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Old 09-10-2009, 06:29 PM   #81
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If the gumment decides to create a single-payer system, I could live with it*, but I don't think additional taxpayer money should fund anything but the most needy of cases. The system should be set-up based on premiums that will cover the costs...

* Like I have a choice...
The group that is in favor of single payer seems to keep saying it will clearly be cost effective, because the profit motive and company overhead is removed. And they keep pointing to the US versus other countries with single payer (the govt) with lower costs and better results. I still think those improved costs/results have more to do with those being "other countries" than it does with them being "single payer".

So here's a parallel to back that up - education is provided by the US and by those other countries. So how do we compare?

Education in the United States - Wikipedia, the free encyclopedia

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Competitiveness

The national results in international comparisons have often been far below the average of developed countries. In OECD's Programme for International Student Assessment 2003, 15 year olds ranked 24th of 38 in mathematics, 19th of 38 in science, 12th of 38 in reading, and 26th of 38 in problem solving.[80] In the 2006 assessment, the U.S. ranked 35th out of 57 in mathematics and 29th out of 57 in science. Reading scores could not be reported due to printing errors in the instructions of the U.S. test booklets. U.S. scores were far behind those of most other developed nations.[81]

Funding for K-12 schools

According to a 2005 report from the OECD, the United States is tied for first place with Switzerland when it comes to annual spending per student on its public schools, with each of those two countries spending more than $11,000 (in U.S. currency). [60] Despite this high level of funding, according to the OECD, U.S. public schools lag behind the schools of other developed countries in the areas of reading, math, and science. [61]
So no one spends more than us, yet we are far below the average in performance. If we get this from govt run eduction, why would be expect govt run health care to be different?

I think vouchers for education would help - let companies compete on a level playing field for students. And I think vouchers for health care would help. How can a company compete with "free" health care? They can't, so the statements that people will still have a choice are a distortion.

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Old 09-10-2009, 06:56 PM   #82
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Well, there will still be a bureaucracy administering a govt plan, so I think that is a wash, at best.

There are plenty of good public schools, and I'll venture that the demographics of the school district have more to do with it than federal funding, or lack thereof.
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Old 09-10-2009, 07:14 PM   #83
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The system should be set-up based on premiums that will cover the costs...
There ya go........ That's my main concern regarding the proposals, or rumored proposals, drifting around Congress now. No one seems to want to be up front about discussing how much it's going to cost and who is going to pay for it.

We really must not create another Medicare where premiums and funding going in fall short of services coming out leading to a future crisis. We're big kids all interested in living a life of leisure instead of working. We should understand, since we're pro's at LBYM to fund FIRE, that whatever new medical insurance plan pops out of those damn Washington buttholes congresscritters, it better be on a pay as we go basis. We, especially those folks on this board who understand how things work financially, owe to the next generations to not have to fund our medical care.
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Old 09-10-2009, 07:25 PM   #84
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There are plenty of good public schools, and I'll venture that the demographics of the school district have more to do with it than federal funding, or lack thereof.
True - however, I would expect the performance per $ spent to improve if there were competition. That's why I would like to see *real* competition in both schools and health care. Vouchers are the only way I know to go about that.

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Old 09-10-2009, 10:41 PM   #85
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True - however, I would expect the performance per $ spent to improve if there were competition. That's why I would like to see *real* competition in both schools and health care. Vouchers are the only way I know to go about that.

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Competition doesn't matter when all the competitors have to negotiate a fee schedule with the same providers and the providers know they hold the all the cards.

The public plan option is only designed to make everyone feel like any one can get insurance. But insurance is not the problem with health care: how we pay for services is the problem.

When debating this problem, it is important to remember that health insurers don't create the cost of health care, they only sell a commitment to help pay the bills when presented. For the most part they are constrained in the premiums they charge AND the benefits they provide by the state departments of insurance. They also aren't responsible for the quality of care (providers are), they can point out which providers seem to be more effective, and they can try to eliminate waste, but they can't control it.

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Old 09-10-2009, 11:35 PM   #86
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My employer provides health insurance. The marketplace expects this and aside from choosing a new employer, I have very little influence in what insurance I get or how much it costs. My employer changes plans annually seeking lower costs. My insurance may restrict what doctors or treatments it will cover. My insurance does side deals with medical providers and sets the rates they will pay for services. Indirectly I benefit from this (or not) as providers set list rates for services way high, so insurers can bargain them down or perhaps to subsidize insurance negotiated rates. In almost every case, there is a deductible amount on my insurance coverage, so I end up paying for almost all my care anyway, but costs are hidden from me and subject to all the insurance side deals which I have very little visibility into, so in most case I do not know how much anything will cost until I've already incurred the bill. For medical equipment, there is a similarly arcane system in which my insurance will "rent to buy" equipment for prices well above real costs, so my contribution towards deductible "rental" is often considerably higher than an actual purchase at true street price would have been.

