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Archive for Tuesday, June 9, 2009

Democrats said to favor insurance requirement

June 9, 2009

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— Senior House Democrats drafting health care legislation are considering slapping an unspecified financial penalty on anyone who refuses to purchase affordable health insurance, a key committee chairman said Monday.

In addition, officials said Democrats are considering a new tax on certain health insurance benefits as one of numerous options to help pay for expanding coverage to the uninsured. No details on the tax were immediately available, and no final decisions were expected until next week at the earliest.

These officials said drafters of the legislation will include a government-run insurance option as well as plans offered by private companies. The government option draws near-unanimous opposition from Republicans and provokes concerns among many Democrats, as well, although President Barack Obama has spoken out in favor of it.

Comments

just_another_bozo_on_this_bus 5 years, 1 month ago

Any plan to require insurance must include a government-run option to provide competition against the insurance companies, which have proven over many decades that they won't stop gouging the American people without that competition.

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Flap Doodle 5 years, 1 month ago

Under the proposed bill:

"The Secretaries of Treasury and HHS would have unlimited discretion to impose new taxes on individuals and employers who do not comply with the new mandates.

The Secretary of HHS could mandate that you provide him or her with “any such other information as [he/she] may prescribe.” "

http://hotair.com/archives/2009/06/08/a-closer-look-at-the-health-care-bill/

What could possibly go wrong with a plan like that?

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SettingTheRecordStraight 5 years, 1 month ago

That's right, bozo. Free markets function best when the government competes with private industry. It's not like there aren't already dozens of insurers competing with each other for business.

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just_another_bozo_on_this_bus 5 years, 1 month ago

Yea, snap, free market "competition" is really working well now-- we have the most expensive healthcare in the world, and it's all but unavailable to 1/3 of the population.

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just_another_bozo_on_this_bus 5 years, 1 month ago

My last comment was to STRS, although it could just as easily have been to snap.

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notajayhawk 5 years, 1 month ago

Gee, my poor old memory must be failing me. For a minute I actually thought I remembered the Republican candidate for president being excoriated for proposing a tax on health care benefits.

Well, I'm sure if that were really the case, then those same whiners will start immediately blasting the Democrats for proposing to tax health care benefits now, right?

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jaywalker 5 years, 1 month ago

Since when did 46 million become 1/3 of 350 million?

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Ryan Neuhofel 5 years, 1 month ago

bozo,

Can you explain how our current system is "free market competition" when . . .

1) People are penalized for shopping for private, non-employer based health plans (since 1942) 2) Government created and encouraged the entire 'managed care' industry (since 1973) 3) Half of all monies spent on health care are from government entities. 4) The coding and billing systems for health providers (ICD-9, CPT) were created by an international bureaucratic body (WHO)

I think you can make many good arguments for measured government intervention into health care, but to say the US has a "free market health care system" currently, or possibly ever, is patently false.

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bankboy119 5 years, 1 month ago

Insurance is a scam pure and simple. Insurance companies should have to operate as Not-For-Profit companies.

As long as you're in decent health, by buying a catastrophic plan and putting money back for the deductible you save money. You can still see your doc once a year for your checkup and go back again when truly necessary and spend less than your normal plan costs. Still, if something major does happen you have insurance to cover it.

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Flap Doodle 5 years, 1 month ago

bozo is welcoming our new overlords with open arms and wallet.

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just_another_bozo_on_this_bus 5 years, 1 month ago

neuhofel-- I agree that what we currently have is not a "free market" system, even though some its most breathless defenders want to pretend that it is. But the fact is, once any industry becomes dominated by large corporations, it ceases to operate as a free market. In such industries, regulation by a (truly) democratic government to force corporations to act responsibly and ethically is necessary.

And in some industries, there is really no reason that they should be dominated by mega-corporations at all. We would all be much better served by individual entrepreneurs and small companies who serve local and regional markets where there would be true competition.

But with health insurance, having a large pool is very desirable, and the best way to accomplish that is a single-payer entity. However, I also like the idea of making health insurance companies operate as consumer-owned non-profits.

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notajayhawk 5 years, 1 month ago

bankboy119 (Anonymous) says…

"Insurance companies should have to operate as Not-For-Profit companies."

And just what business are you in, bankboy, that you'd favor government intervention disallowing profits if your customers complained the price you charged for your own services were too high?

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notajayhawk 5 years, 1 month ago

just_another_bozo_on_this_bus (Anonymous) says…

"But the fact is, once any industry becomes dominated by large corporations, it ceases to operate as a free market. In such industries, regulation by a (truly) democratic government to force corporations to act responsibly and ethically is necessary."

As usual, boohoozo appoints himself as the ultimate judge of what's too much. Small companies are okay (as long as they don't make too much), big companies baaaaaaaad, and nanny-government has to step in and take over.

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SettingTheRecordStraight 5 years, 1 month ago

I'll say it again, bozo. 1/3 of our 46 million uninsured can actually afford health insurance but choose not to purchase it. Another 1/3 qualifies for Medicaid, SCHIP, etc. but have not enrolled. And a final 1/3 (5.1% of our entire population) actually earns too much to qualify for Medicaid but cannot afford private insurance. Reasonable minds agree that the government needs to help this small percentage of our population find insurance.

