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  1. Micael's Avatar
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       #1321  
    Quote Originally Posted by davidra View Post
    Actually, I suspect you misspoke, as HMO's are insurance companies. I support all reasoned cost control measures. For several years I served on an advisory board for a non-profit HMO; this board reviewed the application of member docs for approval of devices and procedures. The panel was made up of mostly outside private practice guys, some of whom weren't even contracted with the health plan. The staff did a great job of collecting publlished literature about efficacy and cost-effectiveness, and the decisions that the panel made were very reasonable. In fact, I found myself as wanting to deny approval of more things than the HMO docs did, just because of a lack of evidence of efficacy. Here's the thing: individuals could not enroll in the HMO. HMO's and insurance companies successfully exclude people that actually are likely to need them. I'm sure you realize that. Pre-existiing conditions? Not a chance, unless you happen to be working for a huge employer so the risk is spread around. And that's what needs to happen. The risk needs to be spread around, but around a much larger group of people. No cherry-picking. Is it any wonder that an HMO that only accepts patients who are actively working have a greater chance of making a profit than someone who accepts all comers, regardless of age or condition? We have systematically excluded people from insurance who need it the most, and I'm not necessarily talking about the elderly (they have excellent coverage) and the poor (they have Medicaid). I'm talking about the worker in the small company, or the day laborer, or the student. I have a friend who probably has polycystic kidney disease, but I can't do the test to document it because she's still a student. Once she has it documented she willl never be able to get insurance the rest of her life. She's 30. Does that should reasonable to you? I have no problem with cost controls; I have a problem with denying coverage to people who need it.
    Then I believe we agree on most points. I work for a not-for-profit but private insurance company. My four primary concerns are 1) keep the decisions personal, between the patient and doctor (with some obvious need for some oversight to avoid waste or fraud); 2) Cover those that need covering, but do not force people into the system... people still have a right to make poor decisions in this country; 3) Drop denying based on pre-existing conditions; and 4) Tort reform. None of these would require a public option to implement, and such an option would have a devastating effects on the entire industry, in my opinion.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  2. Micael's Avatar
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       #1322  
    Quote Originally Posted by zelgo View Post
    Oh, since when has any profit making industry EVER done anything that would work against it's own profits?

    yeah, sure...these insurance companies are doing this all for our good and only our good...

    Which world do you frolic in? La la land, it seems.
    You prattle on... feel free to back up your lie any time. We'll be waiting.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  3. #1323  
    Quote Originally Posted by Micael View Post
    Then I believe we agree on most points. I work for a not-for-profit but private insurance company. My four primary concerns are 1) keep the decisions personal, between the patient and doctor (with some obvious need for some oversight to avoid waste or fraud); 2) Cover those that need covering, but do not force people into the system... people still have a right to make poor decisions in this country; 3) Drop denying based on pre-existing conditions; and 4) Tort reform. None of these would require a public option to implement, and such an option would have a devastating effects on the entire industry, in my opinion.
    You're kidding, right? What would happen to the required finances that you, as a health plan, have to have to make sure your "covered lives" will be cared for if you go bankrupt? You really think all those higher risk people can be covered, that you and your co-workers (who are not delivering care) can still be paid, and that your company will remain solvent? Where will the financial support come from to keep your business going? You will require external funding....like from the government. Insurance companies are banking on the fact that if everyone is covered, they will have enough customers to cover the increased payout expenses. If you want to be totally economically savvy about it, if I were an insurance company I'd strongly favor a public option, and I'd push everone with no money for adequate insurance toward it, and continue to cherry-pick the relatively healthy population I currently have...if I were allowed to do that.


