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Old 08-14-2009, 02:51 PM   #41
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I know it takes courage to tell voters that a govt benefit has to be paid for and that they will be involved in paying for it. But isn't that what we elected this political majority for.......? To have courage and make changes?
I hope you're not holding your breath?
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Old 08-14-2009, 06:15 PM   #42
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A very interesting discussion. There simply can not be any rational or productive progress until the average citizen realizes that the Federal Government is not their parents. No one on this board has any friends in Washington. That is why the constitution was written with very specific restrictions on the power of the Central government. We have ignored that fact since the 1930's and I really am afraid that the unintended consequences are going to be very severe.

A point of reference it that LBJ signed a little bill into law in the 1960's, medicaid. That simple little plan now gives totally free health care to over 50 million people and continues to simply explode in size and expense! The abuse in this system is simply mind boggling. Most of it is being paid for with borrowed money and ultimately will be be paid for my our children. The little rule book for Medicare and Medicare, last figures I could find is over 40,000 pages. The cost of medical care has sky rocketed ever since the government got involved.

So here we sit poised to fix the problem by doing more of the same thing that caused the problem is the first place. Using the Federal Government to "fix health care" is a lot like using a flame thrower to exterminate termites in your house. It works every time. You will kill every termite and you will never have that problem again in that house.. You are not going to like the collateral damage though.

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Old 08-14-2009, 07:16 PM   #43
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It also seems to me, that if we say these "values" are what we collectively want to support, then we ought to collectively be willing to pay for them. It seems disingenuous to me to say we value them, but a future generation should pay for them. IMO, that shows a lack of values.

I'm in favor of progressive taxes (within reason), so I don't have a problem saying that the wealthier can/should support a larger burden. But I do think the vast majority should have some "skin in the game". But pushing the payment onto people who have not reached voting age (or may not even be born yet) is just wrong, IMO.

-ERD50
Very well said...
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Old 08-14-2009, 09:13 PM   #44
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A very interesting discussion. There simply can not be any rational or productive progress until the average citizen realizes that the Federal Government is not their parents. No one on this board has any friends in Washington. That is why the constitution was written with very specific restrictions on the power of the Central government. We have ignored that fact since the 1930's and I really am afraid that the unintended consequences are going to be very severe.

A point of reference it that LBJ signed a little bill into law in the 1960's, medicaid. That simple little plan now gives totally free health care to over 50 million people and continues to simply explode in size and expense! The abuse in this system is simply mind boggling. Most of it is being paid for with borrowed money and ultimately will be be paid for my our children. The little rule book for Medicare and Medicare, last figures I could find is over 40,000 pages. The cost of medical care has sky rocketed ever since the government got involved.

So here we sit poised to fix the problem by doing more of the same thing that caused the problem is the first place. Using the Federal Government to "fix health care" is a lot like using a flame thrower to exterminate termites in your house. It works every time. You will kill every termite and you will never have that problem again in that house.. You are not going to like the collateral damage though.

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Have you thought that maybe the problem is why in the world do we have a country where so many people end up so poor that they can only get healthcare through medicaid? And, many people are poor but they do not fit within a specific category; these people can't get Medicaid in most states and can't afford insurance.

Much of medicaid is for poor elderly, as it covers nursing home care that they can't otherwise afford. I know data from about ten years ago indicated that 1/3 of the medicaid dollar was spent on long term care. I don't know the percentage today. It is next to impossible to hide assets from medicaid to get that care. Is that mind boggling abuse? So, medicaid covers more than traditional medical care. What do we do with our poor elderly without it?

And what are the so called mind boggling facts of abuse in this system? I am sure abuse occurs. Abuse occurs in the insurance industry too. Nothing is perfect, but I don't see mind boggling abuse. The mind boggling fact for me is that the gap between the haves and the have nots. My mind is being boggled every day by the distortions in the debate about health care.

And gee, other countries managed to have universal care without societal collapse and their costs of care have not increased as much as our costs, which may be the highest in the world.

<sigh>

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Old 08-14-2009, 09:31 PM   #45
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Martha.....

Is your issue more that some people don't accept "the proposal" 100% as initially presented or that there is concern about paying for it?