I see nothing in any of these proposals to improve any of this.

Meanwhile, what I really want is medical INSURANCE. Let me pay the real cost of the services at fair competitive prices, but I want to also buy insurance to protect against the rare but astronomical cost of longshot medical risks. I do not need or want so called insurance which partly pays via complicated formulas and bureaucracy of allowable procedures for any and all medical services from the very first dollar. As long as this so-called insurance is in the marketplace distorting pricing, I cannot buy services at fair prices. As long as employers are selecting my "insurance plan" for me, there is no viable marketplace for buying insurance that I really need without the inclusion of the first dollar plans, restrictions, deductibiles and bureaucracy.

I see nothing in any of the proposals that will improve any of this either.
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Old 09-11-2009, 06:29 AM   #87
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The second sentiment is your opinion and is probably not shared by the majority of Americans and is certainly not shared by most other first world countries.
Since this country seemed able to build itself into a world leader without national health care, I really don't see how health care can be a requirement to maintain the social fabric of a society. We have over 200 years without national health care and our society has operated just fine. I think we would last several hours without law enforcement or the fire department before we were thrown into chaos.
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Old 09-11-2009, 08:04 AM   #88
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Competition doesn't matter when all the competitors have to negotiate a fee schedule with the same providers and the providers know they hold the all the cards.

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I'm not suggesting that opening up competition in the insurance area would solve all the problems, but I think it is an important part of the process.



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... so in most case I do not know how much anything will cost until I've already incurred the bill. ....

I see nothing in any of these proposals to improve any of this.

Meanwhile, what I really want is medical INSURANCE. Let me pay the real cost of the services at fair competitive prices, but I want to also buy insurance to protect against the rare but astronomical cost of longshot medical risks. ...

I see nothing in any of the proposals that will improve any of this either.
I agree completely. This article was linked before, but it does cover some of this:

The Atlantic Online | September 2009 | How American Health Care Killed My Father | David Goldhill

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Insurance is probably the most complex, costly, and distortional method of financing any activity; thatís why it is otherwise used to fund only rare, unexpected, and large costs. Imagine sending your weekly grocery bill to an insurance clerk for review, and having the grocer reimbursed by the insurer to whom youíve paid your share. An expensive and wasteful absurdity, no?
If more of us had a high deductible policy and something like an HSA account, I think we would be demanding (and getting) transparency.

And here is a real life example, Lasik procedures, which are rarely covered by insurance:

The Competitive Advantage - ABC News
Quote:
"I can't get away with not telling the patient how much exactly it's going to cost. No one would put up with it," Bonanni said...

Laser eye surgeons have to compete for their patients' business. And a result of that competition is lower prices.

In every other field of medicine, the price is going up faster than consumer prices in general," said Dr. John Goodman, president of the National Center for Policy Analysis.

"[But] the price of Lasik surgery, on average, has gone down by 30 percent."

Prices dropped even though doctors pay for advertising. And while the procedure got cheaper, it also got better.
OK, that was from John Stossel, who some of you may not care for, but can you refute the content?

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Old 09-11-2009, 09:16 AM   #89
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I agree completely. This article was linked before, but it does cover some of this:

The Atlantic Online | September 2009 | How American Health Care Killed My Father | David Goldhill
I loved this article. It talks about the real problems.

Not that I'm necessarily opposed to the proposals floating around now (as much as I can tell about them). They just do not seem to address what I want addressed. They seem to be more directed to getting everyone covered by insurance than fixing the problems in the current system. That's fine, just not the real reform that we ultimately WILL need.

Meanwhile, I could drop my employer coverage and buy my own high deductible with HSA insurance. It would save my employer money and cost me more for insurance since I give up the employer subsidy. Also, since my high deductible company would not be in the same position as the first-dollar insurance companies, they would not have the same power to bargain (set) fees for services, so any health care that I do need would be billed to me at higher rates. Overall, I see no reason to take this kind of financial hit, so I'm still stuck where I was before.
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Old 09-12-2009, 10:44 PM   #90
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Since this country seemed able to build itself into a world leader without national health care, I really don't see how health care can be a requirement to maintain the social fabric of a society. We have over 200 years without national health care and our society has operated just fine. I think we would last several hours without law enforcement or the fire department before we were thrown into chaos.
Agreed.

1) Get rid of the employer-insurance tax break.
2) Drop Medicare.
3) Drop the VHA.

Voila! We're out of the health insurance game entirely.
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Old 09-13-2009, 06:51 AM   #91
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Agreed.

