Archive for Monday, November 22, 2010

Sam Brownback, Pat Roberts sign on to federal health reform challenge

November 22, 2010

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— U.S. Sens. Sam Brownback and Pat Roberts, both Kansas Republicans, have joined a legal challenge of the new federal health care reform bill.

A legal brief, signed by 32 Republican senators, was filed in the lawsuit brought by Florida and 20 other states against the Patient Protection and Affordable Care Act.

The senators contend that the congressionally approved requirement that people purchase health insurance oversteps the bounds of the commerce clause in the U.S. Constitution.

“Indeed, in more than 200 years of debate as to the proper scope of the Commerce Power, the Supreme Court has never suggested that the Commerce Power allows Congress to impose affirmative obligations on passive individuals, or to punish individuals for failing to purchase a particular product,” the legal brief states.

The brief further states, “Defendants would turn the Commerce Power into an impermissible federal police power.”

Brownback, who is the governor-elect, has vowed to fight the federal health care bill.

But the federal government has argued that Congress has broad power to regulate interstate commerce under the commerce clause and that the minimum coverage provision regulates conduct that has substantial effects on interstate commerce.

The penalty for not having insurance is an addition to an individual's tax liability, thus it falls within Congress’ authority to levy taxes and make expenditures for the general welfare, the federal government argues.

U.S. District Judge Roger Vinson of Pensacola, Fla., will hear arguments in the case next month.

The senators’ brief was submitted by Carrie Serverino, chief counsel and policy director for the Washington, D.C.-based Judicial Crisis Network.

Comments

Tom Shewmon 4 years, 8 months ago

Since Obama, Pelosi and Reid strong-armed Americans, what's wrong with states strongarming the thugs right back? First order of business: Dump ObamaCare. Investigate the Obama Regime fully, and press hard for Eric Holder's firing or resignation. A good start.

Will Obama do as Democratic strategists Doug Schoen and Pat Caddell suggested in a co-written editorial a couple weeks ago: immediately announce he will not seek re-election?

But I like it just the way it is for the next year and a half: Obama, Biden, Pelosi and Reid.

Scott Bonnet 4 years, 8 months ago

Just what do you object to? Fox News koolaid drinkers can't begin to explain their opposition! Is it the guarantee of in surability for people with pre-existing conditions? Is it the requirement that insurance compaionies actually pay out 85% of premium in benefits? (as oipposed to 30% profit margins.) Is it that children can stay on their parents policies to the age of 26? Is it that companies can be penalized for price gouging? Is it that we might actuially raise our standing among industrialized countries in terms of health care? Is it that millions of Americans will no longer be without insurance? Is it that millions of uninsured will no longer be using emergency room care for their only health care venue? (A practice that inflates insurance premiums for every American family an average of almost $1200 per year right now.) Care to make an intelligent post in response? I'm really tired of the uneducated vitriole. We get it. You all hate the president. Now, can you explain why you hate the health care reform plan in terms that don't involve Fox News buzzwords?

jafs 4 years, 8 months ago

There are a few logical and reasonable objections to this legislation, in my view.

One would be that the bill is unnecessarily long and complex. Another is the mandate for all to buy insurance, which may not be constitutional. And a third is that the bill doesn't do enough to rein in health care costs.

Scott Bonnet 4 years, 8 months ago

The length and complexity are the Republicans' fault, the Dems original bill was far shorter and much less complex. But length and complexity do not equal bad. To assert lack of constitutionality is just that. Name the amendment. A strict constructionist wouldn't assert things not currently found in the text. Finally, what did the previous system do to "reign in costs." I find it ironic that people supportive of the old system fail to recognize the health care stagflation we've experience over the last decades. By requiring all to be insured, we will no longer have the drain on the system of the insured picking up the emergency room care for the multitudes of unisured. The alternative would be to deny care, totally, to those unable to pay. That would include the healthy young people, uninsured, but involved in health care emergencies. I don't believe this country would support that alternative. Maybe the Republican leadership does.

notajayhawk 4 years, 8 months ago

"Name the amendment."

Name the amendment that allows the government to mandate the purchase of a product by private citizens. I'll wait.

"By requiring all to be insured, we will no longer have the drain on the system of the insured picking up the emergency room care for the multitudes of unisured."

And again, if you try getting your facts straight, the "unisured" [sic] use fewer ER resources than the insured do. But don't let facts get in your way or anything.

whynaut 4 years, 8 months ago

"the [uninsured] use fewer ER resources than the insured do."

geez man. You've made this argument before and it's silly. The uninsured do not use fewer ER resources because they are healthier. They use fewer ER resources because they are scared of being forced into bankruptcy over a single trip to the hospital.

notajayhawk 4 years, 8 months ago

"You've made this argument before and it's silly."

Geez, man, you've used that rebuttal before, and it's inane. "They use fewer ER resources because they are scared of being forced into bankruptcy over a single trip to the hospital." No kiddin', ya' think? Duh.

GOOD for THEM. Because they are the only ones who are doing their part to cut down on unnecessary health care spending. Some studies have shown that as much as 40% of our health care dollars - not what we spend on insurance or administrative costs, but dollars that go for the actual provision of services - does nothing to improve anyone's health. The people that have to actually open their wallet and pay at the point of service are the ones that actually ask the doctor 'Is that really necessary' or 'Is there some cheaper alternative?' Those with insurance, who are essentially paying a flat rate, are the ones saying 'Heck yeah, bring it on, it isn't costing me anything extra.' The worst offenders are the Medicaid users, who use the largest share of ER resources in proportion to their share of the general population, quite possibly because it doesn't cost them anything at all.

If everyone acted as the uninsured do when they have to go to seek care, we wouldn't be spending anything close to two trillion dollars per year on health care.

whynaut 4 years, 8 months ago

Nota, First off....

"The people that have to actually open their wallet and pay at the point of service are the ones that actually ask the doctor 'Is that really necessary' or 'Is there some cheaper alternative?' Those with insurance, who are essentially paying a flat rate, are the ones saying 'Heck yeah, bring it on, it isn't costing me anything extra.' "

Blatant polarization.

Second, your missing the point about the decisions that the uninsured have to make when they need health care. You imply that these decisions are merely a matter of frugality. What if it IS necessary and there AREN'T any alternatives and the would-be patient STILL doesn't have the money?

I think it would do you good to have a little more respect for the decisions that some people are faced with. For instance, my uninsured friend who had to choose between bankruptcy and fertility. If only you had been there with her in the ER, right before surgery, to help her with that decision. (Actually, given the level of pain she was in when she had to make these decisions, she likely would have instructed you to retreat to a remote location and engage in self-intercourse).

Or like my other uninsured friend who is now pregnant. She can choose to start motherhood deep in debt, or she can take her chances trying to find ways around the standard, recommended doctor visits.

Or like my other uninsured friend who WAS pregnant and is now starting motherhood deep in debt, deeper still due to her baby's premature arrival.

In other words, your argument does not address the true complexity of the decisions faced by the uninsured when it comes to their health. Certain aspects of an individual's health are not easily monetized.

You are excellent at arguing Nota. But you are terrible at convincing. In fact, I'd be willing to bet that in your 7669 (and counting) posts, you have yet to convince a single person of anything at all. The fact that it does not seem to hinder you in the slightest seems to indicate that you're more interested in arguing than you are communicating. I just hope, for your sake, that you think all that time has been time well spent, and that there is nothing more productive to which you could be directing your energy.

notajayhawk 4 years, 8 months ago

"What if it IS necessary and there AREN'T any alternatives and the would-be patient STILL doesn't have the money?"

Some of them will die.

That sound shocking? Callous? Maybe so on both counts. It is, however, reality.

How much do we spend on unnecessary treatment just to make sure we don't miss anyone that really needs it? It's nice to think we give as much as it takes, and you seem like that kind of person, and I respect that and even in some ways find it admirable. It is not, however, realistic. Some studies have shown that as much as 40% of the health care we receive is unnecessary. So we take that up to what, 50%? 75% Just to be sure nobody gets left out? Our total health care spending in this country is over two trillion dollars. Do we double that? triple it? It's easy to say "Yes, we can't leave anyone out." Any idea how we're going to bear the costs of six trillion dollars per year, $20,000 per person, $80,000 for a family?

And yes, those numbers made up and arbitrary. Let's talk more practical numbers. Let's talk about one person. Say you have a little six year old girl with severe allergies living in a tiny town of 50 people in the middle of nowhere. Do we raise taxes to pay for an allergist to set up practice there? Or weekly 75-mile round trips by ambulance to the nearest allergist? Again, it's easy to say 'Heck yes, we do whatever it takes.' But guess what - there's another little girl in the town beyond that. And another one in the town beyond that. When does it reach the point where, regardless of whether we want to, we can't pay for it any more?

I realize you never said that we could provide unlimited services to everyone. I believe you're intelligent enough to realize that there will always be a limit, always be a point where we have to accept the fact that resources are finite and we can't provide everyone with all the care they need, let alone want. But that's different from my position only in a matter of degree. We just disagree on where that limit should be. I think when we're spending two trillion dollars per year, when 40% of it is unnecessary, we're past that balance point.

[continued]

notajayhawk 4 years, 8 months ago

[continued]

As to the rest of your post: I feel badly for your friends faced with those difficult decisions. But they were their decisions, not mine. I didn't get a vote, why should I be asked to pay for their choice?

Your own argument doesn't address the complexities - or even the reality - of the system-wide problem. You want to address the needs of the individual regardless of the costs to the population as a whole. I say those costs have to be addressed, not only for the benefit of the society as a whole, but for those individuals as well. Finding a way to pay for ever-increasing costs while doing nothing to address those costs is not a sustainable solution. Sooner or later there will be nobody left to tax, no money left to take from anywhere, and then those people you're talking about will be in an even worse position - and they'll have a lot of company.

I actually get a fair number of PM's agreeing with my posts, and I'm hardly alone in the positions I take. I wasn't expecting to convince you of anything, I frankly couldn't care less. I do make a lot of posts, most of them on this issue, because I'm in an allied health field and it's something I know more than a little bit about. If people post nonsense that's obviously from the Democrats' sound bites or one of the propaganda sites like PNHP, I'll post something disputing that. I have no delusions that I'll convince the people that post that crud of anything - I just want to do my part to make sure they aren't convincing anyone with their false claims.

Scott Bonnet 4 years, 8 months ago

"Name the amendment that allows the government to mandate the purchase of a product by private citizens. I'll wait."

It's called the general welfare clause.

"unisured" [sic] use fewer ER resources than the insured do. But don't let facts get in your way or anything."

And the employed buy more new cars than the unemployed. Interesting, but equally irrelevant. Your claim does nothing to deny the i9mmense cost to the insured and the paying public imposed as a result of uninsured use of emergency care services. Good try "Skippy" back at ya.

jafs 4 years, 8 months ago

Actually, that's not the one the government is using to defend the suit - they're using the interstate commerce clause.

The general welfare phrase comes in the We the People, in order to,...

It can also be interpreted more narrowly or broadly, but the context of the phrase is in the formation of the union.

It's not a specific clause or amendment in the constitution.

notajayhawk 4 years, 8 months ago

Actually, besides the Preamble, it's also mentioned in Article 1, Section 8: "The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States." However, the generally accepted interpretation of that clause is that it's a limitation on taxation (i.e., those are the only thing Congress can collect taxes for), not a standalone power granted to Congress (i.e., they have the power to do anything for the 'good of the country'.)

notajayhawk 4 years, 8 months ago

"It's called the general welfare clause."

Well, let's see. Besides the fact that the general welfare clause is part of the Articles (in addition to the Preamble), not the amendments, it also empowers the federal government to tax, not to force individuals to buy a product from a private business.

Weren't you the one throwing around the 'uneducated' word this morning, skippy?

"And the employed buy more new cars than the unemployed. Interesting, but equally irrelevant. Your claim does nothing to deny the i9mmense cost to the insured and the paying public imposed as a result of uninsured use of emergency care services."

Well, except for that pesky little detail that the insured use more of those resources, and since out-of-pocket rates are typically higher than those negotiated by insurance companies, it's actually the uninsured who are subsidizing the insured. Other than that, you were almost right. Kinda'. Partly.

What else ya' got?

jafs 4 years, 8 months ago

  1. I'm not "right-wing" by any means - in fact, I get accused of the opposite on here all the time.

  2. You asked what could be objected to, without the Fox news stuff - I have never in my entire life watched Fox news.

  3. The question of constitutionality is whether the Commerce clause rightly allows the government to require individuals to purchase health insurance - this is obviously open to interpretation, but I think it's an overly broad interpretation of it that would support this requirement - people don't buy health insurance across state lines, and the "part of a broad regulatory system" thinking can justify just about anything, and I don't believe that was the original intent.

  4. The question of health care costs is undoubtedly complex, but simply requiring insurance doesn't directly affect the underlying cost of health care.

notajayhawk 4 years, 8 months ago

"I'm not "right-wing" by any means"

I will be happy to vouch for jafs in this regard.

I never see him at any of the meetings, anyway.

whats_going_on 4 years, 8 months ago

I somewhat agree with you. I love the idea of it because insurance companies are absolutely out of control. There's no denying that...anyone who does hasn't ever had to worry about it. However, I think it could be "tweeked" a bit.

raw 4 years, 8 months ago

Most Americans want health care reform. The path that existed was generated by the health care industry with minimal oversight from our elected government. That path is the most expensive health care in the world and the return left Americans out of the top tiers in health care return for their dollars. Congress has failed to act for 50 years on health care reform because of the dollars spent by special interests-hospitals, insurance companies, drug companies, doctors, malpractice lawyers etc etc. Look at the campaign against health care reform. Who is sponsoring these ads and who benefits by going back? It's the same power players of the past. The problem with reform is that it did not go far enough to more efficiently use dwindling health care dollars

Alceste 4 years, 8 months ago

What a couple of mean spirited, wealthy dopes. Why is is that so many multi-millionaires think they know what's best for us poor folk? I'll tell you why.....they're worried about their own bottomline and pocketbooks and cloak 'em in the flag. Pure D Disgusting.

notajayhawk 4 years, 8 months ago

"Healthcare reform was about people who paid for health care getting what they paid for."

Care to take a whack at explaining how the legislation passed by the Democrats accomplishes that, skippy? I'll wait, I can always use a laugh to start the week.

notajayhawk 4 years, 8 months ago

"It refers to the actual need for health care reform that the pubs had to lie about in order to sabotage it."

Okay, "jstthefacts" [snicker]. Let's see if you got any. Please show me one quote - just one - from any of the Republicans (let alone these two) that say there is no need for health care reform.