I understand that the President's ardent loyalists are aghast that his "suggestions" are not being taken as stated and implemented 100%. And I know it's not always good political strategy to address costs straight away. But it sure seems like His plan would sell better if just one or two of the opposition's objections were listened to and the total cost was realistically calculated and proposed tax increases presented that would guarantee that today's children are not paying our way.


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And gee, other countries managed to have universal care without societal collapse and their costs of care have not increased as much as our costs, which may be the highest in the world.
I claim no specific knowledge of how the Canadians (for example) tax their citizens to pay for their health care system. But I've not heard the anguish that their system is soon to go broke as I do for Medicare and SS here in the USA. Perhaps they agree with me and recognize costs and pay them as they go? Maybe we could do that for whatever we implement here?

Yes, doing things in a straight forward and honest manner would be a change and would take courage. But He promised he could do that. It's the promise he was elected on.
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Old 08-14-2009, 10:40 PM   #46
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Martha.....

Is your issue more that some people don't accept "the proposal" 100% as initially presented or that there is concern about paying for it?

I understand that the President's ardent loyalists are aghast that his "suggestions" are not being taken as stated and implemented 100%. And I know it's not always good political strategy to address costs straight away. But it sure seems like His plan would sell better if just one or two of the opposition's objections were listened to and the total cost was realistically calculated and proposed tax increases presented that would guarantee that today's children are not paying our way.

Cost is an issue, and figuring out savings has been difficult. I think we need to address these issues. I would never have designed the plan the way things are proposed. I am not a loyalist, I am a medicare for all supporter but know that we will have something less. But that wasn't what I was talking about in the prior post. I was addressing Sevo's statements about medicaid.



Quote:
I claim no specific knowledge of how the Canadians (for example) tax their citizens to pay for their health care system. But I've not heard the anguish that their system is soon to go broke as I do for Medicare and SS here in the USA. Perhaps they agree with me and recognize costs and pay them as they go? Maybe we could do that for whatever we implement here?
Maybe we need to recognize that taxation isn't so bad, especially when we get something like healthcare rather than wars. But hardly anyone wants to mention raising taxes.

How about we return the estate tax to a reasonable level. That will pay for quit a bit of healthcare. Especially for those who are being cut from medicaid.
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Old 08-14-2009, 10:59 PM   #47
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Maybe we need to recognize that taxation isn't so bad, especially when we get something like healthcare rather than wars. But hardly anyone wants to mention raising taxes.
It isn't a matter of taxes being good or bad, it's a matter of understanding that when we buy something, we need to pay for it. We're doomed if we continue to push the burden of govt programs that benefit us today onto the following generations.

No more scams/ponzi schemes like the SS and Medicare funding systems! Time to pay as we go!

I believe the American people would be more willing to accept higher taxes to fund some sort of national health plan than today's explanation consisting of mumbo-jumbo about saving a little here and a little there and taxing only the rich will pay for it.
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Old 08-14-2009, 11:12 PM   #48
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Maybe we need to recognize that taxation isn't so bad, especially when we get something like healthcare rather than wars. .
There ya go. Let's enforce election promises to end the wars by bringing our troops home and then applying the Iraq and Afghanistan war money to fund health care. Then the Administration can announce their proposal for additional taxes to pay the balance of the costs of the new plan real time, on time and not place those costs on the backs of our children for political expediency.

Getting back on topic...... sounds like something that a guy like Franken, who ran on a platform of honesty, would want to do!
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Old 08-15-2009, 06:55 AM   #49
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Cost is a big issue. If you look at the amount spent on health care in other European countries you will see their costs, as a percent of income per capita, are not too much lower than ours. Some of this can be attributed to more pay for doctors in this country. Some to inefficiencies in our system. Some to simple lifestyle choices in America. The biggest issue is whether those costs can be identified, controlled, and maintained. I don't think most of the costs can be. Some can, but I don't think we will see anywhere near the savings required.

I looked at WHO's website and listed the European countries and the US. Since there is a large difference between what some countries earn and others I limited my calculations to those with incomes within $10000 below the US. I then divided the total per capita spent on health care by the per capita income to get a general idea of how much of the per capita income the population spends on health care. The results are:

USA .15
AUSTRIA .11
BELGIAN .11
DENMARK .13
CANADA .11
FINLAND .09
FRANCE .13
GERMANY .11
GREECE .09
ICELAND .15
IRELAND .11
ITALY .10
LUXEMBOURG .11
NETHERLANDS .10
NORWAY .13
SPAIN .08
SWEDEN .11
SWITZERLAND .14
UK .10

With the exception of the US and Greece, every country on the list has the majority of their health care paid for by the government.