But this statistic is in no way a reason to abandon the efficiencies and freedoms of the free market for yet another government program - a program that will increase total healthcare costs, will eliminate healthcare choice, will encourage unhealthy lifestyles, will increase taxes on everyone, will ration healthcare procedures, and will reduce healthcare discovery and innovation.

If you really want to help, focus on meaningful tort reform and on eliminating those lawsuits which unnecessarily drive up the real cost of healthcare, all while enriching plaintiffs' attorneys.

Finally, we could go a long way toward reducing healthcare costs in America by increasing the age for Medicare eligibility, by making Health Savings Accounts for the self-employed and under-employed easier to acquire, by modernizing our medical records system, and by adopting a personal mission to shame every smoker, alcoholic and drug user into quitting their expensive and unhealthy habits.

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bankboy119 5 years, 1 month ago

notajayhawk,

My name doesn't give it away? :)

And actually, I've switched from "banks" to credit unions. Yes, there is a difference. Credit unions operate as Not-For-Profit, not Non-Profit, there is a difference.

At the end of the year, after expenses, credit union books have to be zeroed out. Instead of the profit going to shareholders and away from every member who uses the service, the excess is paid back in forms of lower loan rates, higher deposit rates, and increased development into the communities they are involved in. Corporate shareholders are not the ones who benefit.

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bankboy119 5 years, 1 month ago

(cont)

How does this apply to insurance? The problem that people are facing is the inability to purchase affordable insurance correct? Instead of operating to pay their corporate shareholders, insurance companies could be truly looking out for the people they serve. Not punishing them with increased rates to pay higher dividends to their investors.

If the profit was actually returned to the members of the organization I believe that so many wouldn't be priced out like they are.

It's amazing what can happen when people truly start helping people, not try to make a profit.

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gphawk89 5 years, 1 month ago

If they have to do this, they'd better tax everyone the same amount regardless of their salary or even their employment status. If everyone gets to use it, everyone should have to pay for it.

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notajayhawk 5 years, 1 month ago

bankboy119 (Anonymous) says…

"How does this apply to insurance? The problem that people are facing is the inability to purchase affordable insurance correct?"

Incorrect. Nobody cares whether they can afford insurance. They care whether they can afford healthcare - insurance is a means to that end, not an end in itself.

The cost of the actual service delivery in healthcare is the problem, not who pays for it. THAT cost has gotten obscene. Nobody complains about doctors making a profit off peoples's illness. Nobody threw a fit last year when it was announced that 'not-for-profit' LMH took in revenues in excess of expenditures (which, when I was getting my own business degree, we used to call 'profit'). Nobody complains that an ER visit that consists of lying there for 10 hours for 'observation' and maybe a couple of simple blood tests can cost over $10,000, as long as someone else pays for it. If we keep trying to figure out a way to pay for these exhorbitant fees instead of trying to find a way to control them, nothing whatsoever will change. We'll pay taxes instead of insurance premiums, maybe, but we won't be able to afford either.

By the way, do you now prefer to go by the name 'creditboy' or 'unionboy'? :)

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average 5 years, 1 month ago

Home and automobile insurance are nothing like health insurance. Nothing.

You can build a nice new home in Greensburg, Kansas. You can easily get homeowner's insurance on it. The chance of getting hit by a tornado next is no different than any other point in western Kansas, just because there was a tornado. Largely uncorrelated.

My mother lost a kidney to cancer at 40. No insurer would voluntarily take her on, without it being a mandate, for any amount of money. Even if they disclaimed everything having to do with her having had cancer. Because health is highly correlated, and the health insurers have big records-keeping systems and huge numbers of actuaries.

Moreover, she can't change bodies, like someone in a hurricane-prone area can move. Nor did her medical issues stem from imprudence, like a repeat-speeder's car insurance.

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just_another_bozo_on_this_bus 5 years, 1 month ago

LO-- the insurance industry is a scam on about every level, auto insurance included. Just because the discussion here is about health insurance doesn't mean that's the only insurance scam that needs to be addressed.

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Ryan Neuhofel 5 years, 1 month ago

bozo says . . . "Yea, snap, free market “competition” is really working well now" (sarcastically) . . . . 1 hour later says . . . "I agree that what we currently have is not a “free market” system even though some its most breathless defenders want to pretend that it is"

I don't like to make debates personal, but it seems as though YOU were the one pretending we have a free-market system (albiet attacking, not defending). However, I do agree that most people on both sides are usually arguing a strawman in this debate . . don't poke yourself in the eye!

Furthermore, the dramatic growth of the private third-party heath industry (and related profits) was encouraged and often mandated by legislation from Washington - supported by a majority of both parties for the past 30 years (Read about the history of 'managed care' starting with Managed Care of 1973). We often assume increased profits are gained by “charging more” (aka higher profit margins), but the transformation of health plans from true insurance to ‘managers of all health care dollars’ (now 90% of all payments) is the true reason for their growth – NOT free-markets or greedy charges (review history of profit margins – steady at 3-6% for 30 years!). Basically, these “mega corporations” were created by politicians and now many people want the very same politicians to “tame” their own creation! Call me a skeptic, but I don’t trust they will do the right thing for the average person.