Just one.

notajayhawk 4 years, 8 months ago

One quote, "jstthefacts" [snicker], just one. Just one. Funny how, as usual, you had time to respond, but didn't have time to post any "facts". Spin away, Mr. Maytag.

notajayhawk 4 years, 8 months ago

Oh, yeah, the rantings of an anonymous user on a small-town newspaper's message boards, that he saw with his "own two eyes" constitutes "facts". Sure. How about this, since you can't provide a link - how's about just telling us who these "pubs" were that "lied" about the need for health care reform, and maybe when they supposedly stated these lies?

Hmm. Didn't think so.

"Don't need to have to have someone tell me first so I can then tell you who told me "

Translation: "I have no source that can verify the BS I've been posting because I made it up." Thanks for the clarification.

Even for you, "jstthefacts" [snicker], that one was pretty pathetic.

notajayhawk 4 years, 8 months ago

Nice quotes, "jstthefacts" [snicker]. Except - gee, what a surprise - I don't see anywhere that any of those people said 'We don't need health care reform'.

You made a claim, I called you on it, I asked you to back it up three times and you couldn't produce. Thanks for proving you're nothing but a lying troll. Come back when you've got something interesting to say, child.

notajayhawk 4 years, 8 months ago

Gonna' post a link, "jstthefacts' [snicker]?

Got just one quote, "jstthefacts" [snicker]?

Didn't think so.

notajayhawk 4 years, 8 months ago

Yes, they're all quotes. And I did not question the validity of a single one of them.

And not one of them answered the question I asked you, or backed up the statement made by you that I questioned.

Keep garfinkeling, little one.

Alceste 4 years, 8 months ago

Healthcare_Moocher: So you're writing they're actually worried about me given I pay income tax, property tax, sales tax, blah, blah, blah. I shall add, also, that I pay a much more stinging aspect of my income than these two guys.....who can most certainly really afford to pay a whole, whole, whole lot more. And, pay they shall. Soon come. Your simpleton like thought that I do not pay income tax or have a Grade C health insurance plan provided by none of your business is most amusing! Neither Brownback nor Roberts give a rat's rear end about the "taxpayer" and their voting records on THE critical legislation (the one's where they give themselves pay raises and all manner of free lunches) speaks for itself.

Your smudge of Obama as an "icon" is duly noted. Conversation between the Right Wing Elite: "Man, we've really done bad these past 8 years, haven't we?" Answers the other...."What say we let that African-American guy take the fall for it?" The other guys respond....."OH MY! That's brilliant....we mess it up....and the African-American guy takes the heat!!! Excellent. Pass that caviar around a lttle bit more Dick. George...don't bogart that spoon, man....."

whats_going_on 4 years, 8 months ago

...are you ever worried about having enough money to feed your family? Honestly now. And I'm not talking about nightly dinners on the plaza feeding.

gogogirl 4 years, 8 months ago

You say you are not "mean spirited". I beg to differ. Your self-centered comment that people should earn their own health care is pretty shabby. Sounds like you are very bitter against poor people who possibly can't find jobs and get healthcare for their families. We are put on this earth to help our fellow human beings - I don't think you understand that!

notanota 4 years, 8 months ago

Your selfishness aside, you do realize that the poor have already been getting health care at taxpayer expense and would still be getting it if Obamacare were repealed, right? This bill was about making sure the middle class was also able to find insurance and not get excluded for preexisting conditions.

overthemoon 4 years, 8 months ago

Since neither Brownback nor Roberts could take the effort to actually propose workable solutions to the nations healthcare crisis, it is ludicrous for them to be complaining about a bill that is almost precisely a carbon copy of Republican proposals offered several times over the past 10-15 years which included mandates for insurance coverage. And no. Tort reform is not a solution but a tiny drop in the bucket. I'd like for them to explain how they will make up for the increases in health care's percentage of our GNP while they noodle around for the next 20 years trying to come up with something that Republicans can take credit for.

The plan outlined in the 'contract on America' kills the bill, and then reconstructs it in nearly the same mold. All of this is yet another politicized manipulation on the part of a party whose members did nothing to earn their salaries for the past two years.

notajayhawk 4 years, 8 months ago

"I'd like for them to explain how they will make up for the increases in health care's percentage of our GNP while they noodle "

I'd like to see you take a whack at explaining how the legislation that was passed does any such thing. You up to it, moonie?

Scott Bonnet 4 years, 8 months ago

Read my post above. Dare you to respond.

notajayhawk 4 years, 8 months ago

"Read my post above. Dare you to respond."

Ooh, I love a good dare. Let's see, where to start - if I can stop laughing long enough, let's start with this one:

"Is it the requirement that insurance compaionies actually pay out 85% of premium in benefits? (as oipposed to 30% profit margins.)"

  • 30%, skippy? Which orifice did you pull that one out of? The industry-wide average is about 4%. Most of the for-profit companies are publicly traded, and their financial filings are public records. Try looking it up.

  • It's not a straight 85% loss ratio, skip, it's 80% for companies insuring individuals and small companies, and 85% for those insuring large companies. Wanna' take a guess at what the industry-wide average is right now? It's 80% for companies insuring individuals and small companies, and 85% for those insuring large companies.

  • I'd tell you to give just a little bit of thought to what the effect on health insurance premiums, and overall health care costs, with a mandated ratio in the absence of a premium cap, but you don't have to put too much thought into it. Try looking at what happened in the states that instituted such a provision. (Hint: They didn't go down, skippy.)

"Is it that children can stay on their parents policies to the age of 26?"

And why, exactly, should mommy and daddy's employer and co-workers have to pick up the tab because mommy and daddy want to keep supporting junior until he finishes grad school?

"Is it that we might actuially raise our standing among industrialized countries in terms of health care?"

Um, there is no objective measure of the output of health care systems across countries. None. But hey, if you believe that that adopting a health care payment system like Sweden's will make you grow taller, be my guest.

"Is it that millions of uninsured will no longer be using emergency room care for their only health care venue?"

Again, perhaps if you checked your facts; the uninsured are the only group that uses a smaller share of ER resources (in terms of numbers of visits and dollars of services provided) than their share of the population. The group that uses the biggest share in relation to their share of the population is Medicaid users. And congratulations - this legislation just took a lot of people who were in the group using ER's the least, moved them into the group that uses them the most, and you're paying for them!

"I'm really tired of the uneducated vitriole."

Perhaps if your post reflected just a tiny modicum of being informed on the issue, just a speck of understanding, just anything other than the Democratic sound bites, I'd be able to stop laughing at that one long enough to get to the rest of your 'points'.

Scott Bonnet 4 years, 8 months ago

Get your "facts" from someone other than Faux News and I'll take you seriouslly. Try the Brookings Institution. Look at any objective source. And no, the industry doesn't come close to paying out claims at the rates you state. Give a source. Any legitimate source. I'll take "Skippy" and consider it a complement from you. The CBO and the GAO both stand by the benefits of this plan. Also, the crack about kids in grad school just further illustrates the absurdity of a private heath care system. Come back when you have something based in fact to say.

notajayhawk 4 years, 8 months ago

http://biz.yahoo.com/p/522conamed.html

Healthcare Plans, Net Profit Margin %, 4.80

Got a link to that 30% number you threw out there, skip?

While you're at it, browse around a little. As I already mentioned, the financial filings of publicly traded corporations are public record, many of them available from links you can follow from the industry browser. Have someone explain how to read an income statement to you, take a course in third grade math, and you can figure out the loss ratio for yourself.

Of course, facts aren't going to mean much to you, since you don't seem to understand the concept of what a "fact" is. "The CBO and the GAO both stand by the benefits of this plan." Seriously? Got a link to that whopper? It is not the purpose of either of those offices to "stand by the benefits" of anything. It's their job to evaluate the costs. And if you, for once, got past the sound bites and did a little investigating on your own, the CBO's judgment that the legislation will pay for itself is based on 1) cuts to Medicare that are never going to happen, and 2) the assumption that the total cost will be only what's specifically mandated in the bill, not including any discretionary spending that arises later as a result of the legislation.

Come back when you're ready to play with the adults.

overthemoon 4 years, 8 months ago

In case you don't know, employees pay for their own family policies. Only in very few situations does the company pay for anything other than the employee's insurance. More often these days, the business is shifting some of the costs to the employee.

The thirty percent of Health insurance premiums paid out to non-claim costs is correct. That is not the same as saying they have a 30% profit. But that 30% pays for employee percs, advertising, lobbying and other excessive expenditures that we as 'customers' pay for. Most of them are against our own best interest.

overthemoon 4 years, 8 months ago

And I got that 30% average by looking at the annual reports of the 5 big insurance carriers.

notajayhawk 4 years, 8 months ago

Really? How about Molina, for example, with a million and a half policyholders and $3.66 billion in premium revenue - with a medical claims percentage of 86.8%

http://biz.yahoo.com/e/100316/moh10-k.html

Or Wellpoint (you remember them, the ones that started all the screaming about their premium increases in California), with 33 million members, $56 billion in premiums, and a loss ratio of 82.6%

http://yahoo.brand.edgar-online.com/displayfilinginfo.aspx?FilingID=7064897-428204-433082&type=sect&dcn=0001193125-10-034180

Maybe if you gave me the particular companies you're looking at, I can see what you're talking about.

notajayhawk 4 years, 8 months ago

Incidentally, I'm not saying you made up your numbers or anything like that. Are you sure, for instance, you were looking at premium revenue and not total revenue when making your calculations?

notajayhawk 4 years, 8 months ago

"In case you don't know, employees pay for their own family policies."

1) That is not always the case, particularly for government employees. Some pay a slightly smaller percentage of the family coverage, but they do quite often pay some of it.

2) The last time I used employer-sponsored health insurance, it cost me $34/month to cover my children - regardless of how many children I had. Toddlers are less expensive to insure than 20-somethings, if the latter are added, everybody's family premiums go up.

3) If it cost junior as much to be added to mommy and daddy's family coverage as it cost him to pay for his own policy, this conversation wouldn't be taking place.

"The thirty percent of Health insurance premiums paid out to non-claim costs is correct."

No, it is not correct.

That infamous 30% figure comes from an article that was published years ago in the NEJM. The article was written by the same doctors who started Physicians for a National Health Plan, one of whom freely admits the primary reason she became a doctor was to publish articles like that to promote her social welfare agenda. Besides the ridiculous methodological weaknesses (e.g., their data comes in large part from a survey asking doctors how much time they think they spend on administrative duties, then assuming all health care providers spend the same amount of time), and the fact that the data is hopelessly outdated with technological advances in administrative functions, that 30% figure is for the dollars that go to health care providers, not insurers. A large portion of those administrative costs have nothing whatsoever to do with billing and insurance. The salary of the receptionist is an administrative cost. So are the practice's computers, phones, copy machines. So is the entire medical records department. And as a provider, I assure you that the amount of administrative expense spent on regulatory compliance exceeds that spent on billing and insurance. None of those things would be reduced if we changed the way we pay for our health care.

But the propaganda sites evidently have a lot of people believing it all goes to insurance. In the article as published in the NEJM, there is no claim made that 30% of the spending goes to insurance companies. They never would have been published if they made that claim, which is not supportable by their data. That didn't stop them from making that claim on their website, however. Incidentally, those same whacky docs at PNHP are the ones responsible for the specious claim that more than half of bankruptcies are "caused" by medical expenses.

Stop listening to the sound bites and do your homework.

rtwngr 4 years, 8 months ago

President Obama was asked, point blank, by George Stephanopolous about this being a tax on lower income Americans in direct opposition to his campaign promises about not raising taxes on income less than $250,000. President Obama said that it was not a tax but a penalty. Now his administration is defending its right to levy it as a tax. This president is a disingenuous failure of a leader. Roll the whole thing back and start over!

Scott Bonnet 4 years, 8 months ago

Start over WITH socialized medicine, just like every other industrialized country on Earth. We need national health care.

Alceste 4 years, 8 months ago

Here! Here! RickSuttle.....most excellent observation.

I have two family members that vehemently oppose healh care reform. Guess what? Both are doctors (specialists at that; not in Kansas; very good at what they do; and ONLY serve CASH paying customers as in NO INSURANCE ALLOWED); each raking in/netting in excess of $2,000,000.00 per annum and how they love to say "You know, a million dollars isn't what it used to be....". Oh yes, they do speak like that! It's really pretty funny.....

notajayhawk 4 years, 8 months ago

The problem being that, if everyone had universal coverage that was paid for out of their taxes instead of having to regularly open up their wallets, there's no incentive for your relatives to reduce their fees, since nobody's going to complain about them. But I'm glad you recognize the role of the provider in over-inflated health care costs instead of just the insurance companies.

Unless, of course, you mean a real socialist system, where all services are actually provided by the government. That being the case, got any idea where the government's going to come up with the trillions upon trillions of dollars it would take to buy up every health care facility in the country, or the legal precedent for drafting every health care provider in the country into being a government employee?

Scott Bonnet 4 years, 8 months ago

How about almost any of the systems of the major Western European industrialized countries, or the Japanese?

notajayhawk 4 years, 8 months ago

Um, I dunno' - how about them? Did they start off as private systems that the government spent trillions of dollars to buy up?

But since you brought those up, here's a little question for you: How much do doctors get paid in those countries compared to doctors in this country? You really believe that if we change the way we pay for our health care, physicians are going to cut their rates in half?

See, skip, altering an existing system to copy a system that evolved that way does not result in the same cost savings, especially when that other system exists in a completely different environment with a completely different set of circumstances.

Bob_Keeshan 4 years, 8 months ago

Two guys who've got theirs signing up to be sure their health care is protected at the expense of others.

Now that's leadership.

notajayhawk 4 years, 8 months ago

Of course, those two guys get it in return for services provided, the same as any other federal employee, while you're just standing there with your hand out.

Bob_Keeshan 4 years, 8 months ago

Just keep telling yourself that. What services, exactly, are they providing? Top quality Republican services?

Republicans = dedicated public servants Democrats = career politicians.

Got it. Enjoy your day trolling on another healthcare story.

notajayhawk 4 years, 8 months ago

Oh, that's right, according to bobbie, United States Senators are not federal employees.

Oh, wait, it appears he thinks that only Republican Senators are not public employees. Only those noble Democrats are really providing any service.

Service to HIM, of course.

"Enjoy your day trolling on another healthcare story."

Let's see, on the other thread about this same story, right up there near the top:

Bob_Keeshan (anonymous) replies… "They aren't federal employees, they are elected officials. Regardless, it is government run and government subsidized health care."

And today, hopping in again, right up near the top:

Bob_Keeshan (anonymous) says… "Two guys who've got theirs signing up to be sure their health care is protected at the expense of others."

You want to keep repeating the same old party-line lies, bobbie, I'll just keep right on making you look foolish. Have a wonderful day, Cap'n.

Cait McKnelly 4 years, 8 months ago

You really don't know the meaning of the word "sarcasm" do you Nota?