Sorry for the hijack, now back to your regularly scheduled thread.
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Old 08-15-2009, 07:07 AM   #50
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What an excellent discussion! Martha knows a lot about health care so I read her posts on the topic with interest, others here obviously do as well. Maybe I'm alone, but to me the central topics are:

1) We can't afford to just institutionalize the system we have. It's already substantially more expensive than other developed countries universal care plans, and we don't have better health stats to show for it.
2) Really changing our system to something workable/affordable like Canada, the UK, Switzerland, Germany, Taiwan, etc. is going to require pissing off some of the most powerful special interest groups like doctors, insurers and lawyers. No one believes Obama, or anyone in Wash DC for that matter, has the nerve/political capital to piss off special interests. There is a bigger problem than health care itself!
3) Despite the large numbers of uninsured, most people have health insurance through their employers or the government (elderly), so they are afraid of any change and expect it will increase their costs or reduce the access/choice. So the electorate is a considerable obstacle - and the real root of the problem.
4) I agree with ERD50's remark above "It also seems to me, that if we say these "values" are what we collectively want to support, then we ought to collectively be willing to pay for them. It seems disingenuous to me to say we value them, but a future generation should pay for them. IMO, that shows a lack of values."
5) If we just institutionalize what we have and we accept #4, that kind of health care is going to cost much, much more. Those, including Obama, who try to say otherwise 'no tax increase for those making $250K or less' can only be saying we're going to make future generations pay for this - and too many people realize it.

Just for starters...

I am part of the problem I guess. I actually sat down to read the 1017-18 pages of HR3200 a few nights ago to separate the media hyberbole from fact. There is no way I could get through it, and I think I'm reasonably intelligent - guess not.

IMO we really need to move to a system like Canada, the UK, Switzerland, Germany, Taiwan or a close variant. But I don't think we collectively have the will to do it - not just Obama, all of us. So Obama et al will do something by the end of the year, but it won't do much, and it will only make it worse (by a little). We kick the can down the street once again...

I would accept a Canada, UK, Switzerland, Germany, Taiwan type universal health care system - with all the limitations that may imply (not as great as the right would have you believe, and I'm a conservative)
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Old 08-15-2009, 07:23 AM   #51
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We are down in the dumps about this. Maybe August will let people vent and they can get back to work in September. Even if we have some patchwork it won't necessarily make things worse. HIPAA portability rules didn't make things worse and it helped people moving from job to job and pushed the states to have a last resort plan if you came off of a group plan. That helped a significant amount of people even though it was patchwork and wasn't enough (no cost limitations and nothing for the uninsured unless they came off of a group plan).
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Old 08-15-2009, 07:54 AM   #52
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Cost is a big issue. If you look at the amount spent on health care in other European countries you will see their costs, as a percent of income per capita, are not too much lower than ours. Some of this can be attributed to more pay for doctors in this country. Some to inefficiencies in our system. Some to simple lifestyle choices in America. The biggest issue is whether those costs can be identified, controlled, and maintained. I don't think most of the costs can be. Some can, but I don't think we will see anywhere near the savings required.

I looked at WHO's website and listed the European countries and the US. Since there is a large difference between what some countries earn and others I limited my calculations to those with incomes within $10000 below the US. I then divided the total per capita spent on health care by the per capita income to get a general idea of how much of the per capita income the population spends on health care. The results are:

USA .15
AUSTRIA .11
BELGIAN .11
DENMARK .13
CANADA .11
FINLAND .09
FRANCE .13
GERMANY .11
GREECE .09
ICELAND .15
IRELAND .11
ITALY .10
LUXEMBOURG .11
NETHERLANDS .10
NORWAY .13
SPAIN .08
SWEDEN .11
SWITZERLAND .14
UK .10

With the exception of the US and Greece, every country on the list has the majority of their health care paid for by the government.