As a physician, I personally feel that patients (consumers) and health care providers (doctors, etc.) must voluntarily disengage from third parties (“mega corporations” and government planners) when they are unnecessary – which is the vast majority of the time. Direct relationships (local) for the majority of medical care is feasible . . . despite the persistence of Washington to have all health care controlled or managed by a third-party.

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SettingTheRecordStraight 5 years, 1 month ago

logicsound,

But America doesn't get less for more, as you suggest.

Those countries with socialized medicine have fewer healthcare choices. They have greater populations engaged in unhealthy lifestyles. They're tax rates are an abomination. Many of their healthcare procedures are rationed. And healthcare discovery and innovation does not occur there like it does in the United States.

If I have a "right to healthcare," then I demand a right to healthcare choice, not an inefficient government-run bureaucracy.

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KansasVoter 5 years, 1 month ago

"These officials said drafters of the legislation will include a government-run insurance option"

I'll be one of the first to switch from my private insurance (which is a total rip-off) to the government-run option. The health insurance industry is just a giant leech on the American people.

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bankboy119 5 years, 1 month ago

notajayhawk,

I don't believe the actual prices are the problem. That's what a free market is and I don't believe that the government should set . If people are willing to pay for the services they aren't overpriced. If a physician isn't that good then he/she should demand lower payment. On the other hand, if he/she IS that good, and people are willing to wait and pay to see him/her, he's/she's 100% entitled to his/her money.

Part of the reason for them being so high is the ridiculous insurance prices. Part because there is lack of competition in the industry. It's simple supply and demand when it comes down to it.

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just_another_bozo_on_this_bus 5 years, 1 month ago

neuhofel,

I suppose if no one ever got anything more serious than the flu or a bad sprain, pooling of resources (i.e., insurance) would be totally unnecessary. Sadly, that's not the case. Unless, of course, doctors and nurses just want to work for free.

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just_another_bozo_on_this_bus 5 years, 1 month ago

The problem with your last post, STRS, is that you are completely, factually wrong.

But thankfully, this is America, and you're well within your rights to have thoroughly misinformed opinions.

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SettingTheRecordStraight 5 years, 1 month ago

"The problem with your last post, STRS, is that you are completely, factually wrong." -bozo

Really? How? You're being intellectually lazy today with your posts today. You're not adding any value.

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Ryan Neuhofel 5 years, 1 month ago

bozo,

You are just playing in the hay at this point . . . the strawman has been defeated.

I never advocated elimination of insurance for catostrophic and unexpected health events. In fact, I think every citizen should have finicial protection against major, unexpected medical expenses (major injury, long hospitalization, cancer, surgery, etc.). But there is a stark and meaningful difference between 'insurance' and a 'third party managing (paying) all health care' at many levels (economically, socially, etc.). Obviously, you can't or don't see the distinction.

I don't see how a third-party, with it's associated costs (including profits in the private sector), adds any value to routine, expected medical care - whether preventive, minor, or maintenance of chronic conditions. 90% of people know what type of medical care they will require over the next year . . .why should they pre-pay a third-party to then pay the doctor administrering the care? That's equivalent to pre-paying your auto insurance company to manage your oil changes or tire replacement. (and yes, I know cars and people aren't the same)

Also, I have spent my my entire adult life studying health and medicine, but thanks for the reminder about the spectrum of human disease.

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SettingTheRecordStraight 5 years, 1 month ago

The Post Office is bankrupt, logicsound. A healthcare system "run as well as the postal service" would be a nightmare. It's also taxpayer subsidized. It's also a profitless government institution in direct competition with for-profit companies. And DHL is not out of business; it's merely not doing business in the US any longer.

And as far as government efficiency goes, please consider the government's management of Amtrak, the war in Iraq, the Department of Motor Vehicles, many of our VA hospitals, Hurricane Katrina clean-up, and Medicare, Medicaid, and Social Security (the three of which are either broke or on the fast track to bankruptcy) before you choose to handcuff our healthcare system to the largest, most inefficient manager of people and money in the United States.

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just_another_bozo_on_this_bus 5 years, 1 month ago

"Really? How? You're being intellectually lazy today with your posts today. You're not adding any value."

Jeez, dude, your posts have been nothing but intellectually lazy, in addition to dishonest and/or factually incorrect. I gave all the reply your posts warrant.

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Flap Doodle 5 years, 1 month ago

Doesn't Canda have an ideal health-care system? No, actually they don't.

"...Indeed, Canada's provincial governments themselves rely on American medicine. Between 2006 and 2008, Ontario sent more than 160 patients to New York and Michigan for emergency neurosurgery -- described by the Globe and Mail newspaper as "broken necks, burst aneurysms and other types of bleeding in or around the brain."

Only half of ER patients are treated in a timely manner by national and international standards, according to a government study. The physician shortage is so severe that some towns hold lotteries, with the winners gaining access to the local doc.