Bob_Keeshan 4 years, 8 months ago

Nota is like shooting fish in a barrel.

notajayhawk 4 years, 8 months ago

Ooh, good comeback, Cap'n.

Still waiting for your explanation of how Senators are not federal employees. Any time now.

gogogirl 4 years, 8 months ago

You got that right. They have theirs and don't really give a crap about the rest of us. What a great pair of "leaders".

Carol Bowen 4 years, 8 months ago

Try writing to them. Their responses reinforce their positions regardless of what you said. We need to put pressure on our "representatives."

Cait McKnelly 4 years, 8 months ago

I automatically bypass anything Tom has to say. It's not worth reading and just takes up space on my computer screen.

woodscolt 4 years, 8 months ago

And that is the real story, cait. I skim one of toms posts every couple months and move immediately on. He regurgitates the same tired old crap over and over and over......................

irvan moore 4 years, 8 months ago

i find it interesting that those on the right and those on the left forget about the majority of us who are in the middle and would like to see both sides working together to solve problems instead of trying to fix blame on the other side.

Jimo 4 years, 8 months ago

Perhaps you haven't been following events closely. The health insurance reforms WERE the result of both sides working together: Democrats set aside their own big government preferences and adopted Republican ideas on health insurance. That Republicans immediately repudiated their own policies once the Dems endorsed them (apparently the Dems have kooties) doesn't alter the reality that the reforms are bipartisan and moderate in nature.

sourpuss 4 years, 8 months ago

There is no reason to resort to hyperbole about something as basic as reasonably affordable access to quality health care. Any one of us could be in a position where, under the "current" free-for-all, could not afford care if we became seriously ill. Anyone can lose their job, become injured to the point of disabilities (be careful on your way home), or have a loved one with a problem. One of the functions of government is to care for its people in terms of basic needs (clean water, military protection, keeping poisons out of consumer products, regulating dangerous professions - so your little orphans don't fall in threshing machines, you know) and providing some -structure- to the health industry is important.

Capitalism doesn't work with health. You, the consumer, cannot just say, "Oh, I won't get that chemotherapy - aspirin is cheaper." Your health isn't a new laptop.

Also, the fact that this bill is "Obamacare" is because the Republicans would not sit down and discuss this pressing need like grown ups. Instead, they decided that obstructionism and contrairianism was the way to go. Maybe it was - maybe people don't want any form of social net to catch them should they fall through. I can tell you though, it is hard enough to be sick without worrying about paying for it later.

Foetuses have a right to medical care - shouldn't an actual person?

notajayhawk 4 years, 8 months ago

"Capitalism doesn't work with health. You, the consumer, cannot just say, "Oh, I won't get that chemotherapy - aspirin is cheaper." Your health isn't a new laptop."

When is the last time capitalism was allowed to work in health care, sourpuss? The very existence of third-party payment completely removes the ability of market forces to control costs. And the legislation that was passed does nothing - absolutely nothing - to make health care more affordable, it just shifts those costs onto someone else.

Scott Bonnet 4 years, 8 months ago

What does that mean? Allow capitalism to work? Capitalism has rendered our health care system 37th in quality, but 1st in cost the world. Insurance and pharmaceutical companies have gotten fat at the capitalist heath care trough.

notajayhawk 4 years, 8 months ago

"What does that mean? Allow capitalism to work?"

Oh, lordie, it's Romper Room time. Well, at least you managed to get me to stop laughing.

[sigh]

It is a fallacy that health care is a necessity that is not subject to market forces. Yes, when you need it, you need it. But, just like those other 'necessities' like food and gasoline, you don't need as much of it as you consume, nor do you have to purchase it from the guy that charges the most. Some studies have shown that as much as 40% of our health care spending (and I don't mean insurance, I mean the actual dollars spent on services provided) do absolutely nothing to improve health. For an example, the organizations that prepare the rankings you alluded to, like the OECD, note that Americans get far and away more MRI's per capita than people in any other country, without any significantly higher prevalence of pathology to account for that discrepancy.

But with a third party system, there is every incentive for providers to add on as many services as they can, and absolutely no incentive for consumers to decline those services. If you go to the emergency room and they want to do an MRI where an x-ray would have been just fine, or when you just had one at the same ER the day before, you have no incentive to question the need for that or discuss more affordable options. Just as you have no incentive to ask for a generic $10 medicine that's been working just fine for 50 years, instead of the $400 latest 'wonder drug' that the pharmaco rep is pushing this week. And you have no incentive to go across town to an ER where the charges might total $5000 instead of to the ER that's going to bill you $15000 for the same treatment. You have no incentive because your co-pay is going to be the same either way. Suppose food worked the same way - suppose you paid a monthly 'premium' and a small 'co-pay' every time you went to the store. Wouldn't you shop at Dillons instead of Aldis, walk out with a fuller cart, and full of top sirloin steaks instead of hamburger?

"Capitalism has rendered our health care system 37th in quality, but 1st in cost the world."

First of all, the rankings you refer to are measures of health, not health care. There are a lot of factors that go into overall health that have nothing whatsoever to do with the health care system. Try looking, for example, at the top causes of infant mortality, and tell me what they have to do with health care. Second, capitalism had nothing whatsoever to do with our rankings, as the third-party payment system, coupled with excessive regulation, has made our system anything but capitalist.

"Insurance and pharmaceutical companies have gotten fat at the capitalist heath care trough."

The average profit margin for health insurance companies is about the same as that of 'non-profit' Lawrence Memorial Hospital. The difference is, insurance companies make a bigger profit if you're not sick, while LMH makes more money if you are.

Jimo 4 years, 8 months ago

Might that not be because health care lacks virtually every prerequisite for market forces to work effectively?

While it's untrue that "the legislation that was passed does nothing" to make care more affordable, that's a direct consequence of GOP refusal to be involved in the process. Why should Dems take all the heat for controlling costs? Besides, insuring the uninsured - IS - a process of lowering costs rather than keeping with the partial delivery of medical services to the uninsured in the most expensive and inefficient means conceivable!

"It just shifts those costs onto someone else". ROFL As if "costs" just disappear because millions have no insurance. Someone, you don't seem to grasp how insurance works (hint: costs are shifted onto someone else - everyone else, actually). But of course by providing insured access to health care, many of those "costs" are much smaller as minor problems are kept minor.

notajayhawk 4 years, 8 months ago

"Might that not be because health care lacks virtually every prerequisite for market forces to work effectively? "

Um, no, because it doesn't lack those prerequisites, and such a belief reflects a pitiful lack of understanding of market forces. For a start, see the response I just posted to RickSuttle above. The evidence already exists. As much as 40% of the health care we receive is unnecessary under our current, third-party payment system. The uninsured - you know, the ones that actually make decisions with their wallets - use fewer health care resources than those with insurance. There's a pediatrician who writes LTE's to this paper urging universal coverage (which would, of course, prop up his fee structure). On his website, he urges people without insurance to discuss lower cost alternatives with their doctor. Now tell me, jimmie boy - why don't the doctors, or the patients, discuss those lower cost options even if they have insurance?

"that's a direct consequence of GOP refusal to be involved in the process. Why should Dems take all the heat for controlling costs?"

Perhaps because this was a purely Democratic proposal? The Republicans did not have the numbers to interfere in any way to alter the legislation as passed, jimmie boy. If the Democrats wanted a public option for example (which also wouldn't have brought down overall costs), they could have passed it, just as they passed the final bill, without any Republican involvement at all. They couldn't even sell it to their own membership.

"Besides, insuring the uninsured - IS - a process of lowering costs"

Um, no, it isn't. It lowers the cost to the individual that now only has to pay his premium and co-pays instead of paying out-of-pocket, but does nothing whatsoever to reduce the system-wide costs. As a matter of fact, the legislation as passed exerts forces to inflate overall health care spending, but I seriously doubt you're capable of understanding the effects of a loss-ratio mandate in the absence of a premium cap, together with a mandate to purchase coverage.

"rather than keeping with the partial delivery of medical services to the uninsured in the most expensive and inefficient means conceivable!"

Oh, you're one of those who bought into the urban myth that the uninsured are flocking to emergency rooms, I suppose?

"ROFL As if "costs" just disappear because millions have no insurance."

Um, they do, because people without insurance use less services.

"But of course by providing insured access to health care, many of those "costs" are much smaller as minor problems are kept minor."

Another urban myth. If a thousand people rush to their doctor for every little cough, yes, it's cheaper to treat the ten of them who have early lung cancer. But the cost of those doctor visits for the other 990 who just had a cold more than makes up for those costs.

'Thanks for playing anyway, jimmie. Keep up the good work of propagating those Democratic sound bites.

notajayhawk 4 years, 8 months ago

"The health insurance reforms WERE the result of both sides working together: ... the reforms are bipartisan and moderate in nature." - Jimo, 9:36 a.m.

"that's a direct consequence of GOP refusal to be involved in the process" - Jimo, 9:50 a.m.

As always, jimmie boy,

just

frikkin'

brilliant.

notanota 4 years, 8 months ago

There are ways that capitalism could work for cost savings. However, that can only happen when the doctor isn't thinking about profit maximization. It's not only third party payments that break this system. A direct payment per service would also potentially lead to unnecessary tests and over treatment.

jayhawklawrence 4 years, 8 months ago

It might be a good move to see the arguments discussed in a courtroom, presided over by a judge, and aired on national television.

We might get closer to actually understanding how the bill is supposed to work.

Maybe then, we can work to make it a better bill than it currently is.

If the Republicans win this thing, look for lawsuits affecting car insurance and a lot of other issues. There will be collateral damage, but these folks only care about having a platform to attack the president for two more years.

notajayhawk 4 years, 8 months ago

"look for lawsuits affecting car insurance and a lot of other issues."

Oh, puhleeze, When is that tired old invalid comparison ever going to die?

Scott Bonnet 4 years, 8 months ago

Even the Righties estimate lawsuits have an overall 2% impact on health care cost. Thanks for not being a Jayhawk.

notajayhawk 4 years, 8 months ago

I'd much rather spend 2% to stop this train wreck than absorb the skyrocketing costs the Democrats are giving us.

Bob_Keeshan 4 years, 8 months ago

16 out of "over 110" is "particularly well rewarded"?

Math is not the strong suit of whomever wrote the e-mail you decided to cut and paste. Care to point out who the other "over 94" organizations are?

Scott Bonnet 4 years, 8 months ago

Please note, all of those organizations provide insurance to their own members.

Cait McKnelly 4 years, 8 months ago

Yeah and railroads get out of paying SS taxes for years because they were able to prove they could provide better retirement. These organizations were able to prove they could provide healthcare to their workers. Dunno what your problem is.

pusscanthropus 4 years, 8 months ago

Get me the "F" out of Kansas. Both of these twerps are embarrassing. Oh BTW all you AT&T customers--AT&T was Brownback's biggest supporter in his senatorial campaign.

Liberty275 4 years, 8 months ago

Obama's health insurance mandate isn't really so bad in hindsight. Instead of beer drugs and internet, 20 somethings can pay for insurance at the metaphorical point of a gun. It will be interesting to see how well they like spending $300 each month for something they more than likely will never use.

LOL.

sourpuss 4 years, 8 months ago

They have to buy car insurance they may or may not use. Many people need health care - maternity care, injuries, non-catastrophic infections. $300 is very high. I only pay $600/year overseas. Of course, that goes through the government. The government could provide better plans than private insurers because they wouldn't need to turn a profit. American "20 somethings" have to keep the fat cats fat, in "Obamacare" although that is actually "Blue Dog Dem" care - Obama wanted a public option.

notajayhawk 4 years, 8 months ago

"They have to buy car insurance they may or may not use."

Okay, try to keep up.

You do not have to have car insurance because you do not have to drive.

You do not have to insure against your own losses with car insurance (i.e. you don't have to carry comprehensive insurance), you only have to insure against the loss you might inflict on others (i.e. liability insurance).

The only way to compare the current car insurance mandate to health care is if you mandated that providers, not consumers, had to carry insurance (e.g. a mandate for physicians to carry malpractice insurance).

Oh, and BTW, there is no federal law requiring car insurance. It's left up to the states to decide.

Scott Bonnet 4 years, 8 months ago

Uninsured twenty-somethings cost all of us a fortune, when they suffer catastrophic injury or illness. The theory behind insurance is shared risk, with young healthy people allowing older people to suffer greater losses. Without young healthy people in the pool, it is non-economical.

notajayhawk 4 years, 8 months ago

"Uninsured twenty-somethings cost all of us a fortune, when they suffer catastrophic injury or illness."

based on a belief system that the uninsured won't pay their own bills, or for some reason they shouldn't be responsible for them. A belief system, I might add, which does not reflect favorably on those who espouse it. I don't know about you, skippy, but when I go to the doctor or emergency room, they send me a bill. Maybe you should consider the utterly alien concept that some people actually pay theirs.

notanota 4 years, 8 months ago

When you pay off that bill for a traumatic injury that requires months of hospitalization, months of physical therapy, and renders you unable to work for an extended but not permanent period of time, we'll talk. Well, maybe we'll talk, depending on whether you opted for the budget physical therapist.

notajayhawk 4 years, 8 months ago

Which is, again, based on your assumption that I haven't done so already.

You seriously ought to ask yourself why you are utterly incapable of grasping the concept of paying one's own bills.

notanota 4 years, 8 months ago

If you told me you'd suffered a traumatic brain injury, I would believe you. I wouldn't believe you paid a two million dollar bill yourself, though. That is, in fact, the amount on the bill when a friend of mine's child suffered such an injury.

notajayhawk 4 years, 8 months ago

Sounds like your friend, in fact, got seriously overcharged. A friend of mine spent some time on an operating room table a few years ago while they tried to stuff a significant portion of his brain back into the confines of his skull cavity. They also had to take to occasional pause to re-start his heart (three times). He didn't get charged a tenth of what you're talking about.

notajayhawk 4 years, 8 months ago

Incidentally, have you given any thought - any whatsoever - to what the heck cost 2 million dollars? Did they use disposable solid-gold scalpels? Did they buy a brand new CT scanner just for that one person? Did they fly in a surgeon from Australia on a private plane?

The point you consistently fail to grasp is that 2 million dollars for any medical treatment is too d@mned much. We can not afford to pay that, whether it's out-of-pocket, through insurance premiums, or in taxes. It's too much. And covering more people with insurance makes that problem worse, it doesn't make it better. Because whether your friend had insurance or not, somebody paid for all that.

notanota 4 years, 8 months ago

Two million dollars = helicopter transport, time in a coma, months of pediatric intensive care, visits from pediatric neurologists, physical therapy and equipment along with the staff to work one-on-one with him, expensive medical scans, surgery, medical ventilators, medication, etc.

