Debt/Deficit/Taxes and Health Care Reform

[chinaco]

We may be looking at a future round of health care legislation that could lead to some form of Universal Health Care.


Bottom line: A big part of the problem with the debt and deficit is the continued spiraling cost of health care.

The discussions going forward could lead to real health care reform (a transition plan to some form of Universal Health Care).

The same old problems will come up... business special interests will try to jockey for position (read their gain).

The issue that has always been so peculiar (to me) is that we (in the US) spend much more than anyone else and have poor health statistics. We have to be overpaying! Something does not seem right!

IMO - they have the momentum to make that sort of change in the coming debt talks. But the problem is that there are many who simply benefit from the current dysfunctional system. They will fight to keep it as is.

 

[MichaelB]

The McKinsey study on health care has been referenced here multiple times. Here is a link McKinsey & Company - Synthesis - Accounting for the cost of health care in the United States - January 2007

Their summary: the prices are high, there is too much administrative overhead because there are too many organizations involved, and there is overuse because there is no incentive to use less.

 

[youbet]

there is overuse because there is no incentive to use less.

+1

And there comes the rub. How do you construct incentives that discourage excessive or unnecessary use of the system that don't deprive care from those least able to pay? Or that don't depend on a thick "rule book" influenced inappropriately by politics?

Tough issues.

 

[ERD50]

+1

And there comes the rub. How do you construct incentives that discourage excessive or unnecessary use of the system that don't deprive care from those least able to pay? Or that don't depend on a thick "rule book" influenced inappropriately by politics?

Tough issues.

It is tough, but I think there are huge steps we could take before we risk depriving anyone of their needs. One thing would be price transparency.

In another thread, I was bringing up the Medicare wheelchair fiasco again. Some people claim they could have bought a perfectly adequate wheelchair for less than their co-pay for a 12 month rental. Now, if that info was transparent and the choice was offered, the patient would have:

A) Saved money out of pocket.
B) Had a wheelchair that they could decide to keep if needed later, or sold, donated, or lent to another individual.

Its a win-win-win-win (patient, govt, tax-payers,recipient of the hand-me-down wheelchair). And the recipient may start the savings all over again!

Price transparency and options would go a long way it seems.

-ERD50

 

[chinaco]

+1

And there comes the rub. How do you construct incentives that discourage excessive or unnecessary use of the system that don't deprive care from those least able to pay? Or that don't depend on a thick "rule book" influenced inappropriately by politics?

Tough issues.

It will never be perfect and there will always be some issues.

I was told England has tried to deal with this issue.... maybe someone can comment about how it works.

 

[youbet]

Price transparency and options would go a long way it seems.

I agree that price transparency is a good thing and sadly missing in much of our health care market. The issue remains, however, how do we motivate people to be aware of "value" in health care without putting an onerous burden on those least able to pay?

Make no mistake, I'm all for having our citizens become good health care shoppers and for having health care providers competing for their business. It's constructing the safety net below the low income folks that sometimes mystifies me as to how we do it with enough compassion to satisfy my "soft side" while still providing impetus to shop for value and act responsibly.

I give the Canadians (and other similar systems) credit. They have their "rule book" which provides services some feel are wasteful and unneccesary and doesn't provide some services others feel are needed. But it is what it is and they live with the discord politically while providing what seems to be a reasonable level of basic healthcare.

 

[MichaelB]

It is tough, but I think there are huge steps we could take before we risk depriving anyone of their needs. One thing would be price transparency.

In another thread, I was bringing up the Medicare wheelchair fiasco again. Some people claim they could have bought a perfectly adequate wheelchair for less than their co-pay for a 12 month rental. Now, if that info was transparent and the choice was offered, the patient would have:

A) Saved money out of pocket.
B) Had a wheelchair that they could decide to keep if needed later, or sold, donated, or lent to another individual.

Its a win-win-win-win (patient, govt, tax-payers,recipient of the hand-me-down wheelchair). And the recipient may start the savings all over again!

Price transparency and options would go a long way it seems.

-ERD50

What do you mean by price transparency and in what way would that contribute to lower overall cost of health care.

Can you quantify how much Medicare wheelchair example you are so fond of actually costs in excess spending?

 

[youbet]

What do you mean by price transparency and in what way would that contribute to lower overall cost of health care.

