a change of the rules. To call every benefit or subsidy a tax on everyone else is stretching things way out of proportion.
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Old 11-06-2009, 09:31 AM   #59
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One way this new program could be cheaper for an individual is if the government put price controls on doctors, hospitals and drug companies, and no one is talking about that to my knowledge.

The only other way I can think of is to rob Peter to pay for Paul; and it always works out that I am Peter, even though I live in a 500 sq ft apartment in a building built in 1927.
In addition to these two ways of reducing costs to an individual (price controls on services or cost shifting to other individuals) why not lower costs by taking steps to improve competition, thereby improving both the quality of services and the efficiency of their delivery? That's the force that works well in almost every other aspect of our economic lives. Health care is different in important respects, but I'm confident eliminating the structural impediments to competition is the best way to get a handle on costs. There are good ways to do this (and powerful vested interests opposed to it).
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Old 11-06-2009, 09:38 AM   #60
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I'm with Ziggy. "Tax increase" and "subsidy reduction" feels a lot the same if you're one of the guys actually paying for the subsidy everyone is receiving.

Though I can see why this "subsidy" approach is attractive . . .
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