Join Early Retirement Today
Reply
 
Thread Tools Search this Thread Display Modes
Old 07-16-2009, 03:05 PM   #101
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: May 2005
Posts: 13,263
Martha,

When one side of the debate is not really interested in 'reform', but just wants to move to a single payer system... it is kind of hard to compromise...

I think there are many good ideas out there to get health care costs down... one would be to have a list of 'standards' to follow... we are basically machines that need to be fixed... just like a car... they have a standard schedule for fixing my car, why not for fixing me?

Another (which I know a lot of stuff will fly at me on this)... stop spending so much (insurance) money at the end of life!!! This costs are huge for some (most?)... (I added insurance since I do not have a problem with someone spending their own money if they wish)...

Also, stop spending a lot of money on brain dead people... I remember a story (I think it was on this forum) where a welfare mom had a hospital keep her child on machines for a year or more.... costing millions... she came to see her baby... and we paid for it...

There are many more big drains... one of them is the high cost of keeping some people alive.. if your medicine is costing over $100,000 a year... you probably die in most of the other countries people tout.... but here, if you have insurance, you get it paid for by the plan... this might not be to many people, but I keep hearing about how much it cost to keep someone with AIDS alive...

OK.... wait.... go.....
__________________

__________________
Texas Proud is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 07-16-2009, 03:17 PM   #102
Moderator
ziggy29's Avatar
 
Join Date: Oct 2005
Location: Texas
Posts: 15,612
Quote:
Originally Posted by Texas Proud View Post
When one side of the debate is not really interested in 'reform', but just wants to move to a single payer system... it is kind of hard to compromise...
I haven't heard too much insistence from the political left that we wind up with "single payer" such as the "Medicare For All" bill that has been debated in Congress in the past, or that the entire bill is paid directly by the government through taxes (which is what 'single payer' usually is accepted to mean).

To the extent that side of the aisle is "insisting" on anything, it seems to be these two things:

1. Everybody is covered.
2. No underwriting or pre-existing condition exclusions.

These may be tough to achieve with cost controls, but they don't *have* to mean single payer. I think a lot of people would consider eliminating insurance company profits as a "nice to have" but it's really not one of the core non-negotiable expected outcomes.

In any event, I think the political leadership is going to have trouble convincing the Blue Dogs that we can afford it. And without them this goes nowhere.
__________________

__________________
"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

RIP to Reemy, my avatar dog (2003 - 9/16/2017)
ziggy29 is offline   Reply With Quote
Old 07-16-2009, 03:25 PM   #103
Recycles dryer sheets
 
Join Date: Jan 2009
Posts: 190
Quote:
Originally Posted by Martha View Post
There is no "official record." If you applied for a new health insurance policy you would have to disclose visits (if there was a question about doctor visits or who you see as a doctor) even if you paid with cash. Otherwise you would be lying which is arguably fraud.
Hmmm, I bought my policy through ehealthinsurance.com and there were no questions about doctor visits or current doctors, only past diagnoses and I believe some yes/no questions about current health. And I believe my last/current insurer (which I was still under from COBRA) which is where I presume they got my medical records from. Oh well...
__________________
Kabekew is offline   Reply With Quote
Old 07-16-2009, 03:43 PM   #104
Moderator Emeritus
Martha's Avatar
 
Join Date: Feb 2004
Location: minnesota
Posts: 13,212
Quote:
Originally Posted by Texas Proud View Post
Martha,

When one side of the debate is not really interested in 'reform', but just wants to move to a single payer system... it is kind of hard to compromise...

I think there are many good ideas out there to get health care costs down... one would be to have a list of 'standards' to follow... we are basically machines that need to be fixed... just like a car... they have a standard schedule for fixing my car, why not for fixing me?

Another (which I know a lot of stuff will fly at me on this)... stop spending so much (insurance) money at the end of life!!! This costs are huge for some (most?)... (I added insurance since I do not have a problem with someone spending their own money if they wish)...

Also, stop spending a lot of money on brain dead people... I remember a story (I think it was on this forum) where a welfare mom had a hospital keep her child on machines for a year or more.... costing millions... she came to see her baby... and we paid for it...

There are many more big drains... one of them is the high cost of keeping some people alive.. if your medicine is costing over $100,000 a year... you probably die in most of the other countries people tout.... but here, if you have insurance, you get it paid for by the plan... this might not be to many people, but I keep hearing about how much it cost to keep someone with AIDS alive...