Overall, according to a study published in Lancet Oncology last year, five-year cancer survival rates are higher in the U.S. than those in Canada. Based on data from the Joint Canada/U.S. Survey of Health (done by Statistics Canada and the U.S. National Center for Health Statistics), Americans have greater access to preventive screening tests and have higher treatment rates for chronic illnesses. No wonder: To limit the growth in health spending, governments restrict the supply of health care by rationing it through waiting. The same survey data show, as June and Paul O'Neill note in a paper published in 2007 in the Forum for Health Economics & Policy, that the poor under socialized medicine seem to be less healthy relative to the nonpoor than their American counterparts.

Ironically, as the U.S. is on the verge of rushing toward government health care, Canada is reforming its system in the opposite direction. In 2005, Canada's supreme court struck down key laws in Quebec that established a government monopoly of health services. Claude Castonguay, who headed the Quebec government commission that recommended the creation of its public health-care system in the 1960s, also has second thoughts. Last year, after completing another review, he declared the system in "crisis" and suggested a massive expansion of private services -- even advocating that public hospitals rent facilities to physicians in off-hours."

http://online.wsj.com/article/SB124451570546396929.html#mod=rss_opinion_main

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Ryan Neuhofel 5 years, 1 month ago

logic says. . ."By contrast, DHL—an efficient private business—didn't survive in the U.S., by that example alone, I have invalidated your claim that private business is always more effective than government."

Your logic is . . . . well . . . logical to a third-grader.

http://www.gao.gov/products/GAO-09-332T The USPS had a debt of $2.8 billion in fiscal year 2008 . . . In 1 year alone! At what level of debt does the USPS fail to survive?

In contrast, DHL failed to produce monies (revenues) in excess of overhead costs (aka, profits) to keep the company financially sustainable or investors optomistic about it's prospects. On the other had, if DHL was backed by the government (with taxpayer money) I'm sure they would've been happy to operate a trillion dollar debt/deficit and continuing paying their employees and executives.

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just_another_bozo_on_this_bus 5 years, 1 month ago

Neuhofel--

I really wouldn't be opposed to some form of a pay-as-you-go system as you seem to be proposing, but as you acknowledge, it wouldn't work for most serious medical conditions. And if it weren't for those serious and seriously expensive maladies, we wouldn't even be having this discussion, now would we?

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sinverguenza 5 years, 1 month ago

In a world where 60 percent of personal bankruptcies can be attributed to medical bills - when most of those persons HAD insurance coverage - there is definitely something wrong.

We need to:

1) Assure access to affordable health care for all 2) Make sure the service is actually worth all the money we put into it (whether it's a gov. option or a private co.)

I've always supported a mandate and I think it's a step in the right direction because it either encourages people to get the care they need or puts money back into the system to pay for that care through penalties.

There are still a plethora of other kinks to work out, but I've yet to hear a single person against the government option give cause to believe the private companies are going to better themselves, their coverage or their prices otherwise.

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Ryan Neuhofel 5 years, 1 month ago

bozo,

Who's on first?!

My point is that insurance (any type of third party) should be utilized appropriately - becuase it has associated costs (whether private or government ran). When it's 'overused' (as in managed care) for routine and expected services - the associated costs outweigh it's benefits . . . as the past 30 years have tought us!

I'm not downplaying the burden or cost of caring for serious medical conditions. Obviously, a 72 year old diabetic will require more routine care than a healthy 18 year old, but even most diabetes care can be predicted . . they will need 4-6 physician visits per year for check-ups and to adjust meds, a visit to eye doctor, etc. But the events are still expected (predictable) and shouldn't require third party (insurance) management.

I also think a prosperous nation (such as ours) should provide some type of health care assistance for the 'needy' (poor, sick, etc.). We can obviously have a civil debate about WHOM should recieive taxpayer assistance (and associated dollar amounts), but I think it's much more important to consider HOW public assistance is structured. The current debate is how we can best place the "uninsured" into the current system, which will do little to solve the problem of inflation (which effects everyone!).

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Richard Heckler 5 years, 1 month ago

$1.2 trillion tax dollars goes to cover 60% of those insured which is a huge gravy train for insurance companies. Lobbyists are spending millions of health care dollars to defend that gravy train.

There are enough of OUR tax dollars floating around Washington DC to more than afford coverage for all in the USA. The $1.2 trillion mentioned above would cover all in the USA instead of only 60% of those covered by the insurance industry. Dollars and sense says dump the medical insurance industry.

Anyway tax dollars belong to US so why not cut off corporate subsidies to wealthy corporations and pay medical insurance for all in the USA = better bang for OUR tax dollars

What can your tax dollars buy for 24/7 care no matter what?

All taxpayers need coverage, taxpayers need relief and big time reduction in cost.

HR 676 is the only equitable approach that includes all of us.

HR 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, and long term care.

A family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs.

HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

Health care costs and facts: http://www.nchc.org/facts/cost.shtml http://www.dollarsandsense.org/archives/2008/0508harrison.html

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Richard Heckler 5 years, 1 month ago

HR676 National Health Insurance would encourage new small business and make americans more employable.

Not only that HR 676 would reduce the cost of USD 497,city,state and federal governments.

USE our existing pie of tax dollars to insure all in the USA for 24/7 health care!