    And tort reform, IMHO, will make essentially no difference in practice patterns. People do what they do based on history and education much more than they do on defensive medicine. And making a profit fits in there somewhere as well. All unbiased evaluations of the effects of tort reform suggest that it has almost no effect on the vast waste in the system. I'm fine with it, I just don't think it will make any difference. More strict controls will make the difference.
  4. #1324  
    Quote Originally Posted by zelgo View Post
    First, your referring to the Heritage Foundation "research" on healthcare is laughable.
    I didn't refer to it as research. I referred to it as analysis.
    Something is suspect when every non-partisan research organization shows how Medicare's 2-3% administrative costs are far, far below the 20-30% charged by private insurance, yet Heritage, an organization funded by conservative private industry, finds the opposite.
    I see you're disputing the position simply because your ideology disagrees with it. The Heritage analysis does not, in fact, disagree with those numbers or find the opposite. It does not dispute that, as a percentage of benefits provided, Medicare costs are lower. What it points out is that such a measure is not directly comparable, and that cost per beneficiary would be a fairer comparison if we're going to be measuring efficiency.
    I'm sure of you look around the web, you'll find impassioned research "proving" the earth is flat too.
    Straw man. The passion is irrelevant. The reasoning is what counts. You're taking the same ad hominem tack as Krugman's response. I'll let the author's response stand on that.
    As for shifting the burden from private industry to government does not simply shift an equal burden--it actually lessens the burden.
    Considering that CBO analysis disagrees with the numbers promoted by proponents, I'm reluctant to have faith in that estimate.
    Government can provide healthcare to all, including the 47 currently uninsured--without co-pays and premiums we pay now. It actually becomes cheaper for the entire country and cheaper for all individually. People will no longer go bankrupt because of medical cost. People will not have to choose between food and medicine. It also sets up the chance for increasing healthcare quality because of government standards.
    Certainly an impassioned response. Is that from the sister site to the flat-earth one?
    The Fed isn't offering any of this for free, of course. We pay for it in taxes (no more than we pay in insurance premiums and co-pays right now)--but we get much more back than we do now.
    Well, until the Baby Boomers retire, as you so often point out.
    The federal government has taken that stance by offering food stamps and low-cost housing for those who have trouble paying for them.
    No. If it had taken the stance I mentioned, it would be providing it for all citizens. Rights are not 'provided' only to people that can't afford them. Even if health care were a right, does that mean the federal government must bankroll my newspaper venture since I can't afford to start one on my own?
    The point of the federal government is to protect its citizens, particularly if the states have been unable to do so.
    The point of the federal government is to protect its member states' and citizens' rights and freedoms and to provide regulation for the interactions between those states.
    I detest the Patriot Act, not because the federal government does not have the power to create massive, overarching bills, but because it tramples on our individual civil rights. Guantanamo detention remains an embarrassment in our history because it ignores basic human rights, as well as the Geneva Conventions, which we signed.
    So, you're OK only with those massive, overarching bills that agree with you politically. Seems your positions against those are purely ideology-based and not based on the principles of the Constitution. Fair enough.

    The premise is not flawed--it says it right in the Constitution: The Fed is allowed--

    "...to make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof."

    I repeat "all laws."

    If you think the wording it vague, take it up with the original framers of the Constitution--or change it with an Amendment. Otherwise, follow it literally, as the originalists so love to do...
    The wording isn't vague. You left out some significant verbiage there. "all Laws" is dependent on their being necessary and proper for executing the powers vested by the Constitution. Your premise that it will be necessary and proper to the execution of the powers vested by the Constitution is not supported, so it still does not follow. I repeat "necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution".
    ‎"Is that suck and salvage the Kevin Costner method?" - Chris Matthews on Hardball, July 6, 2010. Wonder if he's talking about his oil device or his movie career...
  5. #1325  
    At least with regard to health plans, in actuality the differences between profit and non-profit are less than you might think. The "profit" is usually pretty similar, which should not surprise since they are run very similarly. The major difference is that the money goes to support and expand the company and not to shareholders. From what I have experienced, it sure doesn't go back to either the providers or the enrollees.
  6. Micael's Avatar
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       #1326  
    Actually, it does davidra. Its fundamental, and I'm floored that you need that explained to you. The vast bulk of the money flows to you, the care provider, and the pharmaceutical companies. If anyone should be examined for cutting costs, its there. Insurance companies allow for people to have your procedures, the ones they would not normally have been able to afford. Thank goodness for insurance companies!
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  7. #1327  
    Micael, let's make sure you understand what I said. There is little difference between for-profit and not-for-profit HMO's and health plans from the consumer side in terms of the profit. I was talking about profit, not total expenditures. If you have any evidence to the contrary, I'd like to see it. I contract with both Humana and AvMed, one profit, one non-profit. The reimbursements are very similar, the premiums and deductibles are the same, and from my working at one of them for a while as an advisor, I have it on authority from the president of the company that there are actually minimal differences. Please show me otherwise. The other thing that's similar is that the slowdown in payment is also similar. Our hospital had to sue a non-profit HMO when they broke their own contract and withheld payments for over a year.

    I'd like to say insurance companies are a necessary evil....but I think at this point they aren't necessary. Medicare does just fine at a much lower cost.
  8. #1328  
    Here's what it's all about Micael:

    Blue Cross CEO's pay rose 26% - The Boston Globe

    He's just one healthcare executive in one state. Think about how many procedures could be done for $4.3 million. This doesn't even include what was paid to shareholders.

