The Health Insurers have already won

[youbet]

Quote:

Originally Posted by mews We have this idea that the employer-linked coverage is the god-given model, the right, true, and one way, just because it is a few generations old at this point.

Not true mew. Apparently you have this idea that the eimployer-linked coverage is the god-given model........

But WE don't. Not by any means.

[youbet]

Quote:

Originally Posted by . . . Yrs to Go As we're talking about a government plan, the government would be the "decider".

Although Obama has vowed there would be no "panels" deciding what procedures would be covered or who qualifies for them.

[Gone4Good]

Quote:

Originally Posted by IndependentlyPoor A free flow of information and knowledgeable consumers are required for a free market to function, and neither exists in the case of medical care.

This is a market design problem, not a market problem. And this design flaw is intricately linked with 1st dollar insurance.

You don't have the information you want because you don't need it. The doctor says "I think you should have an MRI" and you say "Sure". The doctor doesn't care that it is a $3,000 test and neither do you. You don't know whether the test is absolutely necessary, or whether a less expensive alternative is available, because you have no reason to ask. Nobody knows. Nobody cares.

If you were talking to a car mechanic instead of a doctor the conversation would be completely different. That's true even for people who can't tell a piston valve from a mitral valve. There are all kinds of things I'm not expert in. That doesn't prevent me from engaging in a free market for services.

And just to be sure, I'm not talking about trying to force people to comparison shop for a heart transplant. At ~5% of AGI, most people's deductible is going to get chewed up pretty early on by any large procedure so market forces stop working at that level anyway. It is for those larger, more complicated, and more expensive items where the government needs to employ comparative effectiveness research (a.k.a. "Death Panels") to hold down costs.

[Gone4Good]

Quote:

Originally Posted by youbet Although Obama has vowed there would be no "panels" deciding what procedures would be covered or who qualifies for them.

I don't believe Obama is posting on this message board (pssst . . . I'm not Obama) so what I'm suggesting really doesn't have any bearing on what he may, or may not, support.

I happen to be a proud supporter of "Death Panels" if that term, as it has been used recently, is defined as government actually measuring the benefits of its programs against their costs. That, BTW, is something "conservatives" used to support too.

Besides, nowhere did I see a prohibition, in either my comments or in any healthcare bill pending before Congress, against people either buying supplemental insurance or paying out of pocket for those things not covered by a government plan. So someone will have to explain to me why if the government doesn't provide something that people can still get on their own, it amounts to a death sentence. I guess by that logic, I've been sentenced to starvation because the government doesn't buy my food, but yet, somehow I still eat.

[Martha]

Quote:

Originally Posted by youbet Although Obama has vowed there would be no "panels" deciding what procedures would be covered or who qualifies for them.

Has he? Someone has to decide what is covered and what is not covered. The example I gave earlier is that I don't want goofy treatments paid for with government dollars, such as chiropractic treatments for allergies.

[youbet]

Quote:

Originally Posted by Martha Has he?

Yes. Empathically. Now whether he gets what he wants or not is open to question.

[youbet]

Quote:

Originally Posted by Martha The example I gave earlier is that I don't want goofy treatments paid for with government dollars, such as chiropractic treatments for allergies.

Using "goofy treatments" as examples understates the problem. How about some examples where solid justifications can be given for allowing or not allowing some given treatment for a specific individual under specific circumstances? Who will make the decisions on all the "close calls?"

[haha]

I want Charles Rangel to decide. He may have memory problems regarding real estate investments and taxes, but the man dresses well. Geithner is qualified as to tax irregularities, but he falls short on the all-important clothes criterion.

Ha

[youbet]

Quote:

Originally Posted by . . . Yrs to Go what I'm suggesting really doesn't have any bearing on what he may, or may not, support. .

That, for sure, is the understatement of the day!

But, what he does support might just be what happens......... or not.......

[modhatter]

Saw this guy on TV. and was impressed with him. Don't remember if it was on Book Review or not.
His name is T.R. Reed. He has a book out called:

"The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care "

Sounds like a very informative book for the members here "obsessed" with the current discussions on health care. (as I am) You can read all the reviews on Amazon. He has traveled the world to uncover the truths, and false conceptions of each countries health care system. He has also been a patient himself in six of these countries.

I just went on line to see if it was available on Audiobook, but I guess it is too new for audio yet. I am leaving on a long............. drive on Sunday, and have no time to order the book from Amazon. Would hate to have to pay $25 at book store for it, when I can get it for $15. Anyway, thought some of you other folks may be interested in it, as the subject matter of the book has been argued extensively on this thread.

[Gone4Good]

Quote:

Originally Posted by youbet How about some examples where solid justifications can be given for allowing or not allowing some given treatment for a specific individual under specific circumstances? Who will make the decisions on all the "close calls?"

The whole discussion of government bureaucrats denying coverage is a canard that assumes a false choice. In the "new" system a panel of government bureaucrats who deny coverage will replace the existing panel of insurance company bureaucrats who deny coverage. So what.

And for those who want ridiculously heroic end of life care and fear the government may (rightfully) not pay for it, I'm sure ridiculously-heroic-end-of-life-care insurance will be available from private insurers, just like Medi-gap insurance exists for those things not covered by Medicare.

[youbet]

Your comments are unrelated to what I said. Perhaps you meant to quote another post?

[lets-retire]

Quote:

Originally Posted by Martha Do you mean the finance committee bill? Here is the link to the bill and amendments: Finance

I don't see many details in that proposal. That is where the problem lies, the details.