While waiting for ERD50 to return, please allow my opinion.......

Price transparency is part of having an overall educated and knowledgible healthcare consumer.

For a number of years, I worked as a manager responsible for several hundred blue collar employees. MegaCorp provided a comprehensive health care plan at low cost.

It was a rare day that I did not have an employee come to me regarding "issues" with health care coverage and payments and ask that I intervene for them in HR. Sometimes the requests were legitimate involving administrative errors, etc. But most of the time the dissatisfaction revolved around their misunderstanding of a generous benefit and what costs really were. Many people were just unaware that in order to have money to pay for life saying surgeries, etc., the "plan" had to disallow coverage for less critical things like aroma therapy, over the counter drugs, acupuncture and non-prescribed massage therapy.

1. Until a significant campaign was undertaken to show employees how much the healthcare plan cost, few had any idea.

2. Alternative sources for tests were widely misunderstood. For example, there were higher co-pays for lab tests provided by the doc's office than for having them done at a lab. If I recall correctly, tests at a lab were covered 100% and at doc's office at 80% or something like that. Until MegaCorp published cost figures showing that they had been able to negotiate prices for tests done by a lab at a tiny fraction of the same tests in doc's office, some folks were up in arms.

3. Generic drugs and the savings involved were widely misunderstood.

4. The definition of "family" was contentious. "My cousin and her 3 kids need to live with me after fleeing from an abusive husband. Why won't MegaCorp cover them? What a heartless company!" There was no understanding that such a liberal definition of family would lead to costs that MegaCorp could not bear and still compete.

It's really important for citizens to be good healthcare shoppers and price transparency is part of that. Or, we have to go to a plan where allowed services are strictly dictated by a universal plan and live with whatever they come up with.

 

[GregLee]

What do you mean by price transparency and in what way would that contribute to lower overall cost of health care.

I have gotten itemized statements from CMS, from time to time, since 2006, and I've even looked at them occasionally, through curiosity. Pretty boring. When I could match up the items with things I could recall actually happening, the charges sometimes don't seem to make sense. If I had ever cared enough to pursue the details, maybe I could have found someone to explain them to me, or maybe they truly made no sense. Who knows? I've always found better uses for my time than to go into it.

Besides, does it really make a difference item by item how much, e.g., a hospital gets from Medicare? To stay in business and make a profit, the hospital has to get a sufficient total amount monthly from Medicare, and if it didn't pad out some items, it would have to work the system in some other way. Rationalizing billing for specific items here and there is not necessarily going to make any real difference in total costs.

 

[MichaelB]

I agree people should know what healthcare insurance costs. Eliminating the link between job and insurance would help. It would make it much easier to deal with early retirement. This would also eliminate the taxpayer subsidy included in employer paid healthcare, which probably leads to misallocation of use.

People in other countries do not seem to be “better consumers” and in many cases have more choices. How that leads to lower overall cost is still not apparent.

 

[Tadpole]

It is tough, but I think there are huge steps we could take before we risk depriving anyone of their needs. One thing would be price transparency.

In another thread, I was bringing up the Medicare wheelchair fiasco again. Some people claim they could have bought a perfectly adequate wheelchair for less than their co-pay for a 12 month rental. Now, if that info was transparent and the choice was offered, the patient would have:

A) Saved money out of pocket.
B) Had a wheelchair that they could decide to keep if needed later, or sold, donated, or lent to another individual.

Its a win-win-win-win (patient, govt, tax-payers,recipient of the hand-me-down wheelchair). And the recipient may start the savings all over again!

Price transparency and options would go a long way it seems.

-ERD50

We ran into that same phenomena in our private health care insurance. We just bought the wheelchair.

 

[obgyn65]

My bet is that this thread is going to be shut down sooner or later I have given up discussing any topic related to the HC reform.

 

[flyfishnevada]

My bet is that this thread is going to be shut down sooner or later I have given up discussing any topic related to the HC reform.

I am too going to resist the urge to express my opinion. This has become one of those polarizing topics and discussion seems to be pointless.

 

[chinaco]

It is probably one of the most important issues of our day. However it is addressed (or possibly not addressed).


The last time around there was a lot of emotion. Many people thought they had somehow done things right and that they would never be affected.

I think the financial crisis is beginning to sink in... we are all vulnerable in many ways.