OK.... wait.... go.....
The legislators are not even talking about single payer, because it can't feasibly be done under current rules. I find that shameful because at least we should have a discussion about it. The big problem with insurance companies is the high cost of administration by medical providers. IIRC, a study a read a couple of years ago found that we could save 17% by going single payer just in admin costs of the providers.

Unfortunately or fortunately, we aren't cars, we aren't all made to the same specks, so one size fits all wont work. However, there can be a best practice and then require a reason for deviation from that practice. That is often done now with drugs that are non-formulary with an insurance company but the patient has the ability to get the drug if there are special circumstances.

I do understand, from talking to Meadbh, that very expensive care for very ill babies is treated about the same in Canada as it is in the US. Babies can get the care even if the odds distinctly don't favor survival.

As far as meds costing $100,000 a year, I would look at why the high cost. Orphan drug? I have a friend with some kind of weird immune disease that has about $50,000 a year in drug costs. She still is a productive member of society, a practicing lawyer for a large medical center.

But I do agree, at some point things are hopeless and a decision needs to be made that we are not going to pay for further "care." The question is what is that point.
__________________
.


No more lawyer stuff, no more political stuff, so no more CYA

Martha is offline   Reply With Quote
Old 07-16-2009, 04:47 PM   #105
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: May 2005
Posts: 13,263
Quote:
Originally Posted by ziggy29 View Post
I haven't heard too much insistence from the political left that we wind up with "single payer" such as the "Medicare For All" bill that has been debated in Congress in the past, or that the entire bill is paid directly by the government through taxes (which is what 'single payer' usually is accepted to mean).

To the extent that side of the aisle is "insisting" on anything, it seems to be these two things:

1. Everybody is covered.
2. No underwriting or pre-existing condition exclusions.

These may be tough to achieve with cost controls, but they don't *have* to mean single payer. I think a lot of people would consider eliminating insurance company profits as a "nice to have" but it's really not one of the core non-negotiable expected outcomes.

In any event, I think the political leadership is going to have trouble convincing the Blue Dogs that we can afford it. And without them this goes nowhere.


Add to your list 3. 'government option'.... that is the first step to single payor... slippery slope and all...



And I recently read that the CBO said the current bill would NOT reduce costs, but make them go up faster...
__________________
Texas Proud is offline   Reply With Quote
Old 07-16-2009, 06:33 PM   #106
Thinks s/he gets paid by the post
ladelfina's Avatar
 
Join Date: Oct 2005
Posts: 2,713
I have been reading some sickening stories of insurers strong-arming employers to fire sick employees, people who can work fine and may even be on the way to wellness, but who have cost - or may cost - the insurer "too much".

The insurer tells the biz: "lose this person or we will jack everyone's rate 25%" or "we will dump you".

And, as with the "no bp over 120/80".. that threshold of "too much" keeps lowering.

So, thanks to the insurance companies (who the Senators and Congressmen have sworn to protect at all costs to their constituents).. a number of people find themselves not only without insurance coverage.. but without a job, as well.

I fail to see why this is not criminal and fraudulent, yet to listen to the way some protect the status quo, one hears that practices like these are to be revered because they are 'capitalist' and not 'socialist'.
__________________
ladelfina is offline   Reply With Quote
Old 07-16-2009, 10:12 PM   #107
Moderator Emeritus
Martha's Avatar
 
Join Date: Feb 2004
Location: minnesota
Posts: 13,212
Quote:
Originally Posted by Texas Proud View Post



And I recently read that the CBO said the current bill would NOT reduce costs, but make them go up faster...
One issue with the CBO analysis is that it does not take into account any savings from use of best practices as they are too hard to quantify. At least Obama is emphasizing the need to get cost down through better practices.
__________________
.


No more lawyer stuff, no more political stuff, so no more CYA

Martha is offline   Reply With Quote
Old 07-16-2009, 10:20 PM   #108
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: May 2004
Posts: 11,615
Is there a systemic reason that government will be better at discovering and instituting best practices than are HMOs, health care providers, or insurers? It would seem all of the later have a vested interest ($$) in this, and that's a pretty good motivator. Finding and promulgating best practices doesn't require any resources (data, money, expertise, etc) not now available to these private groups.
__________________
"Freedom begins when you tell Mrs. Grundy to go fly a kite." - R. Heinlein
samclem is offline   Reply With Quote
Old 07-17-2009, 07:40 AM   #109
Thinks s/he gets paid by the post
 
Join Date: Dec 2004
Posts: 1,798
Quote:
Originally Posted by Martha View Post
One issue with the CBO analysis is that it does not take into account any savings from use of best practices as they are too hard to quantify. At least Obama is emphasizing the need to get cost down through better practices.
I agree those savings are difficult to quantify, but are we willing to bet 1/2 a trillion dollars that they will materialize?