Sorry for the hijack, now back to your regularly scheduled thread.
Thanks for working the numbers. I sure would like to see us get a handle on our huge amount of administration burden that takes up so much time and money. I recently read about some things that can be done, like standardizing insurance cards, and simplifying prior authorization and claims processing. http://www.caqh.org/pdf/CAQH_CORE_Ov...March_2006.pdf Electronic record keeping is part of this. But I don't know how much this will reduce the time and cost spent, given that there are 1000s of different insurance plans out there. Fragmentation of our health care sector makes this difficult.

This year old Commonwealth Fund report discusses the issue and some things that can be done.
Organizing the U.S. Health Care Delivery System for High Performance - The Commonwealth Fund
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Old 08-15-2009, 08:10 AM   #53
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I may try to get through HR 3200 again (1017-18 pgs), but is anyone aware of an unbiased detailed summary in plain English? There is a 4-page official summary, but it's basically fluff talk. Probably a stupid question, but I'd like to really understand it - I just could not get through the bill the first time I tried to...
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Old 08-15-2009, 08:40 AM   #54
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I read an article on Money.com (I know unreliable at best) that put the estimated cost to file claims at as high as 210 billion. It seems like a no brainer, using the "eating and elephant" analogy that it would be simple law to write and pass requiring the insurance companies to come up with a simple claim form no more difficult to fill out than the simplest form currently being used, as determined by a survey of billing companies. In order for an insurance company to continue to provide health insurance they must use the form. At the same time a standardized coding system could be implemented. This should save a lot of time and effort and presumably bring some of the admin costs down. The other thing I noticed was many different bills generated from one ER visit. The doctor/lab tech/x-ray tech have to fill out paperwork for the hospital showing what was done. I don't see why the same paperwork can't be forwarded to the billing department to be billed on one bill, instead of filling out more paperwork to be billed separately. Not only would the cost for submitting the bill be lower, but the processing of the bills by the insurance companies would go down.

It seems to be a simple solution that would lower costs that doesn't require 1000 pages to get going.
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Old 08-15-2009, 01:54 PM   #55
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Concerning Medicare going broke. Everyone knows there are Medicare abuses as well as insurance company abuses. I went to a doctor recently who billed Medicare for an expensive procedure he never performed. I have reported him. We must take an active part in preventing these abuses.

Secondly, Medicare is insurance for the elderly who utilize insurance the most and where the majority of very high medical costs are incurred. The private sector is happy to give Medicare patients to the government. If we had more of a balance of younger healthy people paying premiums to offset the Medicare patients, we wouldn't be going broke. Don't forget the public insurance is making record profits by cherry picking these people, and getting rid of the ones that cost them money.

About ten years ago, after carrying my insurance policy for over 15 years, I developed a lump in my neck. I had to have it removed and biopsied. The test came back as negative. The following year my insurance was doubled, and the following year it was doubled again. Then while I was still paying it, they cancelled it with no explanation. I had no idea why, as I had no other health issues and thought I was in pretty good health. Of course now I realize why.
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Old 08-15-2009, 02:04 PM   #56
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If we had more of a balance of younger healthy people paying premiums to offset the Medicare patients, we wouldn't be going broke.
If we collected taxes on a "pay as you go" basis, we wouldn't be going broke.

Per my earlier post, if Congress could not get those tax increases through, then it says that the people really do not want that health care option at that price.

-ERD50
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Old 08-15-2009, 02:25 PM   #57
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If we collected taxes on a "pay as you go" basis, we wouldn't be going broke.

Per my earlier post, if Congress could not get those tax increases through, then it says that the people really do not want that health care option at that price.

-ERD50
Exactly.

The biggest obstacle I see keeping the pro folks and the con folks from getting together on the health care issue is that the pro folks see a new system that costs them less and the con folks see a new health system that costs them more.

I don't think anyone really believes we can implement a new system with excellent services and include the 50M currently uninsured folks and have it cost less, in aggregate, than what we're spending today. And it's not knowing what that incremental cost will be and who's going to pay it that's driving the con folks nuts.

The Administration has the resources to calculate some estimates and can recommend new sources of revenue to meet these costs real time. Why don't they do that? Are they stuck on the concept that they have to "put something over" on the citizens in order to get this to pass?

On the subject of special interest groups........ It's not just MegaCorp pharmasuitical companies and the AMA....... Unions who have negotiated sweet health care packages probably superior to whatever our new national plan will be, want to be exempted. Public employees at all levels want to be able to continue their current coverage unless the national plan turns out to be superior. Congress Critters want to keep their current coverage. Etc. etc.