He very nearly didn't live, and I doubt his mom even thought about cost at the time of the injury, even though her plan held her responsible for 20% of the cost, which is the point that you fail to grasp. Yes, someone had to pay it. She had to pay enough that if money were a motivator, she'd have been motivated.

Direct payment will not fix this. People will not comparison shop for budget plans when it's a matter of saving the life of their child. In order for a market system to drive down prices, you have to have the option to walk away. I can choose not to drive a car, if I think they're too expensive. There's no option to walk away when you're on the table having your heart restarted. The only walking away that can be done is with the bill afterward.

notajayhawk 4 years, 8 months ago

"People will not comparison shop for budget plans when it's a matter of saving the life of their child."

How many times are you going to beat to death the same false choice?

Two million dollars is too much. Got that? No? Let me repeat it: Two million dollars is too much. Still not clear on this? Here, let me try again: Two million dollars is too much. As long as someone else is paying the other 80% for you, you have no incentive whatsoever to try to change that. Markets are driven by groups of people, not individuals. If a single individual, for whatever reason, legitimate or not, chooses not to comparison shop, that's up to them. Others will learn from their mistakes.

MyName 4 years, 8 months ago

Yeah, let's make a magic number and go ahead with worthless hyperbole instead of explaining why a proposal that is nearly identical to one implemented by a Republican Governor from Massachusetts is somehow an extremist plot.

And I'm sure all of the other countries in the western world who have government healthcare systems are holding their citizens "at the point of a gun" too. Get a clue, and join the 20th century.

Liberty275 4 years, 8 months ago

"Metaphorical" is a word you are unfamiliar with, isn't it? It's a real word with a real meaning. Go look it up.

I realize it is a stretch for you, so I'll go ahead and explain it. In this case I was using the common metaphor of the barrel of a gun to represent the fee/tax the obama administration and his current and former lackey's in congress decided people should pay if they choose not to enrich corporate coffers by purchasing a certain product simply because they are American, get more than a certain amount of money from somewhere and are still breathing. By using the metaphor, I am not only stating the fact, but also commenting on it and giving my opinion.

Metaphors are useful shortcuts in communication. You might find them useful now that you know what they are.

Also, if you think people around the world like giving the money they work for to the government, I believe you are mistaken. If people liked giving their money to the government, taxation would be redundant and not necessary.

as for my "magic number", it is derived from a smaller number than 1/2 of the amount my wife and I pay for health insurance through our employers. Math is probably magical to you too, but not to everyone.

Gareth Skarka 4 years, 8 months ago

I love the subtle bit of propaganda occurring here:

As any child of the 1970s and 80s who remembers "Schoolhouse Rock" can tell you, a piece of legislation that passes both houses of Congress and is signed by The President stops being a BILL and is now a LAW.

But I guess we wouldn't want to read about how our elected officials are trying to overthrow the law of the land, so it's much better to say that they're trying to "challenge" a "federal bill."

Disgusting.

And of course, it will work, because people are ignorant and willing to be blinded by their party ideology.

From here on out, if one side legally passes a law via normal constitutional channels, the other side will then spend all of their time trying to repeal those laws. Welcome to the next 50 years of politics.

notajayhawk 4 years, 8 months ago

"But I guess we wouldn't want to read about how our elected officials are trying to overthrow the law of the land, so it's much better to say that they're trying to "challenge" a "federal bill.""

That go for everything both houses of Congress passed and was signed by the president, Gareth? Like the Defense of Marriage Act, for example?

Oh, and by the way, while the legislation was, indeed, passed and signed, most of its provisions have not yet taken effect.

Gareth Skarka 4 years, 8 months ago

Unconstitutional does not mean "Stuff I don't like", genius.

And don't give me that "State's Rights" garbage -- you hayseeds lost that battle in the 1860s.

Nobody cares if "your'n ah-gin in."

notajayhawk 4 years, 8 months ago

"And don't give me that "State's Rights" garbage -- you hayseeds lost that battle in the 1860s."

Just curious as to where you stand on another issue, Gareth, like the story in the paper yesterday about the California law that allows illegal immigrants to get in-state tuition (or, for that matter, Kansas' nearly identical law). Especially given that federal law prohibits that.

Flap Doodle 4 years, 8 months ago

The king of Saudi Arabia is traveling to get some medical tests done and he's not going to Canada, England or Cuba. He's coming to America. I seem to recall that our health care system was unfavorably compared to many other countries by the shrill voices on the sinister side of the aisle during the debate of Dear Leader's mad scheme.

Scott Bonnet 4 years, 8 months ago

It is a great system for the very wealthy. I'm not. How about you?

Jimo 4 years, 8 months ago

Well, the shopping is better here for the three wives while he recovers.

Sorry, most countries don't view medicine as a profit center and aren't going to accommodate limited resources to treat some wealthy foreigner if that means depriving a needy local. Or so over-invest in medicine - to the detriment of the rest of the economy - that there's wasted, unnecessary resources sitting idle for your Muslim buddy to appropriate.

Rather than achieve your goal of lauding the U.S. medical system, your example merely serves to indict it.

Gareth Skarka 4 years, 8 months ago

Oh, it's a great system -- if you're a multi-billionaire.

Genius.

Jonathan Kealing 4 years, 8 months ago

It's getting caught in the spam filter. Not sure what about your post is tripping the filter, though.

Unreal 4 years, 8 months ago

I've got a great idea for all the tea-baggers & republicans that don't want to be a part of the new healthcare system . . . have our government allow them to opt out. Then, when they come down with cancer, get diabetes, have a heart attack, etc. and their healthcare provider either drops them (and then no one else will pick them up because it's a pre-existing condition) and their benefits are maxed out, too friggin bad!!! How can some of the middle class be so ignorant and buy into the idea that somehow this healthcare reform is bad? If you don't want it, fine. Don't get it. And when you get sick and dropped by your provider, don't come crying to anyone. But let the rest of us with a brain in our head, enjoy the benefits of this reform. I received a Blue Cross/Blue Shield of KS DVD in the mail about the changes of this new healthcare bill, and after watching it, I still don't understand why in the world some people in this country don't want it. Then I realized that it really boils down to the fact that a democratic congress/president got it passed, and that alone, is what the tea-baggers and republicans are p'd about. Because when you break this healthcare bill down, and ask anyone if they like the different provisions in it, everyone does. The ones complaining just don't want to pony any money up for it. Hmmm.....I thought all you teabaggers & republicans were against free handouts from the government? If you are, then you shouldn't mind paying a little for healthcare!

Cait McKnelly 4 years, 8 months ago

What a great idea! No one shoves Medicare down the throat of the elderly. If they want to opt out, let them.

Unreal 4 years, 8 months ago

I think for anyone that chants "get government out of my life", they should not be provided police protection, fire protection, Medicare, Social Security, healthcare, etc. These are all government programs whether on a local level, state level, or federal level. I don't think people realize just how dumb they sound when they chant or say idiotic things like this.

Liberty275 4 years, 8 months ago

"have our government allow them to opt out"

Nitwit. We have already opted out by paying for our own insurance. I don't mind buying it, but I don't want to be forced to buy anything.

notajayhawk 4 years, 8 months ago

"How can some of the middle class be so ignorant and buy into the idea that somehow this healthcare reform is bad?"

Funny, I was just wondering how so many could be ignorant enough to think it's good.

"If you don't want it, fine. Don't get it."

Um, yeah. Except the legislation doesn't allow for that, which is pretty much what a majority of the population objects to.

"Then I realized that it really boils down to the fact that a democratic congress/president got it passed, and that alone, is what the tea-baggers and republicans are p'd about."

Then I realized that it really boils down to the fact that a democratic congress/president got it passed, and that alone, is what the liberals and moochers are gung-ho about. There, fixed that for ya'.

"Because when you break this healthcare bill down, and ask anyone if they like the different provisions in it, everyone does."

Well, with the exception (for one) of the health insurance mandate, without which all the other proposals fall apart.

"then you shouldn't mind paying a little for healthcare!"

I do pay for my own health care. Stop trying to get me to pay for yours.

pace 4 years, 8 months ago

I am for health care reform. I know if I write a letter to Brownback and Roberts it wouldn't matter a bit. If they do get a lot of letters it would only mean to them , they need to crank up the crazy ads,

Cait McKnelly 4 years, 8 months ago

I wrote a letter to Brownback in support of specific legislation in the Senate. It was legislation he was against. What I got back was a preprinted form letter with a rubber stamp signature full of obfuscation that didn't even address the issue I wrote about, much less the legislation. I wrote to Dennis Moore about legislation in the House and not only did I receive a well written reply regarding that legislation but it also discussed further legislation coming up in Congress about the same issue. It was signed with his name by ball point pen. Whether it was signed by him or a staffer, it was a real signature. I threw away Brownback's letter like any other piece of preprinted junk mail. I kept Dennis Moore's. Who do you think I respect more?

notajayhawk 4 years, 8 months ago

The one who lied to you (but with a pretty signature)?

Cait McKnelly 4 years, 8 months ago

Ever notice how preprinted signatures are always perfect and pretty? You actually got one right!

Brendon Allen 4 years, 8 months ago

Once again what is being missed in this particular argument about universal coverage is that if you get rid of this you also get rid of disallowing pre-existing conditions to be excluded. But of course that is never mentioned in these suits as most all americans favor this (70% in the last poll I saw). Why you ask? Without a universal coverage mandate you end up in a moral hazard situation where it makes more sense to be a free rider of the system and then buy in when you get cancer, heart disease, etc as they will have to cover you. So if you are suing over this make sure the public knows it goes hand in hand with the pre-existing condition clause because anything else is just misrepresentation. Without a coverage mandate the system will not adequately spread the risk over a diverse population and you are right back to where you are today. Is the bill flawed? Yep, it does nothing to look at the cost side of the equation, but that is where congress SHOULD come in and fix it. this is the one thing they do well, reforming existing legislation. This should not be decided in the courts. Grow up and talk together to work it out and make it work. I don't like all of "Obamacare" but I have to applaud the democrats for at least trying to do something that will soon control 1/4 of GDP and make use even more uncompetitive on the world stage. I welcome the republicans to come in and add the price cutting side of the equation and even tort reform (though as stated this is a drop in the bucket). As an independent so far all I see is a party of NO and no new ideas. That is a shame.

notajayhawk 4 years, 8 months ago

"Once again what is being missed in this particular argument about universal coverage is that if you get rid of this you also get rid of disallowing pre-existing conditions to be excluded. But of course that is never mentioned in these suits as most all americans favor this (70% in the last poll I saw)."

That's not lost at all. The interdependency of the coverage for pre-existing conditions and the mandate has been discussed ad nauseum. And while you're correct that most people favor coverage for pre-existing conditions, they most definitely do not favor the mandate. Just as they favor a public option, but not if it raises taxes or adds to the deficit. Everyone always wants the goodies, until they see the price tag. When you ask the questions with the costs included, the support you're talking about dries up pretty quick.

Brendon Allen 4 years, 8 months ago

I think ad nauseum is overstating. Almost everyone I talk to says the same thing, they don't want the government telling them they have to have insurance, etc but they say there are some things they like, like the pre-existing condition clause. The interdependance is lost on the majority of people and I have seen very little talk about that exact point (and I do consider myself pretty up to date on current events, the economist is one of the few places I have seen it in fact). I think the flip of this is that more people would support universal coverage if they knew it was tied to pre-existing coverage (Since when do we think of the long term cost, no matter what the tea party claims). However this hints on a larger problem with "Obamacare", perception is 9/10 of an omnibus legislation like this and that is what this administration really messed up. They allowed the right to take center stage with "death panels" and taking away medicare and anything positive was lost in the fray (there were several positives to this legislation). Unfortunately it will be the people that lose in the end and real debate and change in health care instead becomes a court case about states rights.

notajayhawk 4 years, 8 months ago

"I think the flip of this is that more people would support universal coverage if they knew it was tied to pre-existing coverage"

I think it equally, or possibly more likely that the reverse is true. I.e., the support for pre-existing condition coverage would go down is it was linked to single payer.

The polls on single-payer can tell you a lot. There is a huge variance between polls, the results are so dependent on how the question is asked and the terminology used (e.g. saying "single payer" tends to reduce support, saying "a Medicare-like system" tends to increase it). If you ask if people are generally in favor, yes or no, the support is higher than if you offer several choices and ask them to pick one or rank them. And when you throw in qualifiers (like the cost, limitation of choices, etc.), the support drops off rather quickly.

This is hardly a new phenomenon, nor is it exclusive to the health care issue. Everybody wants more playgrounds for their kids - just not in their neighborhood. Everyone wants criminals off the streets - but only if their taxes don't go up to pay for new prisons (especially if it's to be built in their town). Heck, everyone wants potholes fixed, libraries expanded, public transportation - but only if they're all free. Everybody always wants everything, if you separate it from the downside. But when you present them both together, support drops off, as can be seen in the polls related to the health care legislation that was passed.

Cait McKnelly 4 years, 8 months ago

Just wait until you hit the lifetime limits of your health insurance, Tom. Then you can "die quick" (and the rest of us can breathe a sigh of relief).

jafs 4 years, 8 months ago

Come on.

There's no need for that sort of personal animosity.

If you don't like his posts, you can always ignore them.

Cait McKnelly 4 years, 8 months ago

Would I had the ability to place people on ignore! But the LJ World won't give us that.

jafs 4 years, 8 months ago

Here's a thought - when you see his name, don't read the post.

notajayhawk 4 years, 8 months ago

"Republican solution = status quo"

When the car you're in is speeding towards a cliff, it's a good idea to put on the brakes and stay where you are.

Or to put it another way, if your three year old is lighting a fire in his bedroom to keep warm, you don't have to know how to improve the insulation factor in your home to know it's probably a good idea to put the fire out. And preferably take the matches away.

RedwoodCoast 4 years, 8 months ago

$25,000 in the hole for a week-long stay in the hospital. At the current rate, I'll get that paid off in about 13 years or so. Nope, nothing wrong with healthcare in this country. And Republicans really care about folks like me. That's why they want to give me tax cuts, right? The only way Republican economic ideology is going to help me is if I wake up one day to find myself somehow acquiring several million dollars. In other words, Republicans aren't going to do anything that will benefit my current financial situation. So many indigent suckas out there swallowing the Republican bait... it's sad to watch.

notajayhawk 4 years, 8 months ago

"you are dead wrong as usual. I do have insurance."

And if what you spent on premiums covered all your health care expenses (i.e., if you were "self-sufficient"), then you wouldn't need insurance, would you?

notajayhawk 4 years, 8 months ago

"The hole purpose of insurance is to spread risk."

Sorry I let this one go for so long.