1) Get rid of the employer-insurance tax break.
2) Drop Medicare.
3) Drop the VHA.

Voila! We're out of the health insurance game entirely.
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Old 09-13-2009, 06:52 AM   #92
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The facts need to be separated from the fiction. Blocking efforts to have any meaningful debate over reform of any type is the goal of the big insurance providers. They love the extremist positions that cast fear and doubt on the simple efforts to look beyond what we have. The fear of the unknown and the straw men being created in this debate are low points in our nation's history. Listen to what is being said, ask good questions, ask more questions, read and study, and in the end if you think the US healthcare payment and insurance situation is what you want then voice your opinion. The reckless emotion filled fear stories are a shame. True support and true opposition to this effort need to have rational and careful study and debate....not some radio hosts blowhard rants seeking to enrich themselves. If you or your family has never encountered exclusion or not being insured or not being able to leave a job no matter what due to not portability or pre-existing conditions maybe you can't understand the urgent need for some type of reform.
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Old 09-13-2009, 07:22 AM   #93
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The facts need to be separated from the fiction. Blocking efforts to have any meaningful debate over reform of any type is the goal of the big insurance providers. They love the extremist positions that cast fear and doubt on the simple efforts to look beyond what we have. The fear of the unknown and the straw men being created in this debate are low points in our nation's history. Listen to what is being said, ask good questions, ask more questions, read and study, and in the end if you think the US healthcare payment and insurance situation is what you want then voice your opinion. The reckless emotion filled fear stories are a shame. True support and true opposition to this effort need to have rational and careful study and debate....not some radio hosts blowhard rants seeking to enrich themselves. If you or your family has never encountered exclusion or not being insured or not being able to leave a job no matter what due to not portability or pre-existing conditions maybe you can't understand the urgent need for some type of reform.
All I can say is I compared the insurance I had with what is being imposed...uh...proposed and I came out ahead with private insurance. Simple assumptions made were the cost of insurance would remain the same (unlikely due to increased demand resulting in increased costs). I would only have the minimum coverage required at the premium level. I don't see where it is advantageous for a company to offer more because odds are add-ons would be money losers. The end result is with current "bad" insurance I paid IIRC about $500 for the wife's surgery. If I had government health care I would have paid in excess of $3000. At the time I could not afford that amount and she would still have the issue that caused her to go to the hospital in the first place.
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Old 09-13-2009, 11:50 AM   #94
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I agree with his diagnosis of the problem, but if you look at his solution it is entirely unworkable.

A "catastrophic insurance plan" with benefits starting at $50K? Is that annually?

"Chronic conditions with expected annual costs above some lower threshold would also be covered." By who? Presumably a single payer government plan, although he doesn't say. Wouldn't private insurers just dump unprofitable chronically sick individuals on to the taxpayer?

He suggests diverting existing Medicaid spending to give 60MM low income individuals a couple thousand dollar HSA contribution. But then how do people currently relying on Medicaid pay for health care?



I completely agree that individuals should have more skin the in the game when it comes to paying for health care. 1st dollar, third-party payment schemes like our current system are a horrible idea. But we also have to recognize that someone has to shoulder the burden of the chronically ill. Private companies will never willingly do that.
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Old 09-13-2009, 12:11 PM   #95
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And here is a real life example, Lasik procedures, which are rarely covered by insurance:

The Competitive Advantage - ABC News
Yes, but think for a moment about what is happening with Lasik. It is a completely optional procedure. One that I could benefit from, but have chosen not to because of the cost. My, and countless other peoples, decision to forgo the procedure is what puts downward pressure on prices. Now apply that same logic to a heart transplant.
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Old 09-13-2009, 01:36 PM   #96
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RE: The Atlantic Online | September 2009 | How American Health Care Killed My Father | David Goldhill

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I agree with his diagnosis of the problem, but if you look at his solution it is entirely unworkable.
Yes, I don't necessarily agree with everything in the article, but I do think there are some nugget of wisdom in there.


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Wouldn't private insurers just dump unprofitable chronically sick individuals on to the taxpayer? ...

But we also have to recognize that someone has to shoulder the burden of the chronically ill. Private companies will never willingly do that.
As long as insurance is an "opt in" this will always be a problem. If we all had a voucher, and everyone was going to be covered (by private or public, their choice), there would be no underwriting, and this problem would go away. The chronically ill would just be a normal representation of the total pool, so average premiums would cover them. That's not true when most chronically ill would want to self-select insurance, and many healthy people would opt-out on insurance.


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Yes, but think for a moment about what is happening with Lasik. It is a completely optional procedure. ...

