senator Franken

[Martha]

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).

 

[Martha]

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_Overview_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

 

[Midpack]

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...

 

[lets-retire]

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.

 

[modhatter]

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.

 

[ERD50]

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

 

[youbet]

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.

 

[Sevo]

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!

 

[modhatter]

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”.

 

[ERD50]

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

 

[samclem]

C
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.

Per this very interesting link provided by M Paquette on another thread, the Swiss spend slightly less of their GDP on health care than we do, have nearly universal coverage, and "the government" (i.e. taxpayers) pick up only 25% of the cost (vs 44.7% in the U.S.) . And, it's a market-based system--100% private insurance.

 

[Sevo]

I fully agree our present system is not just immoral it is insane. The maddening thing is that we got here through government intervention. The first step was when FDR locked health insurance to employment. Then in the 1960s when we started this ponzi scheme that we now have with medicare and medicaid. At that point market forces were simply destroyed and the cost of medicine started this upward spiral. The feds were poring tax payer money and borrowed money into the system. Like sharks to blood the trial lawyers started circling and are now one of the biggest contributors to reelection campaigns. Obama flatly came out and said he has no intentions of restricting law suits. For profit organizations took over most hospitals. Health insurance companies became giants and working through the government have basically held us all hostage. The unintended consequences are really starting to be felt by every one now and every one is in a panic. Which is kind of silly because we have all known for a long time that this that this is where we are going. We're Broke

Now the very same people who got us in this mess are offering to fix it by giving us a double dose of the medicine that we took the first time. Wow that's truly brilliant. We as a country have been brain washing into thinking that the only answer for any of our problems has to come from the Federal government. That is silly. The government is far far more often the cause of problems rather than the answer.

This system 1,000 + pages in the house and 600+ pages in the Senate that is going to rammed down out throats is going to do nothing more than make our problems worse in the long run. In the short run it is going to feel great. In the long run as a nation we are going to pay a terrible price.

I keep hearing over and over again about how other countries have such wonderful medical systems. I just don't see any one fleeing the US to get medical care in any of those countries ??

I do know this for a fact my mother in law got a combination Heart/ Liver transplant when she was 67. She is 70 now happy healthy , robust and enjoying life. My children see their grandmother often. That simply would have been impossible under the new plan proposed and it would be impossible in almost every other country in the world except for the US.

Hang on and hope.

 

[Martha]

I keep hearing over and over again about how other countries have such wonderful medical systems. I just don't see any one fleeing the US to get medical care in any of those countries ??

Some here go to Mexico and other countries for dental care. Not for quality reasons, but for cost reasons. Medical tourism is becoming more popular. Of course though you still need enough money to go to where you want for the care. But in general, people tend to and want to stay close to home for their medical care. And you can't always predict when you will need it and may not be in a condition to travel when you do.

I do know this for a fact my mother in law got a combination Heart/ Liver transplant when she was 67. She is 70 now happy healthy , robust and enjoying life. My children see their grandmother often. That simply would have been impossible under the new plan proposed and it would be impossible in almost every other country in the world except for the US.

I do not believe that this is the case. Good to hear your mother is doing well.

 

[M Paquette]

II keep hearing over and over again about how other countries have such wonderful medical systems. I just don't see any one fleeing the US to get medical care in any of those countries ??

Anyone can get care in most foreign countries. They'll just have to pay for it.

In the Swiss system, for example, essentially all Swiss citizens have insurance that covers 90% (10% copay) with a deductible from around 300 to 2000 Swiss Francs (279-1860 US dollars), depending on policy. (There are around 85 insurance companies, and they compete on policies offering benefits beyond the basic mandated level.)

You can use their hospitals and other medical services. If you as a foreigner don't have insurance they will expect a substantial deposit before they'll proceed beyond emergency care and stabilization. They ARE capitalists, after all.

http://healthcare-economist.com/2008/04/23/health-care-around-the-world-switzerland/

I do know this for a fact my mother in law got a combination Heart/ Liver transplant when she was 67. She is 70 now happy healthy , robust and enjoying life. My children see their grandmother often. That simply would have been impossible under the new plan proposed and it would be impossible in almost every other country in the world except for the US.

Are you sure this would be impossible under the proposed new plan? I can't find anything in it that would prevent this.