Actually, the "hole purpose" of insurance is to reduce the risk to the individual by spreading it around. Insurance companies set their premium rates according to actuarial tables. If one out of every thousand of their policyholders is going to incur a million-dollar expense for treatment of a cancer in a given year, they spread the cost of that million dollars over the monthly premiums of those thousand policyholders. From the perspective of the individual policyholder, they can balance the risk of that one-in-a-thousand chance they'll be the one to incur that expense against the risk of spending of wasting $100/month and being one of the other 999. At least, for now they can make their decision on which is the bigger risk under their personal circumstances.

Universal coverage defeats the "hole purpose" of insurance, since there is no longer any risk. Everyone pays a premium (and actually, being mandated to pay the premium and belong to the pool is more of a tax than an insurance premium), out of which everyone's care is paid for. It no longer matters whether you're the one or one of the 999. There is no longer any risk to balance. And yes, that kind of collectivism is a form of socialism.

notajayhawk 4 years, 8 months ago

(Incidentally, I'm not messing with you over the typo, I'm just not sure that spelling wouldn't be more correct on several levels.)

notajayhawk 4 years, 8 months ago

"$25,000 in the hole for a week-long stay in the hospital. At the current rate, I'll get that paid off in about 13 years or so. Nope, nothing wrong with healthcare in this country."

No, there most definitely IS something wrong. But what's wrong is that it cost you $25,000 for a week in the hospital, not how we choose to pay for it. Shifting the costs to someone else without doing something about the skyrocketing costs is an unsustainable solution.

notanota 4 years, 8 months ago

You're right. A single-payer system is the most cost effective solution.

notajayhawk 4 years, 8 months ago

No, actually, removing third-party payment from the system altogether would be the most cost-effective solution.

And even if single-payer was more cost effective than our current system (it has the potential to be, but also the potential to be less cost effective), the non-monetary costs would more than make up the difference.

notanota 4 years, 8 months ago

Single payer isn't third party, genius. In such a system, the doctors are all employees of the government, and the payments go to the government, not the doctors. Profit is removed as a motive for treatment.

jafs 4 years, 8 months ago

I think that's incorrect.

Single-payer systems are basically Medicare for all systems, in which the government acts as the sole insurance company. Canada's system is like this.

What you describe is socialized care, as in England.

notanota 4 years, 8 months ago

Both are actually examples of single-payer systems. Medicare for all would be one method of single payer, and NHS is another. The key to calling it single-payer is that there is only one entity which handles the payments.

notajayhawk 4 years, 8 months ago

"Single payer isn't third party, genius. In such a system, the doctors are all employees of the government, and the payments go to the government, not the doctors. Profit is removed as a motive for treatment. "

Um, no, genius. Canada has a single-payer system, and the providers are not government employees. Expanding Medicare to cover everyone would be a single-payer system, and the providers are not government employees. There is a difference between a true, socialized system and a single-payer system. A very small difference, but a difference. Doctors that take Medicare still make a profit, genius.

Seriously, if you're going to try to debate this issue, at least learn the terms correctly.

notanota 4 years, 8 months ago

If I'm going to debate this issue for realz, dude, I wouldn't be hanging out with a dog-icon sporting non Lawrencinan. Now, I looked it up, since you asked so sweet and totally non trollishly about it.

http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?mode=&index=17627&field=all&HM=&II=&PA=&form=&input=

"An approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company. The proposed advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs. (From Slee and Slee, Health Care Reform Terms, 1993, p106)"

While they could be more specific and say that health care providers remain private practitioners, they do not do so. Some Web sources do, and some either explicitly include NHS and other fully government operated systems or leave it up to interpretation.

Operationally, "socialized medicine" has been broadened to the point that it tends to be used for any form of health care in an industrial nation that isn't the US, so I find the term to be pretty useless in general discussions.

Here endeth this particular sidetrack down semantics and hairsplitting lane.

In a direct payment model where patients pay doctors directly for treatment with no risk management pool, you will see a small dip in some fees, yes. You'll also see care providers leave rural areas for richer urban locations. There's still incentive to overcharge and over-medicate. If an insurance staff of medical professionals can't see that a doctor is routinely over diagnosing, your University of Google degree isn't going to get you much further in determining whether you're receiving necessary or unnecessary care.

notajayhawk 4 years, 8 months ago

"While they could be more specific and say that health care providers remain private practitioners, they do not do so. Some Web sources do, and some either explicitly include NHS and other fully government operated systems or leave it up to interpretation. "

Or, in other words, contrary to the claim you made ("Single payer isn't third party, genius"), single-payer is indeed still a third-party system. The word "payer" probably should have given that away.

"There's still incentive to overcharge and over-medicate."

There is, however, an incentive for consumers to resist that overcharging and those unnecessary treatments. Of course providers still have the incentive to charge as much as they can get - this is the very nature of a market-based system, which is balanced by the consumer having the incentive to pay as little as they can. With a third-party system, the consumers have no such incentive.

"your University of Google degree isn't going to get you much further in determining whether you're receiving necessary or unnecessary care."

You can, however, ASK. Right now the general rule is that providers automatically start with the big guns (e.g. an MRI instead of an x-ray, Olanzapine instead of haloperidol). And the consumer just says "Okay".

notanota 4 years, 8 months ago

Most consumers like to trust that the people who examine their private bits are making decisions based on medical efficacy and not profit maximization. One way to insure that isn't the case is to turn doctors into used car dealerships.

notajayhawk 4 years, 8 months ago

Yeah, well, most consumers are fools if that's what they believe. I always find it amusing when people are full of such outrage over what the CEO of their health insurer makes, but have no problem with Lexus their doctor drives from his million-dollar house to the country club.

Here's a little thought to chew on: Insurance companies make more money if you're not sick. Doctors make more money the sicker you are.

handley 4 years, 8 months ago

I wonder what would happen if all of those people that were so against health care would lose their health care coverage? Just wondering.

notajayhawk 4 years, 8 months ago

"Your doctor charged me and my insurance more to cover for your health care."

Flat out wrong. Go to any health care provider and see how much higher the rates are for the same treatments when you pay out of pocket, compared to the negotiated rates of the insurance companies. It's Liberty and I that are paying for your health care, and we don't even have insurance!

notajayhawk 4 years, 8 months ago

"So which is it? Are doctors charging cash paying customers less (discounted rates and free care) or are they making them pay more? "

Hmm. I said "how much higher the rates are for the same treatments."

Didja' happen to see the words "same treatment" there?

Try to follow along:

We both go to the ER with identical injuries, say we both caught our finger when we closed the hood of the car. I get billed $1,000 for the basic ER visit, plus $50 for an x-ray, and $10 for a shot of morphine. Your insurance company gets billed $500, the negotiated rate for the basic ER visit, plus $25 for the x-ray, and $25 for a shot of Fentanil. You also get an MRI for which your insurance company pays $500. When we leave, I get a couple of pharmacorp sample packets of generic painkillers, you get a prescription for a name brand. I get told to follow up with my GP as soon as I can, you get an appointment set up with whatever orthopedic specialist takes your insurance. The orthopod does a follow up MRI, plus a couple of hundred bucks for the office visit (my GP charges me $75).

You got more services. You got 2 MRI's, a prescription, a visit to a specialist, and a more expensive medication while we were at the ER. The total cost for everything you got was higher than the total cost of my services. But for the same services, those that we both got, I got charged more. The $1,000 that it cost me for the basic ER visit went in part to cover the loss they took on your insurance company only paying $500. Same with the x-ray. (The two unnecessary MRI's also went towards making up the losses from the negotiated rates.) You didn't subsidize anything I got, because I didn't get all those extras. And the one thing I got for free didn't affect you at all.

Got it? Glad I could help.

notajayhawk 4 years, 8 months ago

I don't know what the heck kind of insurance you have, but you seriously need to drop it and get real coverage. On every bill I ever got when I had insurance, the lines looked like this:

A: What they billed B: What insurance paid C: Insurance discount (subtract B from A to get C)

That's the entire concept of a negotiated rate. The provider agrees to take the rate the insurance company pays, and is precluded from billing the patient from the rest (other than a set deductible and/or co-pay).

notajayhawk 4 years, 8 months ago

Just wanted to add an example to that post:

Several years ago my wife suffered a serious accident, resulting in multiple broken bones. She spent about 12 hours receiving trauma care in the ER, had two surgeries, and was in the hospital for 9 days. Total billing was over $48 thousand. Total amount the insurance company paid: $11 thousand. Total amount we paid: Zero. Nada. Zip. Bupkiss.

Among the amounts that the insurance company did not pay was the entire bill from the trauma care in the ER. My insurance company, like many insurance companies, had as part of the provider agreement a clause that they don't get paid for ER services - at all - if the patient is subsequently admitted (there are reasons for this). Everything else, including the hospital day rate, the doctors' billing, the x-rays, the medications, the OT, the band-aids, everything, was provided at a (sometimes ridiculously) discounted rate.

And we were not responsible for a single dollar of the difference. Not even the regular co-pay for the ER, since all the ER charges were waived. Not even the items that were denied by the insurance company as being unnecessary or otherwise inappropriate. The hospital couldn't bill us for any of the difference, because those are the terms of their provider agreement with the insurance company. Provider agreements are long, complicated documents. The basic gist is that the company will put them on their approved provider list, which gives the provider two things: A referral source, since numerous patients are going to choose that provider over some other unknown in the phone book because he accepts their insurance (and the patient may even have been directly referred to him by the insurance company or their PCP), and a guarantor of payment for services provided. In return, the provider agrees to accept a lower rate than their standard fee, and as part of that agreement they agree that the fee they accept from the insurance company will be the total fee (plus any applicable co-pay). They agree to waive the right to bill the patient for the difference, or to bill the patient for items the insurance company denies.

There are some plans that do not operate that way. Some pay a set percentage, for example. But if you re-read my posts, you'll see I was talking about negotiated rates, not a coinsurance agreement.

notajayhawk 4 years, 8 months ago

Wow. Too bad you have a policyholder-owned, not-for-profit, mutual insurance company. Sounds like you could have saved a fortune using my big, evil, shareholder-owned, advertising-and-administrative-cost-spending, commission-paying, profit-making insurance company.

notajayhawk 4 years, 8 months ago

vertigo's so cute when he has his little "Ah HAH! Gotcha'!" moments, isn't he?

1) Nowhere did L1 say that he received "same treatment (same tests, same medicine, same follow up guidelines)", as a matter of fact, and as you pointed out yourself in your 11:18 p.m. post, he specifically stated he got less.

2) My assertion was that for the specific billing items that were the same, the billing rate is higher for self-pays than the rates negotiated with the insurance companies. Um, that's pretty much how insurance works.

3) There is no conflict, no "Ah HAH! Gotcha'!" between those two statements.

Your (repeated) contention is that if L1's doctor gave him a break and didn't bill him, you somehow paid for that. Since I see another poster made that same claim, I'll address that one separately below.

notajayhawk 4 years, 8 months ago

"Please explain to me how, as Liberty said he has received, FREE care is billed at a higher rate than that of a negotiated rate with an insurance company?"

Sure, right after you explain to me, and all the boys and girls at home, which part of "same treatment" you seem to be having so much trouble understanding.

Here, let's see if this helps:

same –adjective 1. identical with what is about to be or has just been mentioned: This street is the same one we were on yesterday. 2. being one or identical though having different names, aspects, etc.: These are the same rules though differently worded. 3. agreeing in kind, amount, etc.; corresponding: two boxes of the same dimensions. 4. unchanged in character, condition, etc.: It's the same town after all these years.

I've re-read L1's posts several times now (and I suggest you do the same), and unless I missed one in there somewhere, at no time did L1 say the free services he received were the same services your insurance company paid for. As a matter of fact, you pointed out yourself that L1 said (as I have - several times now) that the services were not the same.

Okay, this appears hopeless, but let's try one more example:

L1 calls his doctor and says 'Doc, I've got a sore throat and a little cough, can you squeeze me in?' The doctor says come on over around lunchtime, tells L1 to open his mouth and say "Ahh", and says it's a strep throat. He writes him a prescription and tells L1 to call him if it doesn't get better. In and out in five minutes. You call your doctor's office and get scheduled for a regular appointment. The nurse puts you on a scale, and takes your temperature and blood pressure. The doctor comes in, does a H&P, has the nurse do a throat culture, and sends you down to the lab for blood tests. Then he says it's a strep throat, writes you a prescription, and tells the nurse to schedule you an appointment with the EN&T guy to follow up. You were there for over an hour.

Yes, you paid more for your treatment for the same illness. No, you did not receive the same treatment for that illness. None of what you've said alters the fact that if L1 did get scheduled for a regular appointment, get the full workup, have the throat culture, get the blood tests, and gone to see the specialist, he would have paid more than you.

That's about the best I can do. If you want to keep beating your head against the wall trying to make some chips in it, be my guest. Maybe have someone else explain it to you - someone that understands the definition of the word "same".

notajayhawk 4 years, 8 months ago

"Spin that one."

Again, vertigo is so cute when he gets his "Ah hah" moments.

Tell me something, vertigo, if you can take a moment away from congratulating yourself on these "assumptions" you caught me on: Did L1 have conjunctivitis?

Have fun arguing, vertigo. If you are seriously so uninformed and clueless that you don't know the difference between cash rates and insurance company negotiated rates, you don't have the slightest understanding of how insurance works, and really have absolutely no business trying to debate anything related to that issue.

notajayhawk 4 years, 8 months ago

"In other words you have no answer as to why my kid didn't get an MRI, XRay, Blood tox screen and all those other unnecessary tests you say those on insurance receive. "

Hmm. Maybe because it would be pretty hard to clinically justify to a third party payer why you did those things for pink-eye, since none of those things would be applicable to those condition, and in the example I gave, we were talking about an injury with possible broken bones. But the fact that you couldn't tell the difference between pink-eye and a broken finger again illustrates why you have no business trying to discuss the issue of health care.

"And you can't explain how someone who's exam bill is $0 is being billed at a higher rate than those on insurance. "

Um, no, the $0-being-more-than-what-you-paid-for-the-same-thing is a claim you keep making, I never said it. Tell us all something, vertigo, since you seem to know more about L1's experience with his doctor than he's told anyone - was it the same exam? First of all, you, for all your whining and moaning that I am assuming things, made the a$$umption that L1 and vertigo Jr. had the same condition. Second, you made the a$$umption that his visit was classified by the doctor as being the same service as what vertigo Jr. was billed for - i.e., a brief consultation, a low intensity exam, etc. Or maybe it was even classified as a follow-up - maybe L1 was there three days earlier, for a visit he did pay for, and the doctor told him it was probably nothing, to come back in a few days if it didn't clear up on its own, and that's why he didn't charge him for coming back in to get some eye drops. I don't know, and neither do you. But you seem to think you do.

None of your attempted twists, spins, and pedantry change the fact that cash-pay patients are billed at a higher rate than those negotiated by insurance providers. This is a basic principle of health insurance, it's the very heart of how insurance companies make money. Your insistence on trying to find an "Ah hah" to try to prove you weren't wrong, in the face of this fundamental tenet of the health care industry, just goes to show (as I said) that you have no business trying to discuss any issue related to that industry.