Don't force employers to pay one thin dime! There are plenty of tax dollars in DC to cover all of us.

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Flap Doodle 5 years, 1 month ago

I knew the ghost of HR 676 would show up on this thread eventually.

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llama726 5 years, 1 month ago

notajayhawk Said:

And just what business are you in, bankboy, that you'd favor government intervention disallowing profits if your customers complained the price you charged for your own services were too high?

I say:

Does bankboy's business decide whether or not someone dies from a condition treatable by adequate health care? Health and lives are not on the line if you work for a software company, but they are with health care. How can you not see the difference?

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bankboy119 5 years, 1 month ago

llama,

There is a difference but I see his/her point. In my post I also said they "should have to" and not just "should" operate as Not-For-Profit companies. I don't believe that the government should intervene because when they do things get worse. (Just wait, it's going to happen with GM, already has with Amtrak.)

The movement should start with the people. Obviously something needs to be done. The current system isn't working.

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Richard Heckler 5 years, 1 month ago

Rationing is what the medical insurance industry offers as we speak and has been for several decades. How is that? The level of care is dependent on how much money one is able to put on the table. Yes this is no question about it corporate american style rationing and or class warfare.

Health care costs and facts:

http://www.nchc.org/facts/cost.shtml

http://www.dollarsandsense.org/archives/2008/0508harrison.html

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SettingTheRecordStraight 5 years, 1 month ago

I can't believe that I'm still being accused of being all about ideology. I'm commited to good ideas that work in the real world. So.... here are a few ways we can strenghten our healthcare system:

Tort reform Electronic medical records Health Savings Accounts Medicare reform Healthy lifestyles Some form of coverage for the 5.1% of Americans that make too much to be on Medicaid but make too little to purchase health insurance.

Those of you who want a government-run healthcare system want one thing: control. It's all about contol. It's always been about control. It always will be about control. We will not let you control us by making us dependent upon you.

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Richard Heckler 5 years, 1 month ago

Sen. Bernie Sanders and Nurses Union Leader Rose Ann DeMoro Urge Obama to Embrace Single-Payer Healthcare System

President Obama is expected to host a group of Democratic Congress members at the White House later today. The meeting comes one week after Obama said he would consider supporting a mandate-based approach to healthcare and the creation of a public insurance option.

http://www.democracynow.org/2009/6/9/sen_bernie_sanders_and_nurses_union

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notajayhawk 5 years, 1 month ago

logicsound09 (Anonymous) says…

"Instead of taking the “what right does the government have to tell me how to run my business?” mindset, why don't you actually look at the issue?"

The typical liberal response - if I disagree with you, I must not know enough about the issue. I work in the healthcare field, logicsound, and I daresay I know a he** of a lot more about how its funding process works than you do.

There is a difference between the government 'telling us how to run our business' and telling us we're not allowed to make a profit. We all accept some degree of government regulation both in our personal lives and in our businesses, but being told how much is an allowable amount of money to make is unacceptable.

"The fact that we pay more for less than any other industrialized nation in the world."

This is in no way, shape, or form a "fact." The fact is that there is no commonly accepted objective measure of the 'output,' of what a person receives for thier healthcare dollars, that can be used to compare between systems. One of the problems with our current system is that in this country we get too much healthcare. You can't go in for a simple ER visit without two or three specialists reviewing the blood test results, the x-rays, etc. People are routinely referred to specialists for follow-up care that can easily be performed by a GP or even a nurse. Expensive diagnostic tests and procedures are routinely performed (and re-performed, and re-performed, and re-performed) based on whether there's someone to bill rather than whether it's needed.

"Why do you defend the current system so vigorously?"

Why do you defend letting the government take over so vigorously?

See how easy that is? Why does everything have to be so black-and-white to you? In my frequent posting on this issue, I have repeatedly mentioned numerous ways the current system could be improved, and pointed to numerous problems that need to be addressed that would not be addressed (and actually would be made worse) by a taxpayer-funded universal system. There have been countless other posters here who have done the same, many of those also working in the healthcare field. I have never, ever said I was happy or even satisfied with the current system and have never defended it - just because I know how much of a disaster nationalizing the system would be does not mean I want things to stay the way they are.

"In an industry like healthcare, every profit dollar derived from insurance premiums and deductibles is a dollar taken away from someone's needed care. That is problematic on its face"

[continued]

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notajayhawk 5 years, 1 month ago

[continued]

So why do we allow doctors to make money? Hospitals? Pharmacies? The companies that make wheelchairs, prosthetics, glucosometers?

Health insurance, like any other insurance, is by definition risk management. They agree to assume the risk for your possible healthcare expenses in return for a fee. If you don't want to pay the fee, if you want to take the risk, assume the risk yourself and go without insurance.

Incidentally, health insurance companies make money not only by denying (often unneeded) services, they do it by negotiating prices that you or I or any other individual could not negotiate for ourselves. That $10,000 ER visit is paid off for $2,000 by the health insurance company, and why shouldn't they get a piece of what was saved? And no matter how much you listen to the left-wingnuts, every single day I see government insurance programs denying coverage for reasons you probably would not believe. And the claims that DO get paid are at the expense of an unbelievable amount of hoops and barrels that need to be jumped through. I spend much more of my time dealing with ridiculous rules and regs to get reimbursement for my patients from government sources than I have ever had to deal with from private insurers.