    Blue Cross gave chairman $16.4m in retirement pay

    Blue Cross gave chairman $16.4m in retirement pay - The Boston Globe

    Think of how many procedures could be done with 16.4 million.

    You can't run the nations healthcare that way. This barely touches the tip of the iceberg
    Last edited by palandri; 08/19/2009 at 01:35 PM.
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  9. #1329  
    Quote Originally Posted by zelgo View Post
    The premise is not flawed--it says it right in the Constitution: The Fed is allowed--

    "...to make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof."

    I repeat "all laws."

    If you think the wording it vague, take it up with the original framers of the Constitution--or change it with an Amendment. Otherwise, follow it literally, as the originalists so love to do...
    I hate to say this....probably shouldn't....but you're just nuts if you interpret the above to include providing health insurance. I mean based on your loose interpretation, anything that benefits "the village" should be provided by the Federal Government. WTF? LOL I think I've finally figured that you are just pulling our chains in here and for that I applaud you.

    Bottom line.....and I'll repeat myself.....there are 2 basic people in this country. Those that believe the government is the answer to everything and those that believe the government is usually what causes most of the problems.

    There is no reason for you to believe this story, but, talked to a client of mine yesterday who voted for Obama. Her husband is a staunch Republican while she has always stayed on the fence, though I believe she is a registered democrat, but she "bit" for this whole change and kumbayah BS. She now regrets her vote. But what was interesting was she was dealing with government employees recently on a unemployment claim and she told me yesterday that if these are the same people she'd be dealing with on a government sponsored health plan, it will be a disaster.

    But....at least it will be "free", right?
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  10. #1330  
    Quote Originally Posted by zelgo View Post
    I'd like to say insurance companies are a necessary evil....but I think at this point they aren't necessary. Medicare does just fine at a much lower cost.
    Sorry doc, but that statement is total BS. They are going bankrupt! LOL People forget this little annoying fact, but I have to believe it is an important fact. Can you deny that? So, if the system you put on a pedestal can't function in the black, why do you think that having the entire system run by the government will work? Oh sure, everyone is happy when they talk about the benefits, great, wonderful, but....big problem....either the government needs to reduce payments further to doctors and hospitals (I have no problem with that, do you?), reduce what is covered, or raise the "contribution" from citizens (tax is such a bad word, let's stick with contribution). But wait, you mean, we need to be paying more????

    Even Geithner knows we are in serious do-do: "Treasury Secretary Timothy Geithner, the head of the trustees group, said the new reports were a reminder that "the longer we wait to address the long-term solvency of Medicare and Social Security, the sooner those challenges will be upon us and the harder the options will be. " From CNSNews.com - Social Security Will Go Bankrupt by 2037 – Four Years Earlier Than Projected

    Anyway, you guys live in this dream world where money flows into the government from some mythical place and everyone can be happy and have no problems. Get real or form your own socialistic country.
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  11. #1331  
    Quote Originally Posted by zelgo View Post
    It's not my ideology that disagrees with it, it's Heritage's motives which makes me question their analysis.
    Because their ideology disagrees with yours. I read the analysis, and although I think it's not perfect (there's no way to know how either set of numbers would change if the populations were merged), it's a reasonable case towards considering an alternate view.
    For example, Heritage says because Medicare's costs are higher so it's administrative costs seem lower.
    Cook says that Medicare's costs are lower as a percentage of benefits paid, but when considering cost per beneficiary, not so much.
    Fine. Medicare is also a much larger program, covering millions more people than the individual insurance companies.
    According to? Private insurers cover ~70% of the population according to the CBPP's reporting of census data compared to ~14% in Medicare and ~13% in Medicaid/SCHIP. Admittedly, those numbers are a few years old, but they seem to be congruent with most of the accepted numbers being bandied about.
    One would assume a larger program would also need more people and paperwork in its administration--yet, even with its size, the administrative cost remains remarkably low.
    Only when considering the cost as a percentage of total benefits.
    What you consider "Principles" of the Constitution seem to be what you think they should be ideologically.
    No, what I consider the Principles of the Constitution are based upon history and the writings of those who created it and the texts of the documents themselves. I find nothing in those which supports your premise.
    The Constitution was set up to protect citizens and safe-guard inalienable rights. Life, Liberty, and the Pursuit of Happiness cannot be achieved without access to healthcare.
    Access to what healthcare? What procedures are necessary and proper to allow the government to execute their powers? That's the problem with your premise. Access to healthcare doesn't mean anything specific. If you can't admit that, we're wasting each other's time.
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  12. Micael's Avatar
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       #1332  
    Quote Originally Posted by zelgo View Post
    As an insurance company employee, you must agree that the way insurance works is to pool costs so that money can be taken from that pool and given to care for the sick.