BTW, if this is how you act in person, I can come up with another possible reason why vertigo Jr's pediatrician charged you more than L1 got charged - it's a concept known in pediatric circles as "PIA-parent".

notanota 4 years, 8 months ago

That's the opening offer. You and I both know that you can negotiate down to the amount insurance would pay if you ask.

notajayhawk 4 years, 8 months ago

"Show me a doctor's office where the costs are advertised. You don't know what you are being billed until you get the bill. "

1) If your doctor won't tell you before you get treatment, go to a different doctor.

2) After you've gotten the bill, if you return to the same doctor next time, you have nobody to blame but yourself.

"People don't price compare doctors."

People with insurance don't. They have no reason to, since their co-pay at Doctor A's office will be the same as their co-pay at Doctor B's office. There is no comparing because they're both the same. When you pay out of pocket, like me, yes, you do price compare.

"They're not going to double their visitation fee in one big hit... but raise it $2 or $3 per visit every so often spread out amongst all the paying patients then they won't lose patients."

If the gas station on one side of the street raises their price by two cents per gallon, I use the one on the other side of the street. If the gas stations are five miles apart, it's not worth the time or gas to drive to the other one, but the convenience factor is built into the equation the same as the gas I'll burn traveling the extra five miles.

notajayhawk 4 years, 8 months ago

"Again if your doctor does this on a routine basis (not just on you but for other patients as well) then realistically they are going to recoup those losses by charging a higher rate to the individuals he/she treats that they do bill."

It's generally not routine.

In addition to the post that appears below, look at my current situation, now that I'm not doing agency work any more. Let's say my budget is built around billing for 30 hours per week. With the proceeds from that, I can cover all my office expenses and take home a reasonable salary. My billing rates are going to be based on that. If I agree to squeeze in an additional client, any extra income from that extra session isn't going to reduce the rate I charge to the other 30 at all, it's going in my pocket. If I choose to see them for a reduced rate, or for free, it didn't cost those other thirty anything additional, they're paying the same rate they would have paid whether or not I squeezed in the extra one.

The same is true even if I put that unscheduled appointment into a cancellation or open slot. Let's say I'm averaging 5 cancellations or no-shows per week. I will adjust my rates so the 25 appointments I have will essentially pay for the 30 slots I scheduled. You could argue that if I put an unscheduled or extra client into one of those slots, the other 25 paid a higher rate to pay for his services. But that's not true - they paid a higher rate to cover my cost for the cancellation or no-show, and they would have paid that whether or not I slid an unscheduled person into one of those open slots. It's the same principle as flying standby on an airline. The other passengers already paid a higher fare because a certain number of cancellations and no-shows were expected. The standby passenger got a cheaper rate, but the other passengers didn't pay for it, they would have paid the same thing if the seat was still empty when the plane took off.

notanota 4 years, 8 months ago

It's really more along the lines of vaccine refusers. A small number of them can mooch off of our herd immunity, but too many and it endangers all of our health.

What would really happen Libertarianopia is that hospitals and doctors would demand payment before services were offered, and free samples would become a thing of the past. This dude is essentially bragging that he gets the occasional bowl of free soup from the soup kitchen and calling the rest of us stupid for buying our food at cost.

notajayhawk 4 years, 8 months ago

"This dude is essentially bragging that he gets the occasional bowl of free soup from the soup kitchen and calling the rest of us stupid for buying our food at cost. "

You're not buying it at cost, though. The insurance premium and co-pays you pay don't come close to covering the cost. And forcing us to buy insurance is doing nothing but trying to spread those costs that you're not paying to us.

And doctors would not be able to make the demands you allude to. The entire reason doctors agree to take a lower negotiated rate for their services is because being on an insurance company's provider list gets them referrals. If they had to actually compete for patients, you might have to pay up front, yes - but you'd be paying a heck of a lot less.

One of the big pieces you're missing here is that L1 is free to negotiate with his physician for any rate they can agree to, including the occasional free service. If you carry insurance, you really can't negotiate anything, even if you had any incentive to do so.

notanota 4 years, 8 months ago

Actually, I can negotiate. I can ask for early discharge from the hospital to avoid an extra copay, home exercises, or fewer visits. I can ask for generic medications or longer times between refills. I can choose a doctor who has a better reputation or one who can see me quicker. And contracts do not prevent doctors from offering the pharmaceutical sample packages to insured patients.

And no, I wouldn't be paying less to pay upfront, unless I avoided care. I'd be paying less now, and potentially much, much more when something I didn't anticipate happened. Or not paying and simply not receiving care. I do have an idea what medical care costs, both with and without insurance.

notajayhawk 4 years, 8 months ago

This is for both none2 and vertigo:

I saw patients all the time for free. Maybe they just 'dropped by' my office. Maybe they called first. There were times when it wasn't billed because it wasn't a full session, there were times when it wasn't billed because you can't bill for more than a certain number of sessions in a particular time frame. But nobody else got billed for that. Yes, the agency or hospital has overhead to cover, building expenses, support staff to pay, etc., as you've pointed out. But those things were already budgeted and paid for out of the minimum billing I was required to put in. If I provided any services in excess of my employee agreement, and didn't bill for providing those services, it didn't cost anyone anything.

It works a little differently in med-surge than it does in mental health, but the principle is still the same. In some cases the provider can't bill. If a doctor already has billing for 40 appointments that are being billed as 15 minute appointments, and he squeezes L1 in between those appointments, or stays an extra few minutes at the end of the day, or works through lunch, he can't bill for that. You can get into all kinds of trouble for billing more hours than you were actually working (I know one psychiatrist who spent a few years as a guest of the federal government for that). Again, as with my situation, all the costs of the practice, including the physician's salary, were already covered by those other 40 appointments; anything extra he provided is not something that's budgeted or expected; you have to plan on covering all those costs from the regularly scheduled appointments. Now, if the doctor slid L1 into a slot that was open due to a cancellation or a slot that simply wasn't scheduled, he may raise his rates to cover that slot that wasn't paid for - but no more than he would have if the slot had remained empty.

As you both pointed out, the doctor is running a business, and he's not going to provide free services without making up the cost - but the part you missed is that as a businessman, the provider already had those costs paid for, or else he wouldn't have been in a position to negotiate a lower rate with L1. In business this is referred to as 'marginal pricing'; i.e., after you've covered all your fixed (administrative and overhead) costs, you can offer a lower rate to an extra customer; it doesn't cost the other customers anything, because they would still have been paying the same rate if you didn't accept the extra customer.

In any event, all that is off focus. The point both of you are missing here is that, as a self-pay patient, L1 and the doctor are free to enter into any arrangement they want to that's mutually agreeable. If that's sometimes lower than the insurance rate or even free, that's between the two of them. When you have a third-party payment arrangement in place, you are not free to negotiate anything beyond what the insurance company already negotiated.

notajayhawk 4 years, 8 months ago

That's why there's a law against asking. /sarcasm

gogogirl 4 years, 8 months ago

Great! Just because you don't have health coverage, you don't want anyone else to have it. Takes all kinds ---

notajayhawk 4 years, 8 months ago

Actually, we'd all be a lot better off if none of us had insurance.

notanota 4 years, 8 months ago

Hope you don't ever get sick, Naive_One.

jafs 4 years, 8 months ago

What was the quality of the care you received?

Both ways.

jafs 4 years, 8 months ago

Glad to hear it.

In my experiences, both personally, and with family members, the quality of our health care system is often not as good as I'd like.

I'd like to see that problem discussed more, as well as the cost issues.

notanota 4 years, 8 months ago

So tell me, what's the cheaper alternative to chemotherapy? What's the cheaper alternative to an organ transplant? A cheaper alternative with actual evidence that proves it works, that is. Are you willing to skip tests to make sure your cancer hasn't returned? Do you opt to avoid oncologists? Do you take your preemie home from the hospital early and hope he doesn't have apnea?

So far, it seems your plan relies on trusting in the charity of others while accusing those who like to set their financial house in order of being "moochers."

notanota 4 years, 8 months ago

I've never gone to the ER for a nosebleed. What a strange way to avoid the question.

notajayhawk 4 years, 8 months ago

"So tell me, what's the cheaper alternative to chemotherapy? What's the cheaper alternative to an organ transplant?"

Sometimes the cheaper alternative to steak isn't hamburger, it's buying the steak at Wal-mart instead of Dillons.

notanota 4 years, 8 months ago

You're buying an organ transplant and chemo at Walmart now? Whaaa?

Seriously, you guys are making no sense at all.

notajayhawk 4 years, 8 months ago

Gee, I was hoping that one was simple enough to understand without a long explanation.

The point is you presented a false choice. Your question implies that there is no alternative to chemo or a transplant other than dying. My reply was intended to show you that you can get that transplant or chemo cheaper. You can't tell me that chemo at Truman in Kansas City costs as much as it does at Sloane-Kettering? Or that you can't get a surgical procedure cheaper in Mexico, let alone overseas, cheaper than here? If you took third party payment out of the equation in this country, the same forces of competition would drive prices lower here, too. The problem isn't that some people don't have a way to pay for it. The problem is that some people do. Insuring more people assures that prices will continue to rise, and sooner or later nobody will be able to afford it.

notanota 4 years, 8 months ago

So you're going to fly to Mexico for your tummy tuck? Good luck, mate. Have you got some data that shows the average cost of optional plastic surgery is going down in the US as a result of market forces? Last I heard, the price was actually going up.

Even if you shop around for the cheapest place to get chemo, you're going to find that it isn't cheap, even with insurance. You could probably save money by utilizing less treatment, but that would also increase the likelihood of relapse. Awesome choice.

notajayhawk 4 years, 8 months ago

"So you're going to fly to Mexico for your tummy tuck?"

Actually, one of my best friends just did.

"Even if you shop around for the cheapest place to get chemo, you're going to find that it isn't cheap, even with insurance."

Which, again, is because of insurance. If more people shopped around, if there was really competition, then it would be cheaper everywhere.

notanota 4 years, 8 months ago

Yes, I know it happens, which is why I bring it up. So, you've got that data on plastic surgery somewhere? The evidence that medical tourism lowers the price in all markets?

As far as cancer treatment goes, it's a bit different than a bit of liposuction, in that as a consumer, I can always just decide it's too expensive and opt to buy nothing. With cancer, skipping treatment means dying. It also means ongoing treatments rather than a quick trip to Guadalajara, which means the oncologist needs to be nearby.

The more likely outcome of a direct payment system is an increase in sham treatments and patent medicines.

notajayhawk 4 years, 8 months ago

"So, you've got that data on plastic surgery somewhere? The evidence that medical tourism lowers the price in all markets? "

That was your argument, not mine, and it was too ridiculous to warrant an answer. But as I see you're insisting on one:

First of all: Gasoline costs 5-10 cents per gallon less in the KC metro than it does here. When I worked in the metro, it was obviously worth it for me to buy all my gasoline at work instead of at home. Now that I'm not commuting anymore, it's not worth the time or gas to drive to Kansas City to save that 5-10 cents. Those costs have to be factored in. On the other hand, if I can save $5000 on a car by driving that same 60 miles, of course I'm going to do it.

Second, as you were, I assume, trying to infer, not everyone has the option of traveling to Mexico or Thailand or wherever to save money on their medical treatment. I never said or even implied that they all could, which means I never implied that lower prices in one place would necessarily lead to lower prices in an entirely different market. If a hospital in Mississippi charges half as much as a hospital in DC for the same treatment, it doesn't mean the price in DC will come down, because there's no reason for it to - per capita income is twice as high in DC.

The market doesn't work to lower prices if there's someone else who will pay the higher prices. It doesn't matter if you, personally, start driving a Prius or riding a bicycle, it's not going to cause gas prices to come down if all your neighbors buy Hummers.

In other words, it doesn't matter if some people choose to go to Mexico to get their treatment, as long as the insurance companies are making it affordable for providers in this country to keep charging higher prices. Your attempted argument actually supports my position rather than disputing it. The very existence of the medical tourism industry demonstrates that people ARE willing to shop around for better deals, to seek out alternatives, and to put the extra effort into patronizing a provider on the other side of the world if it will save a few bucks. As for plastic surgery, that is mostly elective in nature, which again demonstrates that health care is subject to market forces - prices keep going up because demand is rising.

"As far as cancer treatment goes, it's a bit different than a bit of liposuction, in that as a consumer, I can always just decide it's too expensive and opt to buy nothing.With cancer, skipping treatment means dying."

And again, that's a false choice. Same one you tried before, I won't bother repeating why it's still in error.

"It also means ongoing treatments rather than a quick trip to Guadalajara, which means the oncologist needs to be nearby. "

There's nothing that says you couldn't spend the duration of your treatment in Guadalajara, which, again, is part of the costs that would have to be factored in.

notanota 4 years, 8 months ago

In other words, no, market forces do not guarantee lower prices for medical care when demand is high, and medical tourism (the option you brought up) does not actually effectively lower the cost of care.

Plastic surgery is a perfect example of something that is not covered by insurance and can be negotiated, as it is not a necessity. Substitute in something that will kill you if you don't receive it, like cardiac care or chemo (and thus increasing demand) and... oh wait, prices are still going up. Huh.

notajayhawk 4 years, 8 months ago

"The more likely outcome of a direct payment system is an increase in sham treatments and patent medicines. "

If your neighbor dies from the medicine he bought from Joe's-beer-burgers-and-cancer-treatment, you'd be a pretty big fool to go there for your own treatment.

notanota 4 years, 8 months ago

That's fantastic if you happen to have a neighbor with the same rare disease you have and you happen to know the treatment they took and happen to know that the three years he spent in "remission" were actually three years he was spending as a tumor incubator.

Or maybe you'll fall for John's-tumor-be-gone instead.

notajayhawk 4 years, 8 months ago

Oh my goodness! You mean [gasp] people might actually have to take a little responsibility and find out a few things for themselves? Oh, the horror, the horror!!!!!!!!

You can usually find disciplinary records for health care providers on your state's licensing board's website. There are hundreds of other websites where people rate providers on everything from cost to quality of care to how long they sat in the waiting room. People spend days or weeks researching before buying a big screen TV or a washer-dryer. They spend longer before making a more substantial purchase like a car or a house. Yet their search for a doctor generally consists of randomly picking a name off their provider list during the five minutes they were signing up for their health insurance. And the names on that provider list are the ones who haven't cost the insurance company too much money. Now, if you think THAT'S a good arrangement, hey, more power to ya'.

notanota 4 years, 8 months ago

Really? I asked for references from friends, looked up ratings, and went in for the first visit with the idea that I was auditioning my care providers for the job. Guess I should have thrown a dart at a board and been more irresponsible with my choice.