HR 3200

 

[Midpack]

The problems here are ultimately political; politicians, special interests and constituents protecting what they have. We can blame others all we want (and they're certainly not helping), but it's the mainstream voters that ultimately perpetuate our health care mess. Aside from that (difficult I know) - tell me why structurally the system in Canada, the UK, Switzerland, Germany or Taiwan could not work in the US? All are considerably less expensive than the US and the citizens by and large of those countries seem to think they have good health care systems. It's maddening, and what's being proposed sounds like institutionalizing our already costly system and adding the ponzi aspect to it even further.

 

[ziggy29]

Aside from that (difficult I know) - tell me why structurally the system in Canada, the UK, Switzerland, Germany or Taiwan could not work in the US? All are considerably less expensive than the US and the citizens by and large of those countries seem to think they have good health care systems. It's maddening, and what's being proposed sounds like institutionalizing our already costly system and adding the ponzi aspect to it even further.

I think the U.S. is far more balkanized and divided culturally than most developed nations, for one thing. That's also a hurdle when it comes to our education system, I think.

 

[lets-retire]

Paquette--Switzerland pays almost as much as we do of their per capita income on health care.

Midpack--structurally anything can be passed. I think what many people are concerned about is cost vs wait times. Are we willing to give up almost immediate care to save less than a couple thousand dollars per year? It sounds like many are not. Even if we were able to drop our costs 4% to match the Canadian or German systems it only works out to about $1800 per person in savings.

Not long ago on this very forum people were complaining about having to wait a few days for prescriptions to be filled. It turned out that most of these people were buying their drugs from places like Sam's, Costco, Walmart, basically the cheapest places they could find. They weren't paying for the customer service (being immediately available supplies) when they could afford the extra few dollars for it, then they were complaining that they weren't getting the customer service.

 

[Midpack]

Midpack--structurally anything can be passed. I think what many people are concerned about is cost vs wait times. Are we willing to give up almost immediate care to save less than a couple thousand dollars per year? It sounds like many are not. Even if we were able to drop our costs 4% to match the Canadian or German systems it only works out to about $1800 per person in savings.

I get the sense that the wait time issue is somewhat exaggerated by opponents. While I assume wait time would increase, I get the sense the UK and Canada have gotten a better handle on wait times since moving toward universal care. It is all too common for opponents in any debate, not just health care, to 'prove their point by exception.' It's easy to find failures with any system, and trotting out one or two horrifically disturbing cases is easy to do - and unfortunately persuasive with the uninformed masses. A broader view should dominate the debate, not exceptions. We can all find cases in the US where excessive waits or other issues has resulted in the death of someone. If automobiles weren't already accepted in the mainstream, I'd imagine opponents could really stir up the masses nowadays with a few choice lethal accident videos.

This may be biased, but it was informative to me news + public affairs player: video
Yes, I have posted this link before and others have undoubtedly seen it.

 

[M Paquette]

Paquette--Switzerland pays almost as much as we do of their per capita income on health care.

In the 2000 survey, Switzerland spent the most per-capita of all European countries, US $3,216, compared to the US spending at US $4,631. By GDP, in 2000 the US spent 13.2% of GDP on healthcare, while Switzerland spent 10.3%. In the 2005 survey the US spent 15.4% of GDP while Switzerland spent 11.4%.

Wait times and quality of treatment are considered to be similar or slightly better than in the US.

I find comparing the Swiss system to the US to be interesting because they just recently (1997) moved from a system very much like what the US had to a system relying on non-government insurance coverage, with mandated coverage for all. The government specifies the basic services to be covered, and what a basic policy must look like in terms of copay, deductible, and maximum out of pocket. Any company offering insurance has to offer a policy meeting those standards, but may also offer other policies, with different deductibles, additional covered services, etc.

They don't have the morass of government healthcare plans (Medicare/Medicaid/TRICARE/SCHIP, etc), instead providing a simple subsidy for those who could not otherwise afford coverage to bring the cost below about 10% of income.

The insurers have a guaranteed market, in exchange for meeting regulatory requirements on plans that they offer.

 

[eridanus]

In the 2000 survey, Switzerland spent the most per-capita of all European countries, US $3,216, compared to the US spending at US $4,631. By GDP, in 2000 the US spent 13.2% of GDP on healthcare, while Switzerland spent 10.3%. In the 2005 survey the US spent 15.4% of GDP while Switzerland spent 11.4%.

Three words: Lower physician salaries.

 

[haha]

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.

But really, isn't that the essence of a modern "democracy"? Give some highly targeted privileges to the the group, mostly Wall Street, that funds your campaigns and spinmeisters, and give cash awards and services to a large mostly non-taxpaying group that provides your votes.