I read an article in the New York Times about the Massachusetts plan. It seems it took three years for the plan to run into serious financial problems. They cut payments to Boston Medical Center and now the hospital is showing a loss. The state's response was all government programs are asked to do more with less, so should you. With that reasoning and most likely no real up side after the economy gets better, the plan seems to force hospitals to either lose money or close their doors.

Mass. is looking at going to a "global payment" type scheme. It sounded an awful lot like the much reviled HMO system people found to be very bad.
__________________
You don't want to work. You want to live like a king, but the big bad world don't owe you a thing. Get over it--The Eagles
lets-retire is offline   Reply With Quote
Old 07-17-2009, 08:49 AM   #110
Moderator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Rocky Inlets
Posts: 24,426
My experience with US healthcare and reform even those relatives and family members with the most extreme conservative views advocate reform and some type of universal coverage once they have first hand exposure to the abuse, discrimination and exploitation built into the current system. The most vocal opponents are those with strong ideological views that also have large group coverage with multiple options.

We are in a state of denial on this (much like the financial problems we denied for so long) and delay increases the cost of reform.

Improved coverage and lower costs are objectives that pull in opposite directions and cannot be resolved simultaneously in a political system that is based on consensus building. I support beginning with universal coverage and following with cost containment.
__________________
MichaelB is online now   Reply With Quote
Old 07-17-2009, 09:02 AM   #111
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Sep 2005
Location: Northern IL
Posts: 18,264
Quote:
Originally Posted by MichaelB View Post

We are in a state of denial on this (much like the financial problems we denied for so long) and delay increases the cost of reform.
I don't understand statements like this or statements about people defending the "status quo".

Maybe my view is distorted by my own biases, but it looks to me that the overwhelming majority of posters to these threads are in favor of reforms. Some of us are not in favor of just anything/everything labeled as reform, we want meaningful, sustainable reform with more positives than negatives.

I know some people just want to "help" others, no matter the cost. But is seems we have systems like that which are unsustainable, so we may be helping people today, and hurting far more in the future. Do you think the people a few generations out are going to be happy if we mortgaged their future, without their say, just so we could have the health care that we wanted, when we wanted, whether we could pay for it or not?

I think we need reform, and I think we need to be responsible about it, and make sure we can pay for today's costs with today's money. IMO, it is stealing to do what we want, and push the bill forward onto someone else. I don't want to be a part of that.

-ERD50
__________________
ERD50 is offline   Reply With Quote
Old 07-17-2009, 09:18 AM   #112
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: May 2005
Posts: 13,263
Quote:
Originally Posted by MichaelB View Post
We are in a state of denial on this (much like the financial problems we denied for so long) and delay increases the cost of reform.
If reform is going to cost us so much money, then why reform I mean, we are talking over $1 Trillion dollars... who can be sure that what we get from the plans will be any better than we have now, but cost us an extra trillion...




Quote:
Originally Posted by MichaelB View Post
Improved coverage and lower costs are objectives that pull in opposite directions and cannot be resolved simultaneously in a political system that is based on consensus building. I support beginning with universal coverage and following with cost containment.
I agree with the first part, disagree with the second.... from the history of gvmt, I would much rather see lower costs first... and then once that is proved, improve coverage...

Now, I am assuming that 'improved coverage' is the code word for the part where we insure the current uninsured, not giving me more choices right now... not really sure about this...
__________________
Texas Proud is offline   Reply With Quote
Old 07-17-2009, 09:21 AM   #113
Moderator Emeritus
Martha's Avatar
 
Join Date: Feb 2004
Location: minnesota
Posts: 13,212
Quote:
Originally Posted by samclem View Post
Is there a systemic reason that government will be better at discovering and instituting best practices than are HMOs, health care providers, or insurers? It would seem all of the later have a vested interest ($$) in this, and that's a pretty good motivator. Finding and promulgating best practices doesn't require any resources (data, money, expertise, etc) not now available to these private groups.
Possibly. When you have 100s of insurance companies, each with their own rules, efficiencies and best practices are unlikely to result. If you had more of a coordinated effort you might end up with a better result. Like a coordinated effort to compensate for something other than simply procedures. I would like to here more from Meadbh on this issue, as Canada's care costs so much less than our care. It isn't all rationing.
__________________
.