"It's not like insurance is a cutting edge industry that needs high profit potential to incentivize aggressive R&D or innovation."

Really? You really think that claims processing is handled the same way it was 50 years ago?

"There is no valid reason why the health insurance industry should be allowed to generate surplus revenue at the expense of the coverage they purport to provide."

Yes, there is - they're providing a service, like any other. But if you really believe that because we're talking about healthcare no profits should be taken, then, once again, why are the service providers themselves allowed to make money?

"forbid insurance companies to generate profits on basic, preventative care"

Most of them already cover preventative care, because it saves them money. I'm curious, though, how you'd separate that out from their profits.

"and forbid them from denying coverage to those with pre-existing conditions."

Why? What other insurance works that way? Do you think your car insurance rates should be increased to allow someone with 27 speeding tickets and a half-dozen DUI's into the pool? And that they shouldn't have to pay any more than you do? Should your homeowners' insurance rates be raised to allow those homeowners in an arson/vandalism/burglary prone section of Topeka or KCK to get the same rates you do for living in a rural area?

"especially since there is anecdotal evidence everywhere that a better system (or a system at all) is feasible."

There is no evidence at all. There is absolutely no reason to expect that any system in any other country would result in any improvement over what we have if we 'switched over.'

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notajayhawk 5 years, 1 month ago

llama726 (Anonymous) says…

"Does bankboy's business decide whether or not someone dies from a condition treatable by adequate health care? Health and lives are not on the line if you work for a software company, but they are with health care. How can you not see the difference?"

And I repeat what I said to logicsound above: Then why do we allow doctors, hospitals, pharmacies, durable medical supplies manufacturers, etc., etc., etc. to make money? How come nobody's complaining about that?

How come people aren't screaming bloody murder about the fact that a single ER visit can cost as much as a car? Because we expect someone else to pay for it (whether public or private reimbursers), that's why. As long as WE don't get the bill, let them charge what they want, right?

The problem isn't who pays. The problem is that it costs too d*mned much. And as long as we expect someone else to foot the bill, we will never ever look at controlling those underlying costs.

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Ryan Neuhofel 5 years, 1 month ago

logic says, "medicare has historically outperformed private insurance providers"

Exactly, how do you define performance?

I'm glad that Medicare scored well on 'satisfaction surveys' and arbitrary 'quality measurements' (created by Medicare!), but that is hardly a measure of "performance" . . . let alone sustainability. Just like USPS, Medicare has the 'luxury' of operating at staggering deficits - currently $61.6 trillion! The unfunded future liabilities of Medicare are mind boggling and should give all of our unborn children nightmares. How would plugging an increased number of Americans into Medicare help?

The government (taxpayer) could also spend $50k annually for every child and likely achieve a great public education system (while adding trillions of dollars of deficits) - would this qualify as "good performance".

I fully understand the frustration with private managed care and think it has grown to large, but to compare a private company which must maintain excess monies (profit) to survive to government entities which can live forever in debt (or print more money) is totally irrelevant.

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notajayhawk 5 years, 1 month ago

By the way, I've asked this before, and I'll keep asking it: If government-run, taxpayer-funded healthcare is the way to go, how come all healthcare providers don't take Medicaid or Medicare?


bankboy119 (Anonymous) says…

"I don't believe the actual prices are the problem. That's what a free market is and I don't believe that the government should set ."

I am not in favor of price controls either. However, it IS the cost of service delivery, not reimbursement, that is the bulk of the problem. I wasn't kidding or just pulling a number out of the air when I mentioned the ER visit. It was a relative, and being pregnant at the time, she could not even be given an x-ray, let alone anything fancy like an MRI. Her services consisted of a few standard blood tests and a nurse coming by about once per hour to ask how she was doing. Okay, I lied, I did pull the number out of the air - the actual bill was for over $12,000!

"If people are willing to pay for the services they aren't overpriced. If a physician isn't that good then he/she should demand lower payment. On the other hand, if he/she IS that good, and people are willing to wait and pay to see him/her, he's/she's 100% entitled to his/her money."

How would any of what you just said not apply to insurance companies as well?

"Part of the reason for them being so high is the ridiculous insurance prices."

Yes. Malpractice insurance. People will sue a physician in this country if their scar has an unlucky number of suture holes. That's why we are in dire need of tort reform, one of the problems that can be addressed without the government taking over the healthcare industry, and one of the problems that would not be solved by the government taking over the healthcare industry.

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Ryan Neuhofel 5 years, 1 month ago

logic says, "I refuse to believe that our options regarding health insurance are either A) pss a bunch of money away into the insurance companies' shareholders' wallets, or B) pss a bunch of money away into the inefficiency of government"

I'm glad you refuse to believe such a notion . . . because it IS a false choice! Unfortunately, the popular debate is restricted to which third-party - government or private manage care - can best manage all health care decisions (from the routine to major). Both third-party options have unnecessary costs (accounting for 40-60%) of health care expenditures.