Just because I don't use a full direct-pay model doesn't make me any less aware that I'm entrusting myself and my family members' health to the expertise of someone else.

And on the other side of that coin, I know plenty of people who are being bilked right now by alt med phonies and are self-financing the whole deal. Often the comparison is between an expensive but proven SOP treatment not covered by insurance and an altmed with a bunch of testimonials (Doh! websites!) and scientific sounding hogwash. I hear tell people even make up their own certification boards for such things. It's the Libertarian way.

notajayhawk 4 years, 8 months ago

My, my. Quite a bit to accomplish while you're sitting in your personnel office filling out your health insurance forms. I'm impressed.

(Psssst - that was sarcasm.)

"Just because I don't use a full direct-pay model"

You don't use one at all. One thing I noticed you didn't include in your in-depth comparison was prices. And I'll bet you never even considered asking.

jafs 4 years, 8 months ago

The comments about premiums not covering the costs of health care are interesting.

If we went back 7-10 years or so, I'm pretty sure that my health insurance premiums have outpaced my health care costs pretty significantly. I eat well, exercise, don't smoke or drink much, etc.

I also use generic or over the counter medication whenever possible, ask a lot of questions of the doctor, etc.

For insurance companies to make a profit, they must be taking in more than they pay out.

Let's say that someone pays $300-400/month for coverage (not our figures, just a rough guess as to an average cost), then 1 year would be $3600-$4800, and ten would be $36,000-$48,000. Are most people really spending that much on their health care expenses?

notajayhawk 4 years, 8 months ago

On average, yes. In ten years the average American spends about $70,000.

Richard Heckler 4 years, 8 months ago

How would government ruin health care if it is left as a private industry?

How in the world could government make a bigger scam than the current medical insurance industry?

Medicare Insurance runs on 4% admin costs.

The medical insurance industry runs on 31% admin costs plus spends insurance money on political campaigns a plenty,golden parachutes,shareholders and advertisements. Could these be factors that which cause the increase in premiums?

The medical insurance industry also over charges it customers by the billions... http://www.washingtonpost.com/wp-dyn/content/article/2009/06/24/AR2009062401636.html

How many know exactly what their coverage will allow doctors to do?

How many are under insured?

Richard Heckler 4 years, 8 months ago

Republicans are not going to make the medical insurance industry any better because they are accepting too much money from the industry AND taking their talking points from the medical insurance industry.

What the republicans want to do is waste a lot of time. Returning to the previous status quo prior to Obamacare will accomplish what?

These are the same republicans who want to privatize Social Security which would place the nations economy at risk AND will raise the size of the government's deficit to nearly $700 billion per year for the next 20 years, almost tripling the size of the national debt.

Do republicans have any idea what the hell they are doing? NO they don't.

notajayhawk 4 years, 8 months ago

Well, if you'd actually read the story you linked to, they gave you that answer:

"Driving support for the law: Voters by margins of 2-1 or greater want to keep some of its best-known benefits, such as barring insurers from denying coverage for pre-existing conditions. One thing they don't like: the mandate that everyone must buy insurance."

This is hardly a unique phenomenon, and it can be seen in virtually every poll on virtually every public policy decision: Everybody always wants the benefits, nobody ever wants the costs. The simple truth is that even if a majority favored the legislation as passed (which they don't), the entire house of cards collapses without the insurance mandate.

notanota 4 years, 8 months ago

Yes, I too have a problem with the insurance mandate. I think without a public option, it doesn't do enough to keep costs down.

However, the point is that "repeal health care" is not a winning platform.

notajayhawk 4 years, 8 months ago

"However, the point is that "repeal health care" is not a winning platform. "

Wow! You mean the Republicans want to make health care illegal? I didn't know that.

The Democrats couldn't even sell the public option to their own membership, and rightly so.

notanota 4 years, 8 months ago

Red herring. The dem's inability to Stepfordize their membership is not the issue, nor is the political feasibility of a public option today. Your no insurance option isn't coming up for a vote, either. The public may not be sold on the current law completely, but the majority does not want it repealed, especially if they know repealing it means losing the pre-existing coverage.

So yes, a platform of repealing the current health care law is a losing platform, especially if you don't have a backup plan.

notajayhawk 4 years, 8 months ago

"Red herring."

Yes, it was. It was yours, however.

"The public may not be sold on the current law completely, but the majority does not want it repealed, especially if they know repealing it means losing the pre-existing coverage. "

You're missing the point. It's an all-or-nothing package. As I've said - several times now - polls always show that people are in favor of the benefits from a public policy decision, they're not in favor of the costs. And you can't have one without the other. Polls always show, for example, that most people are in favor of continuing to fund AmTrak. Suppose the government tried to pass legislation that tied that continued funding to a mandate that people use the trains to travel between cities - do you really think the public support would still be there?

notanota 4 years, 8 months ago

No, that's the point you're missing. The public does not support repealing when it's made clear that it's an all or nothing scenario. They'd rather pay the cost than not have the coverage.

notajayhawk 4 years, 8 months ago

Wanna' try again? Once more I'll ask, did you actually read the story you linked to?

"16 percent of registered voters want to let it stand as is."

"33 percent want to repeal it."

The rest want it changed, one way or the other. And while more want to expand it than limit it, it doesn't change the fact that only one out of six people want the legislation as passed, and twice as many people want it repealed outright than want it kept "as a package".

Nice try, though.

notanota 4 years, 8 months ago

Here I'm talking about October CBS/NYT polling that found support of outright repeal dropped from 41% to 25% when they were told that repealing it also meant the pre-existing condition clause went away.

Twisting a poll showing 39% of people in favor of expanding the current law into a mandate for repeal is a better example of "nice try."

notajayhawk 4 years, 8 months ago

Nowhere did I say that the 35% (it's 35%, not 39% - again, did you read your own story?) who want it expanded are in favor of repealing it. You made the claim that "The public does not support repealing when it's made clear that it's an all or nothing scenario." This is a specious claim that is simply not supported by the data. The 35% that want it expanded (and the 11% who want it cut back) do not fall into the category of those who have an opinion one way or the other on the "all or nothing" package, since, by definition, their preference is not "all or nothing", they want modifications. You simply can not make the claim, based on that data, that those who are in favor of expansion would "rather pay the cost than not have the coverage" because we have no idea what those costs would be for an expanded bill. Twist it any way you want, only those who said keep it intact or repeal it altogether fall into the category of "all or nothing" - again, by definition. And of the "all or nothing" votes, "nothing" outpaced "all" by a margin of two-to-one. Your claim that those who want it expanded would accept some undefined and hypothetical costs are pure conjecture.

notajayhawk 4 years, 8 months ago

BTW, did you actually read the CBS/NYT poll, or just the sound bites? If you'd read the actual poll, you might have known that respondents identifying themselves as Democrats outnumbered Republicans by about a third. You might also look at the numbers they reported for how they planned to vote in November, compared to what the actual election results were.

That poll asked a lot of questions on a wide range of issues, and if you look at the other questions (those on Social Security, for example), you can figure out a lot about the mindset of the 1,173 respondents.

notanota 4 years, 8 months ago

Sure, there was a little over 1000 respondents, the margin of error is 3%, and the sample was weighted to reflect the demographics of the population. That's how polls work.

notajayhawk 4 years, 8 months ago

It was "weighted", notanota? Seriously? How, exactly, was it "weighted"? If you're just going to make stuff up, there really isn't much point in responding any further. Oh, except perhaps to point out that, while in the October poll those who said leave the bill intact outnumbered those who said repeal it 45-41%, in the more recent November poll, those who said repeal it now outnumber those who said keep it 45-44%.

notanota 4 years, 8 months ago

Oh come on, if you're going to complain that you think I didn't read the poll, I'm not going to spoon feed you the answers, especially when you gave approximations of the weighted numbers yourself. Read the actual poll, indeed. Also note the number of independents.

notajayhawk 4 years, 8 months ago

This is the poll, notanota.

http://s3.amazonaws.com/nytdocs/docs/503/503.pdf

Wanna' show me anywhere in there where it says the numbers reported are "weighted"? Got any clue as to how, exactly they would BE weighted?

notanota 4 years, 8 months ago

CBS gives the weights on the polls they release on their site. NYT lists their general methodology on their website. The info is there. The will for me to explain it all to you is not. Calculate your own T-score.

notajayhawk 4 years, 8 months ago

Yeah, saw that, thanks. Like this, you mean:

"The combined results have been weighted to adjust for variation in the sample relating to geographic area, sex, Hispanic origin, age, education, marital status and number of adults in the household."

"Some findings regarding voting were also weighted in terms of an overall “probable electorate,” which uses responses to questions dealing with voting history, attention to the campaign, intention to vote in 2010, and other indicators of engagement as a measure of the likelihood of respondents’ turning out in November. "

Funny thing, though, notanota: I can't seem to find where they adjusted for political affiliation. Maybe you can find that for me:

http://www.nytimes.com/2010/10/28/us/politics/28mbox.html?_r=1&ref=politics

whats_going_on 4 years, 8 months ago

Do republicans have any idea what the hell they are doing? NO they don't.

yeah, they do, and so do all politicians, unfortunately. They just manipulated a large portion of the population into believing they can really make things "right"...just as democrats did a couple years ago.

pace 4 years, 8 months ago

I thought it was the fear and lie ads the "private" groups flooded our airwaves with. I do blame our selves. Americans are suckers for ads.

Cait McKnelly 4 years, 8 months ago

My ex-husband was only in his early forties when he had quadruple bypass surgery due to a severe genetic predisposition for arteriosclerosis. His dad had it and died very young from it as well. Unfortunately it went terribly wrong from a hospital acquired infection. In the end it cost him a lung. He was in ICU from the end of October to the beginning of the following January and we were called in for the "death watch" twice. The first week of January he was discharged directly from the ICU to a rehab hospital to wean him from the ventilator. He was in the rehab hospital from the first week of January to mid March. He had health insurance through his employer but it was cheap sh** insurance and it only covered a certain percentage. By the time he was discharged he owed literally hundreds of thousand dollars that he would and will never be able to pay and hit his lifetime benefit. He is permanently disabled but it took over two years of fighting with SS to get benefits. He has multiple chronic health problems related to all of this, including oxygen dependence, and desperately needed insurance during that time but because he had used up his lifetime benefit with one company no other would touch him with a ten foot pole. He is now 50 and thanks to Medicare Disability coverage finally has insurance. I guess he was just one of the ones who should have gone ahead and died and "died quick".

notajayhawk 4 years, 8 months ago

Or why part (at least) of the problem could have been solved if the disability process hadn't taken so long.

Of course, Social Security is a government run program, so we shouldn't expect too much from it.

notajayhawk 4 years, 8 months ago

"I guess he was just one of the ones who should have gone ahead and died and "died quick"."

And yet, he's alive. And without insurance. Imagine that.

Cait McKnelly 4 years, 8 months ago

Yeah. Imagine that. His doctor waived his office fees and his drugs and durable medical equipment were paid for through church donations. Imagine that. He filed bankruptcy and lost everything he owned to protect himself from the medical bills. Imagine that. Believe me when I say that the bean counters from both the hospital and the insurance company wish he had died. Imagine that.

notajayhawk 4 years, 8 months ago

And yet, he's alive. After receiving hundreds of thousands of dollars worth of health care. Without insurance. Imagine that. From reading all these posts, I thought nobody had access to care, and everyone died, without insurance. Hmm. Musta' been mistaken.

Cait McKnelly 4 years, 8 months ago

Where do you keep getting that he didn't have insurance? He had insurance. His carrier dropped him when he hit his lifetime limit! Go away Nota. Being deliberately stupid and obtuse doesn't make your point any better. You aren't addressing my post at all but some inner agenda you have. Truth is I'm not sure he wouldn't have died if he hadn't had insurance. My point is that all of this happened with insurance.

notajayhawk 4 years, 8 months ago

Worth repeating:

"My point is that all of this happened with insurance. "

Your point was, I assume, to point out all the evils of our current system - yes, he had coverage, coverage you referred to as "cheap sh** insurance [that] covered a certain percentage". Coverage that was dropped after he reached the lifetime max. Then he was unable to obtain new coverage due to the pre-existing condition, after which he continued to have health care needs for his "multiple chronic health problems".

And despite all the evils of our current system, he still got his care, and he's still alive.

Imagine that.

BTW, cait, are you claiming you posted your little tale for some reason other than "some inner agenda you have"?

Carol Bowen 4 years, 8 months ago

Tacky, inconsiderate post, nota. More crass than usual.

notajayhawk 4 years, 8 months ago

Funny, I was thinking the same thing about cait's original post. She's the one who brought up the heart-tugging story about how awfully her husband was treated by our current system. I merely pointed out that, despite the problems with the system she enumerated, her ex- is, indeed, alive, because he did, indeed, receive the care he required.

notajayhawk 4 years, 8 months ago

"Cheapskates don't want to listen to logic."

Why? Were you planning on starting to use any?

Part of your little spiel was valid. Most of it wasn't. cait didn't say her ex- was brought to the ER with a heart attack. Maybe he was and she left that part out, but that's not what she said. She said he had surgery for a genetic condition. So yes, he could have shopped around and picked a hospital for the surgery that was less expensive than the one he went to. As for the additional care as a result of the infection, he had fewer options, although during the few months he spent in the hospital, there were likely a few times when he was stable enough for transfer. And there was more than ample time to plan for follow-up care at the rehab hospital. Actually, his having partial insurance limited his options, since his choices, including choice of providers, were most likely made by the insurance company.

notajayhawk 4 years, 8 months ago

Don't make the mistaken assumption that I haven't experienced such tragedies as you and other posters have described. But that's part of the problem. I understand what you're saying about it being different when it's personal.

It can't be.

People die. Every single one of us, once each. Sorry if that sounds callous or like I'm trivializing tragedy. It's reality.

On a purely personal, emotional level, if it was my little girl dying of a terminal illness, yes, I'd do whatever it takes. I'd sell everything we owned, work five jobs, beg, borrow, steal. And I might rant and rave and scream at everyone else who I didn't think was willing to help. Nothing would matter more.

But on a practical level, my little girl wouldn't be the only one, would she? We spend two trillion dollars every year on health care. People still die. We could double that and it wouldn't cut the mortality rate in half (let alone eliminate it), quadruple it without cutting that in half. The law of diminishing returns is both incontrovertible and inescapable. You're smart enough to understand that even if we increased spending ten-fold, a hundred-fold, it still might be my little girl, or yours, that isn't going to be one of the lucky ones.

Suppose we just doubled our spending, and it saved 20,000 lives. Is that an equitable arrangement? If you're one of the 20,000, or if one of them is someone you love, the easy answer is yes. But how do we pay for that? How does every man, woman, and child in the country come up with $13,000/year, every family of four $53,000/year?