One thing I learned from decades of managing people is that if you screw 'em all equally, they don't like that but will probably get over it. But if you screw some and not others, those screwed will rebel and fight you and hate you to the end of your days. Obama is learning this. Some people are worried they'll be less well off under a new plan and others will be better off and the lack of detail about who those groups will be and how the proposed changes will effect them is driving folks nuts.

Under whatever plan we have going forward, the vast majority of folks will need to pay in more than they take out. That's how insurance works. Somehow we have developed into a society where we want a health insurance plan where everyone gets more than they put in and yet the pot never runs dry.
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Old 08-15-2009, 03:43 PM   #58
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I wish this was a simple problem. I wish life was as simple as saying that every one can have free health care. I would be first on the band wagon for universal / government run/socialized medicine if it would work. The most remarkable thing is that every one on this board seems to be very kind and generous. The kind of people who are willing to give and give to see that others less fortunate than they have a good life. On average American's are the most generous people the world has ever seen. We desperately want people to succeed .

Reality has this terrible habit of raising it's ugly head. No matter passionately you feel about something it does not change reality and if you fight reality you are going to lose every time. The reality of this situation is simply this. You can not change peoples culture and behavior by giving them free things. We have wonderfully succeeded in driving the number of out of wedlock births through the roof. We have succeeded in placing the hard working tax payers in our country at great risk of losing every thing that they have worked for and we have succeeded in Balkanizing our wonderful country. We have placed our country at the very edge of insolvency. History proves to us that Socialism does not have good out comes.

Now there are simple actions that could cut the cost of health care greatly and provide every one in the country with the opportunity to have health care. But it would mean treating every one in the country equally. And that is not going to fly politically. It would be pretty simple to say that there is a universal health policy for every one in the country. Every one that wants to take it can. Rates are the same for every one regardless of race religion color or how much money they make or have. It could not be free for any one. It would be a pay as you go system. No stealing money from one group to give to another. It would wind up being inexpensive.

This sort of thing is not going to come out of Washington. The politicians in Washington are NOT your friends or parents. They are not interested any anyone's health care except their own. (They are not going to be on any socialized system they shove down our throats). They are only interested in one thing that is getting reelected and maintaining power. There is nothing known to man as addictive as power. They will gladly and with out the simplest twinge of remorse bankrupt the country and leave our children with a dept they can never repay as long as they stay in power.

With the Federal take over of Banks, Auto industry, and now the medical system we are at a turning point in our nation and history.

Hang on and HOPE!
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Old 08-15-2009, 06:22 PM   #59
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Yes politicians are primarily interested in being re-elected first, and doing the right thing second. However, sometimes they do succeed in passing some good legislation

Obama was willing to take on this very difficult issue, which most politicians avoid like the plague. Next he will take on social security reform. Again, something most politicians do not want to touch for fear of not being re-elected. So, I guess I don’t share your cynicism, and think once in a while we do get someone willing to stick their neck out to do the right thing. Granted not often enough, but politics is a tricky game. It’s one profession where always speaking the truth will dash your career very quickly.

I have Medicare and it would be in my best interest to not do anything to rock the boat, as it has worked just fine for me. But I cannot in all consciousness consider myself alone because it is ethically wrong. It is an unjust and inhumane system. Slave owners running large plantations 200 years ago were partaking in an inhumane system, but it worked just great for them.

Our current health insurance system is so flawed, it is a travesty. And if you think that you are immune, you may be very surprised in the future. So, people just may need to make some sacrifices to fix it. I think and hope that whatever is passed that it will evolve to a more cost effective system, and if that requires a government run single payer American style down the road, so be it.

If other countries can do it, so can we. The insurance companies will do nothing to change their current system on their own. Coverage and Cost will never be addressed by insurance companies voluntarily. They have to be forced. Did any of you watch the hearing with the insurance company representatives in congress? They stated unequivocally that they would not agree to stop the current “purge system”.
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Old 08-15-2009, 09:08 PM   #60
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Originally Posted by modhatter View Post
[FONT=Calibri][SIZE=3] The insurance companies will do nothing to change their current system on their own. Coverage and Cost will never be addressed by insurance companies voluntarily. They have to be forced.
If they were truly in competition with each other, they would do it to stay in business, voluntarily.

-ERD50
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