Screw heavily anyone not in either of these groups. They are what BHO would call the rich, but I would call the middle class backbone of the economy and society.

Ha

 

[lets-retire]

In the 2000 survey, Switzerland spent the most per-capita of all European countries, US $3,216, compared to the US spending at US $4,631. By GDP, in 2000 the US spent 13.2% of GDP on healthcare, while Switzerland spent 10.3%. In the 2005 survey the US spent 15.4% of GDP while Switzerland spent 11.4%.

Wait times and quality of treatment are considered to be similar or slightly better than in the US.

I find comparing the Swiss system to the US to be interesting because they just recently (1997) moved from a system very much like what the US had to a system relying on non-government insurance coverage, with mandated coverage for all. The government specifies the basic services to be covered, and what a basic policy must look like in terms of copay, deductible, and maximum out of pocket. Any company offering insurance has to offer a policy meeting those standards, but may also offer other policies, with different deductibles, additional covered services, etc.

They don't have the morass of government healthcare plans (Medicare/Medicaid/TRICARE/SCHIP, etc), instead providing a simple subsidy for those who could not otherwise afford coverage to bring the cost below about 10% of income.

The insurers have a guaranteed market, in exchange for meeting regulatory requirements on plans that they offer.

You can use GDP if you'd like, I prefer to use per capita income vs per capita health care expenditure. I feel it brings the amounts down to a personal level and shows what each person in the society would be spending. Granted these are strictly averages, but since we are talking about a much larger population and variety of personal choices in America neither is really all that accurate. In Washington DC for example, the per capita expenditure for health care subtracting admin and several other costs (I think should be included) is still over 8k per year. Conversely in the state I live it is more around 4k per year.

Using WHO's stats from 2006. The per capita income for the US was $44070 and for Switerland it was $40840. Total per capita expenditure at average exchange rate for health care is $6714 for the US and $5878 for Switzerland. Figure out the percentage of per capita income spent on per capita expenditure for health care and your results will be very similar to 15.2% for the US and 14.4% for Switerland, less than 1% difference.

 

[Sevo]

Switzerland seems like such a wonderful country. I hope one day to visit there. I think it is important when we start doing comparisons between our systems and theirs that we remember that they are a small country with a very homogeneous population. I was surprised that their entire population is less than 8 million people. We have to remember that that we have more illegal aliens, by a big margin in this country than the entire population of Switzerland! In fact we have almost as many people in prison, on parole, or probation as Switzerland has citizens.

Never the less their private system seems much more efficient than ours. In fact any fee for service system will be much more efficient than this monstrosity that the Feds have mandated to us. If we could move to the state level with health care programs and get the Feds out of the mix I think that some of the smaller states might successfully go to a Swiss type system. Having the Federal government mandate profoundly complex plan to to every State and person in the country is a mistake of huge proportions.

Never the less unless basically every tax payer in the country steps up to oppose this monstrosity coming through the congress. We are going to get it shoved down our throats and we are just going to have to live with it for a while. Or at least until the Chinese and Japanese don't show up for the Treasury auctions. We are BROKE as a nation. Or government can not send out the checks it is printing as we speak with out massive borrowing. How we are going to pay for all this with out starting to raid 401K's and massive tax increases is beyond my under standing. All we can do now is

hang on and hope

 

[haha]

Switzerland seems like such a wonderful country. I hope one day to visit there. I think it is important when we start doing comparisons between our systems and theirs that we remember that they are a small country with a very homogeneous population. I was surprised that their entire population is less than 8 million people. We have to remember that that we have more illegal aliens, by a big margin in this country than the entire population of Switzerland! In fact we have almost as many people in prison, on parole, or probation as Switzerland has citizens.

The US is a 3rd world country, with a small group of very wealthy oligarchs at the top, and below a huge underclass of uneducated and economically disabled illegals, criminals, welfare clients and others who will never produce at the level that the nation spends to support them and their children.

Sandwiched betwee these two groups is a shrinking productive middle class.

Much as I dislike it, I think that our problems will never be solved. In principle it could be done; but it will never happen.

Ha

 

[REWahoo]

The US is a 3rd world country, with a small group of very wealthy oligarchs at the top, and below a huge underclass of uneducated and economically disabled illegals, criminals, welfare clients and others...

Where do 'pessimistic old curmudgeons' fit in this classification?