[Martha]

Quote:

Originally Posted by youbet Using "goofy treatments" as examples understates the problem. How about some examples where solid justifications can be given for allowing or not allowing some given treatment for a specific individual under specific circumstances? Who will make the decisions on all the "close calls?"

Then I favor coverage.

I assume that there will be some restrictions and there needs to be. For example, my risk pool has formulary and non-formulary drugs and I will pay a lot more going off of the formulary. Clearly experimental treatments are unlikely to be covered. They aren't now. (If you seek that kind of treatment a trial may be the answer). If a provider prescribes a treatment that does not have good evidence to back it up, maybe the provider should have to justify what they are doing to get reimbursed. Rightly or wrongly, insurance companies do some of this now. What insurance companies don't have prior authorization before surgical procedures? Does such a review system fall under the term "panels?" Are they currently effective at reducing uneccessary care or error or are they just a pita for the provider? What exactly was the President refering to? I would like to know the context.

I know that there are difficult lines to draw. I favor allowing treatment (that has evidence to back it up) provided that there is clear communication of the facts with the patient and the family. My grandniece had a newer procedure to lengthen her intestine. It wasn't so much experiemental as rare, costly, risky and the odds of success were low. It was covered by Medicaid. From talking to a poster who is an MD in Canada, this procedure likely would have been approved there as well. In that kind of case I think medical professionals need to not just assume surgery is the thing to do but talk over with the family all the ramifications. There wasn't enough of that. This is far from being a "death panel" but instead is getting all the facts and being realistic. But this isn't something to mandate, but to encourage discussion.

The whole issue of necessary vs unnecessary care is where we need a lot of help from medical providers to help figure out ways to get quality care but not unnecessary care. Working on alternative incentive systems may help. Strengthening our primary care system may help. I have read that there are better outcomes when primary care doctors have the time and resources to quarterback care by other providers.

I do not have a feel for how much real waste there is in the system.
But I do feel that there is a lot of high cost just because cost can be high. People too often feel expensive is better.

[youbet]

Quote:

Originally Posted by Martha I assume that there will be some restrictions and there needs to be. .

Of course, and the examples you give seem reasonable and, in fact, typical of our private insurance system today. But we're flaunting change here, so many of us who are satisfied with the current system understandably wonder what the future holds, especially with regard to the availability of medical service and what allowed coverage will be as compared to today.

You used phrases such as "encourage discussion" and "help from medical providers." Can't argue with those and I'm happy that's the situation I'm in today. I hope going forward new "systems of control" aren't put in place to interfere.

I think that the sooner the govt proposals include significant detail about what the new system will look like, who'll call the shots and how we'll pay for it (free of hocuspocus numbers please), the sooner people who are likely to give up some level of benefits will feel more comfortable doing so.

The fact that Medicare is a govt program and tens of millions of citizens are already enrolled is ofter thrown out in these discussions. Well, let's apply the Medicare example to the question of coverage and who is allowed to have what. If the new govt health plan covers the same procedures, treatments and drugs as Medicare today and the rules are determined in the same way, does that sound good to you? Or are you saying the future plan needs to be more restrictive than Medicare with more limitations applying to certain people in certain situations?

[Martha]

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Originally Posted by lets-retire I don't see many details in that proposal. That is where the problem lies, the details.

Yup.

[donheff]

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Originally Posted by haha I want Charles Rangel to decide. Ha

I prefer the guy working for the insurance company who gets paid for performance (i.e. his bonuses are based on how many claims he successfully denies).

[Martha]

Quote:

Originally Posted by youbet The fact that Medicare is a govt program and tens of millions of citizens are already enrolled is ofter thrown out in these discussions. Well, let's apply the Medicare example to the question of coverage and who is allowed to have what. If the new govt health plan covers the same procedures, treatments and drugs as Medicare today and the rules are determined in the same way, does that sound good to you? Or are you saying the future plan needs to be more restrictive than Medicare with more limitations applying to certain people in certain situations?

If you are getting at denying a treatment to someone just because they are old, I don't favor that at all. That said, I can imagine a situation where someone might feel like they are not getting something they want paid for when in fact it makes no sense to have the treatment. But this is more of an education issue than a coverage issue.

[mews]

Quote:

Originally Posted by youbet Not true mew. Apparently you have this idea that the eimployer-linked coverage is the god-given model........ But WE don't. Not by any means.

Let me be more precise - the larger "We" -You know - "We the People" -

"We the people on this board" are a very small, self-selected minority. To generalize from what we know, to 'everybody knows' - there is that phrase about the word 'assume'

ta,
mew

(Where did you get the idea that I had that idea about the idea of health care -)

[youbet]

Quote:

Originally Posted by Martha If you are getting at denying a treatment to someone just because they are old, I don't favor that at all. That said, I can imagine a situation where someone might feel like they are not getting something they want paid for when in fact it makes no sense to have the treatment. But this is more of an education issue than a coverage issue.

Ahhhh..... Noooo....... Not getting at anything other than exactly what I said. And specifically NOT the issue of "denying a treatment just because they are old."

We were discussing limitations on what coverage and for who a new nationalized health plan should have. Trying to get away from generalized examples, I simply asked if you would be comfortable with the same limitations on what and who that Medicare has today. Just trying to get a handle on where you stand today beyond the examples. You seem to be saying that you'd be for more limitations.