Now apply that same logic to a heart transplant.
It is clearly easier to be a "smart shopper" for an optional and non-time-critical procedure. But it seems to "work" (for the most part), in other fields. If you call a tow truck because your car broke down on the way to an important meeting, the guy doesn't get there, knowing it is too late for you to call anyone else, and start asking "what is this meeting worth to you?". He's going to charge the normal fee for that service, maybe you pay a reasonable fee to expedite if you want (I got three calls in front of you...).

What we need is transparency. Hospitals should post their charges. I guess this is why an ins co, or govt agency, could be helpful to us. As individuals, we may never need a heart transplant so we don't spend energy worrying about who does it best for a reasonable cost. But the ins co or govt agency can consolidate all this for the many cases they handle, and steer patients to the best values, which should drive cost/benefits to improve over time.

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Old 09-13-2009, 02:13 PM   #97
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As long as insurance is an "opt in" this will always be a problem. If we all had a voucher, and everyone was going to be covered (by private or public, their choice), there would be no underwriting, and this problem would go away.
But it wouldn't because the insurance company still has a powerful financial incentive to shed unprofitable customers, raise their rates, deny claims, or withhold service in other ways ("please hold while your insurance representitive serves more profitable customers"). The only way to prevent them from doing that is to have very invasive regulation - so much so the merits of private insurance become somewhat questionable.

This is why every plan that seriously tries to tackle the chronically ill invariably leads to a "single payer" system. Most "consumer driven" proposals assume the chronically ill are magically taken care of in some unexplained manner. (David Goldhill, in his 11,000 word Atlantic essay, devotes just 14 words to the subject.)

BTW, there is no reason "single payer" insurance can't also have high deductibles and be "customer driven" with respect to suppliers.
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Old 09-13-2009, 02:36 PM   #98
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It is clearly easier to be a "smart shopper" for an optional and non-time-critical procedure. But it seems to "work" (for the most part), in other fields. If you call a tow truck because your car broke down on the way to an important meeting, the guy doesn't get there, knowing it is too late for you to call anyone else, and start asking "what is this meeting worth to you?".
A couple of comments here . . .

The reason a "free market" works for Lasik and might not for other medical services goes beyond just the time-critical nature of the procedure. It goes to the very heart of how a free market works. If you look at a standard supply & demand chart in an Econ 101 text book you will see that an equilibrium price leaves demand unmet. In the case of Lasik, that unmet demand is me, and others, who think the price is too high. In the case of a heart transplant (and many other medical procedures) unmet demand is terminal. So that demand can not be "rationed" out of the market by price (at least as long as we don't want people to die for lack of medical care). But when you add in the demand of all the people who can't afford the procedure, and who wouldn't get it under a true free market, (i.e. move your demand curve to the right) the price of that service rises . . . it has to.

Point two, I strongly suspect that most places have pricing regulations on tow truck operators because of just the kind of abuse you mention. Imagine doing that for the entire medical profession.

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Jordan says he's pleased with the county's ordinance that regulates some aspects of towing, like the amount that can be charged. "You have got to have someone enforce it," he stated. "There is too much blatant theft out there, especially with overcharging."
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Old 09-13-2009, 09:26 PM   #99
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I watched a segment on TV today with Democratic Senator of New Mexico. He mentioned something concerning waste when he was talking about taxing the "gold Plated" insurance policies. He explained that when people who have these policies where everything is paid for and there is no co-pays or limitations, then spending unnecessary time at doctors offices becomes of no consequence to them.

Before getting Medicare, I had a HMO, and had to stay in the network and needed a primary doctor's referral to go to a specialist. It was a bit of a pain, but doable. Now that I have Medicare, I don't have to consult my primary doctor, I can go to whoever I want to whenever I want to. This is more convienient of course, but in all honesty I can see where this freedom is abused. Since I have no skin in the game, it is just too easy to run to any specalist I want to.

To me this is abusing the system, so I have developed a built in Conscience in which I consider whether I think a new doctor's visit if really necessary. I do not want to cause Medicare any additional unnessesary expence. So I agree with the Senator, such freedom at no cost - causes a lot of waste, and there are steps that can be taken to curb it and reduce costs. There are many other areas I think where costs can be reduced, but will spare you.
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Old 09-13-2009, 10:10 PM   #100
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What we need is transparency. Hospitals should post their charges. I guess this is why an ins co, or govt agency, could be helpful to us. As individuals, we may never need a heart transplant so we don't spend energy worrying about who does it best for a reasonable cost. But the ins co or govt agency can consolidate all this for the many cases they handle, and steer patients to the best values, which should drive cost/benefits to improve over time.

-ERD50
ERD,
Check your insurance plan's website for members. Many do have comparative information on hospital procedures. They won't tell you exactly what it costs, but they will tell you which facilities are the most effective/efficient, just like looking at a restaurant review.

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