I plan on starting a direct-model Family Practice after finishing my residency training in 2 years - likely in Lawrence. I will NOT contract with any so-called insurance plans (private or public) and not deny patients care based on insurance coverage (uninsured or otherwise) or health status. Working directly for patients (not faceless third party payers) will allow me to drastically reduce overhead costs and provide much better care and service (house calls, longer appointments, etc.). Also, I will be able to charge 50-70% less than what a typical health plan would pay a doctor (roughly the equivalent of most co-pays) for a given service (visit, lab, meds, etc.). I took an oath to work on behalf of my patients, NOT for the bottom line of BC/BS or a bureaucratic maze.

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bankboy119 5 years, 1 month ago

notajayhawk,

How do you compare insurance companies and physicians? The physicians have a skill that gets them to where they are. The insurance companies tell the doctors how much they can make on what procedure. We, the clients, have zero say. If insurance companies were Not-For-Profit, we would be who the insurance companies are fighting for, not investors.

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Ryan Neuhofel 5 years, 1 month ago

bankboy, "The insurance companies tell the doctors how much they can make on what procedure. We, the clients, have zero say."

You are correct that third-party (insurance) health plans pay doctors (on behalf of the patient) based on their contract (fee schedule for any given service). Ironically, the payment system (fees) is entirely based off of the "non-profit" Medicare's fee schedule - and has for the past 20+ years. Most private health plans pay "90-110% of Medicare" (as we say in the health care biz). If CMS lowers payment to doctors or denies a type of care, private insures usually follow suit.

So . . . with a Not-for-Profit entity (Medicare) basically setting prices for a number of decades, shouldn't the cost/price of health care already be under control? (Assuming Medicare is "fighting for the people")

On a side note, physicians who contract with Medicare cannot legally charge a non-Medicare patient less than what Medicare pays. Medicare views this as "defrauding the government". So, if a Medicare-contract doctor charges a patient "half price" for a visit because the patient is having financial difficulty (or whatever reason) - Medicare can charge the doctor with fraud! Seems like a real compassionate system, huh?

Here is a novel idea . . . the consumer (patient) and provider (doctor) mutually agree on an upfront price for a service/product . . .and make the transaction. Nah, it'd never work, it's entirely too complex!

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notajayhawk 5 years, 1 month ago

bankboy119 (Anonymous) says…

"How do you compare insurance companies and physicians? The physicians have a skill that gets them to where they are."

Which has what to do with anything? It has nothing to do with skill. One might argue that a physician requires more education, training, experience, and skill than a plumber - but if you're a homeowner, you might have already learned that you're going to spend more on a plumber! As you said yourself, it's all a matter of supply and demand. Both the physician and the insurance company provide a service. One might even argue that the physicians services are more indispensible, more urgent, more necessary for sustaining life. Why do we say it's okay for him to make money off our misfortune, but it's not okay for an insurance company to make money for assuming the risk of our misfortune?

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notajayhawk 5 years, 1 month ago

logicsound09 (Anonymous) says…

"I would think that if anything about my position on this issue is clear by now, it's that I'm not locked into one particular solution."

Well, I dunno', what with you only being a member since May 27th and all. ;)

"I'm serious about solving this problem."

I know that. Despite the fact that you're a 'new' member, your comments bear a striking resemblance to those of another seemingly lost member with a remarkably similar name. Perhaps you should consider the possibility that the person you're debating the issue with might also be echoing the point-of-view of a similarly departed member - perhaps even one you found a lot of grounds for agreement with at one time.

"The insurance industry increases it's profits by denying the benefit they purport to provide."

That's not the only way they make money. They make money by negotiating lower fees.

But more importantly, you seem to be holding on to some pie-in-the-sky belief that a government-funded system would not deny services to stay under budget. You only have to look at Social Security and VA benefits to see the fallacy of that belief.

And this is a true story: I was contacted by phone a few weeks ago by a reviewer in Jeff City (I work in Missouri) who called to tell me he was denying my request for additional services for a patient because he had not been able to e-mail me about the request (the agency where I work limits outside e-mail access to only a handful of employees). Yes, you read it right - he called me to tell me the request was denied because he couldn't contact me. And I deal with such ridiculous nonsense on a daily basis.

Besides that, with a taxpayer-funded system, the money dries up when the amount budgeted by the legislature for the fiscal year runs out. At that time you either keep providing services for free, or you stop providing services. The problem is that, unlike a private insurer, there is no connection between revenue and expenditures (i.e., with a private insurer, more enrollees means more expenditures but also more premiums - with a government-funded system, that connection is absent).

I didn't have time to read through your whole post, maybe I'll have time to respond to your other points later tonight. I do believe you want to find a solution. Just don't assume that because someone discounts the proposition on the table, they don't want a solution as much as you do.

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Newell_Post 5 years, 1 month ago

logicsound:

Thanks for posting that Frontline link. I had seen portions of it before, but it is still good. I particularly like the segment on Taiwan. They did what I've said for a while now: study every system in the world and copy the best one(s). Unfortunately, every proposal I see come of DC just looks like an uncoordinated patchwork of political compromises instead of a coordinated, efficient, simple system that actually makes sense.