No more lawyer stuff, no more political stuff, so no more CYA

Martha is offline   Reply With Quote
Old 07-17-2009, 09:56 AM   #114
Thinks s/he gets paid by the post
 
Join Date: Dec 2004
Posts: 1,798
Quote:
Originally Posted by Martha View Post
... as Canada's care costs so much less than our care. It isn't all rationing.
No it isn't all rationing, some is cost shifting to us.
__________________
You don't want to work. You want to live like a king, but the big bad world don't owe you a thing. Get over it--The Eagles
lets-retire is offline   Reply With Quote
Old 07-17-2009, 10:25 AM   #115
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Sep 2005
Location: Northern IL
Posts: 18,264
Quote:
Originally Posted by Martha View Post
as Canada's care costs so much less than our care. It isn't all rationing.
A bit of googling shows that one would really need to put together a well organized document to get a clear picture in order to compare. A few observations about this or that won't do much, I fear. I quickly found several sources that show US spending is about 2x Canada's per capita, which isn't quite so bad in terms of GDP, 15%/10% respectively.

But then you have these data points to consider:

Health care in the United States - Wikipedia, the free encyclopedia

that wiki article is a pretty good read, too many points to cover one-by-one, but a few interesting things -

Quote:
Around 84.7% of citizens have some form of health insurance; either through their employer or the employer of their spouse or parent (59.3%), purchased individually (8.9%), or provided by government programs (27.8%; there is some overlap in these figures).

Of each dollar spent on health care in the United States 31% goes to hospital care, 21% goes to physician services, 10% to pharmaceuticals, 8% to nursing homes, 7% to administrative costs, and 23% to all other categories(diagnostic laboratory services, pharmacies, medical device manufacturers, etc).

Government programs directly cover 27.8% of the population (83 million),[37] including the elderly, disabled, children, veterans, and some of the poor, and federal law mandates public access to emergency services regardless of ability to pay. Public spending accounts for between 45% and 56.1% of U.S. health care spending.
So that might blow the theory that govt is more efficient than 100 ins cos. Or, it might just reflect that the public group is a "high needs" group. It is not so simple.

My point is, there is far more to this than meets the eye.

Also some interesting info (or lack of) on the uninsured (what % of Canada's spending goes to non-citizens?):

Quote:
In 2007, 45.7 million people in the U.S. (15.3% of the population) were without health insurance for at least part of the year.

Among the uninsured population, nearly 37 million were employment-age adults (ages 18 to 64), and more than 27 million worked at least part time. About 38% of the uninsured live in households with incomes of $50,000 or more.[37] According to the Census Bureau, nearly 36 million of the uninsured are legal U.S citizens. Another 9.7 million are non-citizens, but the Census Bureau does not distinguish in its estimate between legal non-citizens and illegal immigrants.
Much more detail in the entry, but clearly the US is leading in research, and to some extent, other countries get a bit of a free ride from this:

Quote:
The United States is a leader in medical innovation. In 2004, the nonindustrial sector spent three times as much as Europe per capita on biomedical research. ... The nation spends a substantial amount on medical research, mostly privately funded. As of 2000, non-profit private organizations (such as the Howard Hughes Medical Institute) funded 7%, private industry funded 57%, and the tax-funded National Institutes of Health supported 36% of medical research in the U.S
edit/add - it would be great to see this all in table form, rather than a string of text - I gotta run, any erstwhile googler's out there want to give it a try? Hey maybe that new search engine for data - "Wolfram Alpha"? I haven't tried it yet.... http://www.wolframalpha.com/

-ERD50
__________________
ERD50 is offline   Reply With Quote
Old 07-17-2009, 11:33 AM   #116
Recycles dryer sheets
 
Join Date: Aug 2007
Posts: 401
Quote:
Originally Posted by ERD50 View Post
I know some people just want to "help" others, no matter the cost. But is seems we have systems like that which are unsustainable, so we may be helping people today, and hurting far more in the future. Do you think the people a few generations out are going to be happy if we mortgaged their future, without their say, just so we could have the health care that we wanted, when we wanted, whether we could pay for it or not?

I think we need reform, and I think we need to be responsible about it, and make sure we can pay for today's costs with today's money. IMO, it is stealing to do what we want, and push the bill forward onto someone else. I don't want to be a part of that.