Following that law of diminishing returns, none2, where do we say "enough"? When we've cut the number down to 20,000? Down to 10,000? Down to 100? Because if you accept the reality that we can spend more and more and more and more and more and we're still not going to save every one, our positions aren't as different as you may think, they differ only in a matter of degree. As I said up above in response to another poster, I say when we're spending two trillion dollars per year, we're past the balance point, and it's time to change directions. We have to stop trying to figure out how to pay for the ever-increasing costs, and find a way to make those costs affordable.

Cait McKnelly 4 years, 8 months ago

"Because if you accept the reality that we can spend more and more and more and more and more and we're still not going to save every one, our positions aren't as different as you may think, they differ only in a matter of degree."

So here's the solution. Die and die quick.

notajayhawk 4 years, 8 months ago

Yes, cait. People die. Get used to it, because you may think Obama is a Messiah, but even he can't change that.

Here's a thought - try answering just one of the questions I posed to none2. How much do we spend to make sure not a single person gets left out - twice what we're spending now? Ten times as much? A hundred times as much? How ya' going to pay for that Utopia, cait?

notanota 4 years, 8 months ago

I have a friend who isn't alive because she lacked insurance and they did not do the expensive procedure that could have saved her life. Imagine that.

notanota 4 years, 8 months ago

I think those two lack the theory of mind skills to actually get your point.

kcaj 4 years, 8 months ago

Good for our Senators! Tis the right thing to do. If people just stop & think for themselves- or run it through the forefathers way of thinking - there's only one answer to it.

Cait McKnelly 4 years, 8 months ago

Only allow white Christian landowners with slaves to vote?

Cait McKnelly 4 years, 8 months ago

Oh! Excuse me! Only allow white Christian *male * landowners with slaves to vote

notanota 4 years, 8 months ago

Silly Cait. You don't need slaves to vote. You just need to be a white, male landowner. Do be sure to count up 3/5ths of each slave for tax and census purposes, though.

Richard Heckler 4 years, 8 months ago

Health insurance dollars go to golden parachutes (In 2009 cigna ceo received a $73 million retirement bonus which is a ton of health care dollars that would cover 6,084 families for one year). Why are health insurance dollars being spent on golden parachutes?

It's the profiteers and/or politicians aka the special interest campaign dollar moochers that do not want single payer. Shareholders are among the moochers.

There are plenty of republicans and democrats who want government run single payer because both parties are tired of paying wayyyyy too much money. People should NOT be filing bankruptcy because they need medical care.

Insured families are filing bankruptcy as a result medical care.

A medical insurance industry pollster of many years advised the industry that the information coming back to them was that the majority of the population wants improved Medicare Insurance for ALL. A government managed system is the choice of america!

"The U.S. health care system is typically characterized as a largely private-sector system, so it may come as a surprise that more than 60% of the $2 trillion annual U.S. health care bill is paid through taxes............ according to a 2002 analysis published in Health Affairs by Harvard Medical School associate professors Steffie Woolhandler and David Himmelstein"

Flap Doodle 4 years, 8 months ago

You know what? I think I've seen this exact same post on another thread.....

notajayhawk 4 years, 8 months ago

What are the odds?

My favorite part of this one - it's also in a bunch of his other classics - is "the majority of the population wants improved Medicare Insurance for ALL". The key word in that sentence being "improved". Here's an idea - let's get it "improved" first, before we think about expanding it any more. Or better still, let's try a system that doesn't need to be "improved" in the first place.

Richard Heckler 4 years, 8 months ago

Republicans apparently don't know that it was their beloved President Theodore Roosevelt who in 1912 proposed national health insurance for all.

MrRighty 4 years, 8 months ago

You really should be careful when you make statements like that Merrill. Trying to equate party politics by the party name any further back than about 30 years is pretty reckless and distortive. The terms republican and democrat and conservative and liberal have had widely different meanings over this country's history. For example, the term liberal years ago was coined in a more business/economic rather than social sense and, if equated with the parties we have today, would actually be considered a "laissez-faire" or modern republican approach to policy. True TR was a "Republican" but he was also a staunch progressive....which is a policy attitude most in line with modern socially liberal Democrats as we know them today.

Cait McKnelly 4 years, 8 months ago

Tell that to the people who love to claim credit for Abraham Lincoln being Republican. Righties just love to throw that name around and take credit for it. Thing is, Lincoln was a true Republican. He believed that this country should be a republic with a strong central government that can and should take precedence over states right. Catch a so called "Republican" believing that now.

notajayhawk 4 years, 8 months ago

Wow, "jstthefacts" [snicker]. Even the merrill-bot doesn't post the same spam multiple times on the same thread!

It appears the ghost of porch_person has possessed another member of the LJW message boards. If you were going to move your 'answer' to my question down here, "jstthefacts" [snicker], you should have moved the question down here, too, so perhaps the people you were trying to impress could see if you actually answered it. Since I'm sure that was just an oversight, here, let me correct that for you:

notajayhawk (anonymous) replies… Okay, "jstthefacts" [snicker]. Let's see if you got any. Please show me one quote - just one - from any of the Republicans (let alone these two) that say there is no need for health care reform. November 22, 2010 at 8:58 a.m.

THAT was the question, little one. And as you know, my comment about whether I should accept the word of an anonymous poster to a message board was in response to your contention that you didn't have any documentation of your claim because the quotes I asked for were things you witnessed. ("Well nota,my posts are full of facts that I saw with my own two eyes.") Even you should be able to understand why that might not carry the same weight of evidence that documented facts do.

You made the claim that Republicans said we don't need health care reform. It was a repeat of a claim you made on the other thread about this story:

jstthefacts (anonymous) replies… The first disservice and lie the republicans subjected the american people to was to deny that we needed health care reform. November 21, 2010 at 9:14 p.m. http://www2.ljworld.com/news/2010/nov/19/brownback-roberts-join-legal-challenge-federal-hea/#c1430952

I have asked you, repeatedly, to back up that statement. A single link, a single quote. If you witnessed such statements, tell us who said that and when. Put aside all your garfinkeling, all your twists and spins and changing the question aside and answer the single question I asked you.

But you can't, can you, troll, because it was just something you pulled out of your posterior?

notajayhawk 4 years, 8 months ago

A simple "No, I can not back up what I said" would have been sufficient.

notajayhawk 4 years, 8 months ago

"I did back up what I said."

Really, troll? Show me where you provided one quote from any Republican saying 'We don't need health care reform'. Or just keep garfinkeling. It's not as if anyone takes your posts seriously, anyway. By the way, I hear they're thinking about opening up a comment on the comics section. That should be more your speed.

notajayhawk 4 years, 8 months ago

Lordie, the kiddie hour gets tiresome around here.

Um, "rush"? Maybe if you put the bong down before trying to comment? Or perhaps actually read the posts you were trying to respond to?

Here, rush, try to focus for a second. See, "jstthefacts" [snicker] alleged that Republicans say there's no need for reform. I said he can't back that up, which he can't, because it isn't true. I also said something has to be done about the two trillion dollars we're spending every year because that's unsustainable (you know, it's 'breaking the country'). Got it yet? Need someone to help you with the two-syllable words? Now, do you feel anywhere near as foolish as your post made you look?

notajayhawk 4 years, 8 months ago

Not my fault you can't read and made a fool of yourself responding to something I didn't say (and in fact said the opposite), junior. I suppose the grown up thing to do here would have been admitting you didn't understand the post and you made a mistake. Maybe when you grow up you'll understand such concepts. But I doubt it.

lucky_guy 4 years, 8 months ago

You guys argued alot but nothing much got accomplished. Brownback and Roberts can sue all they want. The Repubs can submit all the bills they want, in the end NOTHING will get done to change the bill, period. I am in the business of making changes to the healthcare system now so in two years when maybe something could be done to stop the bill there will be too much done by too many people to want to go back. Period. If Brownback wants something else, Kansas as a state can op out just as Oregon is doing and we have an Insurance Commisioner that might be able to do something, but that is a stretch.
By the way I am really tired about you guys saying the bill is too complex and long. My owners manual for my subaru is 250 pages. Harrison's manual of internal medicine is 3300 pages, come on get a grip. We propose paying for every conceivable ailment and permutation thereof and you want that in one page? No way.
Next year Lawrence Memorial Hospital hopes to make $1 million from Health Care reform, do you want to give that back? The ship has sailed get on board that is my advice.

notajayhawk 4 years, 8 months ago

"Brownback and Roberts can sue all they want. The Repubs can submit all the bills they want, in the end nothing will get done to change the bill, period."

They don't have to change the bill.

They don't have to fund it, either.

"I am in the business of making changes to the healthcare system now so in two years when maybe something could be done to stop the bill there will be too much done by too many people to want to go back."

Um, yeah, spanky, that's why they're not waiting two years. Duh.

"We propose paying for every conceivable ailment and permutation thereof and you want that in one page?"

Oh, okay, you didn't mention that you hadn't read the bill. That explains your support.

Um, there is nothing in the bill to "propose paying for every conceivable ailment and permutation thereof". But thanks for playing.

John McCoy 4 years, 8 months ago

Sorry to say, but Kansas seems to be becoming the Oklahoma of the North. i.e. so conservative that it is self-destsructive.

lucky_guy 4 years, 8 months ago

I stand corrected healthcare reform will not cover abortions, but the insurance exchanges and increased Medicaid coverage will cover indirectly NEARLY ever ailment or permutation thereof, except those directly excluded by the exchanges as they are set up. The Senate will not allow any bill to be passed that destroys the act. Obama will veto any bill that gets past that. Law suits take years except of course Bush V Gore. So the prospect of stopping the progression of Reform quickly is not good.
The defunding part is going to be a wild ride. There are some parts that can be defunded like the CLASS act since it is voluntary, and others on that we will have to see.

notajayhawk 4 years, 8 months ago

"I stand corrected healthcare reform will not cover abortions, but the insurance exchanges and increased Medicaid coverage will cover indirectly NEARLY ever ailment or permutation thereof, except those directly excluded by the exchanges as they are set up. "

Your reference to coverage of various ailments was your explanation as to why the bill was so long and complex. That was a specious claim. It is not as if there is any thousand-page list of ailments and treatments that will be covered. The length and complexity of the bill have absolutely nothing to do with the scope of coverage.

There is also nothing in the bill that specifically states that any particular ailment or treatment will be covered (unless you count preventive care as a specific treatment).

"The Senate will not allow any bill to be passed that destroys the act. Obama will veto any bill that gets past that."

Again, that's not necessary. We can wait until 2012.

"Law suits take years except of course Bush V Gore."

Yes, it appears the Supreme Court has shown a willingness to be a little more expedient when there's a deadline involved. A deadline such as, for example, the implementation of various parts of the legislation in question. There are also such things as preliminary injunctions while awaiting a decision - maybe you've heard of those.

"The defunding part is going to be a wild ride. There are some parts that can be defunded like the CLASS act since it is voluntary, and others on that we will have to see."

Again - they don't have to "de-fund" it. They don't have to fund it. With control of the House, they can refuse to pass any appropriations bills that include funding for the so-called 'reform' package.

lucky_guy 4 years, 8 months ago

You are correct but the suit brought will not enjoin the whole act. Only the part dealing with forcing everyone to pay. There are many parts. Contracts have already been signed. People have already signed up their 23 year olds to go on their plans. Things are moving that aren't going to be stopped easily, even if they get an easy injunction. I apologize if I implied there was a list of covered ailments. Healthcare is like making cars in a lot of ways. You spend a lot of time making the design (The Bill) and then the nuts and bolts are put together somewhere else (insurance exchanges, Medicare, Medicaid,etc). You still need both to be long and detailed to get what you want in the end. Look at a HCPC II code book for instance, that is long but still not nearly detailed enough. Your explanation of how going to the ER and your wifes accident was very good. I don't understant why you don't want that for everyone. Maybe costs would be driven down if everyone got a third party to cut their bills by 50 to 75%.

notajayhawk 4 years, 8 months ago

"You are correct but the suit brought will not enjoin the whole act."

Is there a severability clause? This has been one of my - and a lot of other people's - criticisms of the bill from the start. It would have been better to pass a collection of smaller bills, each targeted at a specific part of the problem. This would have accomplished a lot of things, including the possibility of keeping the parts most people approved of, while making it easier to discard the parts that most people don't. It also would have protected the other parts from lawsuits that might take down the whole package. And there's nobody to blame but the Democrats for this. They wanted another 'historic' piece of legislation, a monumental and comprehensive package. Not to mention, they also knew they had a better chance of forcing through one piece of legislation rather than have to fight for several of them. One of the biggest problems with this legislation, though, is that we'll never know what effect any of the individual pieces have. If it helps, we won't know which part helped, if it makes things worse, we won't know which part was the problem. In a way this is a big experiment, and when you're performing an experiment, you don't manipulate all the variables at once.

"Maybe costs would be driven down if everyone got a third party to cut their bills by 50 to 75%."

False assumption. While the rates for the services she received were lower because of the contract between the insurance company and the hospital, it's questionable whether all of those services would have been provided if she didn't have insurance. That's the other edge of the sword. My wife had chronic health problems, and it wasn't unusual to be at the ER three times in the same week. When she had insurance, it was common to have every single one of the tests she had performed repeated on each of those visits, sometimes within 24 hours. There's a nearby hospital we use, the last time she was there at the ER, when we carried insurance, they billed something like $12,000 for ten hours of lying there for 'observation' (I have no idea how much insurance actually paid). The last time I was there, without insurance, the charges were under $1,500. The funny thing is that in my wife's case, it would have been cheaper to admit her to a room for that period of 'observation', but the hospital gets to bill a lot more if they keep her downstairs without admitting her.

notajayhawk 4 years, 8 months ago

Again, Liberty, don't feed jstatroll. If it wasn't for the timing, I'd swear we'd found the resurfacing of porch_person. As it is, jstatroll seems to have stumbled upon an old post with the porch_person playbook, and mistook it for the website's TOS.

notajayhawk 4 years, 8 months ago

jstatroll isn't worth the time, Liberty. He's already shown he can't back up what he says and has nothing left but trying to attack the source. Don't feed ...

notajayhawk 4 years, 8 months ago

"Do you honestly think anyone is going to listen to you Nota ?"

Judging from your pathetic attempt at a response, it's pretty evident you didn't. Of course, that didn't keep you from thinking you knew what I'd said, shooting your mouth off, and making a fool of yourself. Sorry, rush, wasn't me who made you look foolish. In the future, try reading the posts you're replying to - if you don't understand what they're saying, it's probably safer for you to take a pass.

notajayhawk 4 years, 8 months ago

Based on what it costs, it's a luxury. It will remain so until we figure out a way to bring those costs under control. Finding different ways to pay for a luxury doesn't keep it from being a luxury.

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