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ASBESTOS 5 years, 1 month ago

Let's see, if I already have and pay for insurance, these idiots are going to tax me for taking care of myself?

Do any of these elected morons do any math? (They certianly do not read bills before voting on them, so I guess math would not be a strong point.

So let's do the math:

47,000,000 not insured in a country of 300,000,000.

So 253,000,000 are going to get taxed to cover 47,000,000 uninsured?

Did these idiots even think about counting votes yet?

Remember that when talking about the "health care crisis" this is only about the 47,000,000 that are not covered.

The first thing is we could cover those people if we just stopped the waste in Medicare/Medicaid. The GAO and OMB have already done studies on it.

And does anyone notice that nobaody is talking about the insurance companies? That's right because lefty or righty they are paid off by lobbyists.

Don't throw the baby out with the bathwater.

Do not peanalize or damage those of us that can take care of oursleves. Those of us that do pay our own insurance also pay lots of taxes. And remember that 253,000,000 are convered and 47,000,000 are not.

Taxing and changing the system this radically will take all health care from the 253,000,000.

"The needs of the many outweigh the needs of the few."

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Ryan Neuhofel 5 years, 1 month ago

logic,

I actually had watched the Frontline piece as part of a medical school assignment and think we should analyze other nations health care systems in an attempt to improve ours. I'm happy to discuss any ideas about health care in our country or foreign countries.

Your highlighting the "moral hazard" issue (denying coverage or payment to improve the bottom line) with third-party health plans if perfectly valid. However, that issue exists with any third-party administrator of care - whether private (profit) or government (solvency). Also, the "hazard" is multiplied 10-fold when using a pre-paid (aka. managed care) payment system that covers all health care expenses.

The "negotiating power" advantage of third-party managers is largely overstated when considering the additional costs they add to provide such "service". 'Economies of scale' are only economically sensible (for the consumer) when they can actually reduce the end cost of the good/service being purchased . . .clearly managed care has not reduced the overall cost (as basic economics would dictate). If larger 'economies of scale' always reigned supreme, why wouldn't we would all pay for third-party purchasing (negotiation) for groceries?

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notajayhawk 5 years, 1 month ago

logicsound is at least trying and for the most part open-minded on this issue. Despite our frequent differences, he's not merrill or boohoozo or one of the others who just want the government to take care of everything. I can understand the desire to change something out of frustration with the current system. It's hard to be insensitive to those feelings with my own patients and even my own family. But I want a system that works. The proposals being considered as presented in the article above don't fit that description.

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Ryan Neuhofel 5 years, 1 month ago

Speaking of 'moral hazards', I think the unintended negative consequences of having third-parties manage all health care are enourmous and largely go undiscussed.

This is especially evident in Medicaid patients. There are many disadvantages of providing assistance in the form of management (third-party payers). This system discourages self-directive and investment. Why take an active role when somebody else makes all of the real decisions? It also needlessly creates a very distinct two-teir system - with 50%+ (and growing) providers not accepting Medicaid patients. Also, many people in the health care field automatically stereotype Medicaid patients as irresponsible and ungrateful - which is a disservice to patients and providers.

There are alternatives to providing assistance to those "in need" - poor, sick, etc. Providing "health care vouchers or credit" in leu of a government-payer should be an option. Hopefully, the "health vouchers" would be used to purchase routine, primary care directly from doctors and be backed with a catostrophic insurance plan (government or private). This system would certainly encourage people to take a more active role in health care - serving as a source of empowerment. It would certainly serve patients better and reduce the burden on the taxpayer (via decreased administrative costs). Many will attack this plan as "privatization", but I ask those people - Do you oppose "food stamps" program in favor of "government-cheese"? or "rent subsidies" in favor of "the projects"?

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Satirical 5 years, 1 month ago

Be skeptical when anyone claims the government will be more efficient than the private sector, i.e. if only we could get rid of that nasty profit motive, then everything would be better because those profits could be turned into more products/services. If things really worked that way then I would be the biggest advocate for communism.

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Ryan Neuhofel 5 years, 1 month ago

Satirical,

The current health care system has become so frustrustaing and confusing for the average citizen that we feel powerless and desperate for any type of change . . .including government take-over. However, the complexity is the result of misperceptions and ill-defined terms used by the politicians and special interest groups to serve their own purpose. While ideology will play a role in any debate, superficially supporting a plan by proposing "let the private sector work" or "government must take over" does very little to help peole understand the economic root of the problem.

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Satirical 5 years, 1 month ago

Neuhofel…

I am not “superficially supporting a plan.” I am arguing against the logic (or showing how it isn’t logical) to assume that the “government must take over” because once a profit motive is removed more resources will be available at the same level of quality. Hence, we are making similar arguments.

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Ryan Neuhofel 5 years, 1 month ago

sat,

I'm not being critical of your position - In fact, I fully support price-cooridinated (profit-based) economies for the vast majority of industry. People who are inherently skeptical of "private industry and profits" will not be persuaded to support free-market solutions with a stereotypical 'bipolar' (left vs. right) debate.

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