-ERD50
We might be mortgaging our future to pay for health care, but wouldn't we as a country be better off mortgaging our future for something that actually benefits our own citizens directly rather than mortgaging it for something overseas, the IRAQ war, for example. Isn't the cost of that eventually going to be over $1 trillion? Yeah, I know hindsight is 20-20, but hopefully we can learn from that spending mistake. I could give many other examples where the US sends money elsewhere with little or no direct benefit to our own citizens. Even the war in Afghanistan seems to be a waste of money to me. I wish there was as much of an uproar over US spending around the rest of the world as there is on possibly spending more money on a national health plan.
__________________
DallasGuy is offline   Reply With Quote
Old 07-17-2009, 11:34 AM   #117
Moderator Emeritus
Martha's Avatar
 
Join Date: Feb 2004
Location: minnesota
Posts: 13,212
Quote:
Originally Posted by ERD50 View Post
A bit of googling shows that one would really need to put together a well organized document to get a clear picture in order to compare. A few observations about this or that won't do much, I fear. I quickly found several sources that show US spending is about 2x Canada's per capita, which isn't quite so bad in terms of GDP, 15%/10% respectively.

But then you have these data points to consider:

Health care in the United States - Wikipedia, the free encyclopedia

that wiki article is a pretty good read, too many points to cover one-by-one, but a few interesting things -



So that might blow the theory that govt is more efficient than 100 ins cos. Or, it might just reflect that the public group is a "high needs" group. It is not so simple.

My point is, there is far more to this than meets the eye.

Also some interesting info (or lack of) on the uninsured (what % of Canada's spending goes to non-citizens?):



Much more detail in the entry, but clearly the US is leading in research, and to some extent, other countries get a bit of a free ride from this:



edit/add - it would be great to see this all in table form, rather than a string of text - I gotta run, any erstwhile googler's out there want to give it a try? Hey maybe that new search engine for data - "Wolfram Alpha"? I haven't tried it yet.... Wolfram|Alpha

-ERD50
I am not around much today, but these numbers regarding admin costs are inconsistent with what I have read in various studies. It could be how they are broken down. For example, we spend roughly 1/3 of our health care dollar on administrative costs in the US. Part is insurance processing, part is admin costs of providers.

I haven't looked at the wiki article for a long time. Once I helped write it.
__________________
.


No more lawyer stuff, no more political stuff, so no more CYA

Martha is offline   Reply With Quote
Old 07-17-2009, 11:49 AM   #118
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Sep 2005
Location: Northern IL
Posts: 18,264
Quote:
Originally Posted by DallasGuy View Post
We might be mortgaging our future to pay for health care, but wouldn't we as a country be better off mortgaging our future for something that actually benefits our own citizens directly rather than mortgaging it for something overseas, the [FILL IN THE BLANK] for example.
Red Herring. We are talking about spending on health care, not some other topic. Health care is complex enough w/o dragging other stuff into it. Those other things do not change the argument. You want to talk about [FILL IN THE BLANK] , start another thread please.

-ERD50
__________________
ERD50 is offline   Reply With Quote
Old 07-17-2009, 11:54 AM   #119
Recycles dryer sheets
 
Join Date: Aug 2007
Posts: 401
Quote:
Originally Posted by ERD50 View Post
Red Herring. We are talking about spending on health care, not some other topic. Health care is complex enough w/o dragging other stuff into it. Those other things do not change the argument. You want to talk about [FILL IN THE BLANK] , start another thread please.

-ERD50
It's YOUR opinion that it's a red herring...my point is about the priorities that our country has. In MY opinion is that it is important when determining whether to pay for a national health plan or not. A national health plan doesn't seem to be a high priority to YOU...I can accept that.
__________________
DallasGuy is offline   Reply With Quote
Old 07-17-2009, 12:02 PM   #120
Moderator Emeritus
Martha's Avatar
 
Join Date: Feb 2004
Location: minnesota
Posts: 13,212
Here is one of the studies showing the percentage differences in admin costs between the US (31%) and Canada (17%): NEJM -- Costs of Health Care Administration in the United States and Canada

I agree this is all about priorities. How much do we care that we do not always have the best outcomes in the US. That a number of people die each year because of lack of ability to pay for health care? That not only do we have 45 million plus uninsured for at least a year and 80 million plus underinsured? That more and more small employers are dropping insurance?
__________________

__________________
.


No more lawyer stuff, no more political stuff, so no more CYA

Martha is offline   Reply With Quote
Reply

Tags
cobra, hipaa


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Universal health care - best I've seen Rich_by_the_Bay Health and Early Retirement 21 12-13-2007 11:38 AM
New Health Care Proposal -- If it happens what does it mean? chinaco FIRE and Money 9 06-11-2007 04:04 PM
health insurance and effect on increased health care costs Martha Other topics 9 08-08-2006 02:54 PM
Health Care in Retirement Sammy FIRE and Money 9 11-13-2005 09:18 PM
Health Care Lovecraft Young Dreamers 3 02-20-2004 09:28 PM

 

 
All times are GMT -6. The time now is 07:16 AM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.