    The more pools you have, the less effective insurance is and the more expensive it is for each member to join that pool.
    Based on what analysis please? In every other industry, the more pools, the more competition for clients, the better the product and service offerings.

    Why is it you see health insurance any different?
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  13. #1333  
    Quote Originally Posted by clemgrad85 View Post
    Sorry doc, but that statement is total BS. They are going bankrupt! LOL People forget this little annoying fact, but I have to believe it is an important fact. Can you deny that? So, if the system you put on a pedestal can't function in the black, why do you think that having the entire system run by the government will work? Oh sure, everyone is happy when they talk about the benefits, great, wonderful, but....big problem....either the government needs to reduce payments further to doctors and hospitals (I have no problem with that, do you?), reduce what is covered, or raise the "contribution" from citizens (tax is such a bad word, let's stick with contribution). But wait, you mean, we need to be paying more????

    Anyway, you guys live in this dream world where money flows into the government from some mythical place and everyone can be happy and have no problems. Get real or form your own socialistic country.
    Ahh. The "S" word. The last bastion of unreasoned discourse. What, no Hitler reference?

    You want to make up the amount that is being lost in Medicare and way more? Take the overhead money that is supporting Micael and his insurance company cronies. He/they do not provide care at all, yet they collect a significant portion of the health care dollar. A true single payor system for all, with appropriate increases in taxes (I believe in being honest about that) will easily take care of Medicare and Social Security....especially when combined with critical review of unnecessary procedure, negotiating reasonable drug prices from pharmaceutical companies, and yes, possibly decreasing reimbursements to providers. Everybody needs to give up something to provide high quality health care for all. Sure would make things around my office less complicated to just have to deal with Medicare, for example. May be kumbaya to you, but spend some time with people who are dying for lack of care and you might change your mind. We are a selfish nation when it comes to individuals. Maybe it's time to fix that.
  14. Micael's Avatar
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       #1334  
    Quote Originally Posted by davidra View Post
    Ahh. The "S" word. The last bastion of unreasoned discourse. What, no Hitler reference?

    You want to make up the amount that is being lost in Medicare and way more? Take the overhead money that is supporting Micael and his insurance company cronies. He/they do not provide care at all, yet they collect a significant portion of the health care dollar.
    .6% ???? You call that significant? And I really don't care for your tone, and for calling me a cronie. Now where is that ignore button again....
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  15. #1335  
    And you definitely cannot run government run health care the way Nancy wants to do it. No competition at all. Everything decided for you by the government. Changing providers? Not a chance. Really now - die early - save the tax payers big money - that is the government's answer to your health care. Also what makes cheats and lairs like Nancy, Barney, Chris and the other crack pots any different? You think they have your interests at heart? You did hear one at a town hall meeting insist that regardless of what his constituents wanted, he was going to vote for it, the way he saw fit.

    Is that any better than what you are quoting below?

    Quote Originally Posted by palandri View Post
    Here's what it's all about Micael:

    Blue Cross CEO's pay rose 26% - The Boston Globe

    He's just one healthcare executive in one state. Think about how many procedures could be done for $4.3 million. This doesn't even include what was paid to shareholders.

    Blue Cross gave chairman $16.4m in retirement pay

    Blue Cross gave chairman $16.4m in retirement pay - The Boston Globe

    Think of how many procedures could be done with 16.4 million.

    You can't run the nations healthcare that way. This barely touches the tip of the iceberg
  16. #1336  
    Quote Originally Posted by Micael View Post
    .6% ???? You call that significant? And I really don't care for your tone, and for calling me a cronie. Now where is that ignore button again....
    I call 25% overhead in comparison to 4% overhead significant. Yes there are some corrections and the overhead may be slightly higher than that... I don't know where your percentage came from, but I suspect it may be higher than that. It certainly would be interesting to see the amount of money that is spent on for-profit and non-profit health plans for just adminstration alone...but those figures are not accessible, and for good reason. Sorry if you took offense. Some of my best friends are insurance people. I just wish they'd stick to liability, house, auto and life.
  17. #1337  
    Quote Originally Posted by Micael View Post
    .6% ???? You call that significant? And I really don't care for your tone, and for calling me a cronie. Now where is that ignore button again....
    So you can dish it out? but you can't take it? How many times have you called me a Marxist or a Socialist for simply being in a Labor Union?
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  18. #1338  
    Quote Originally Posted by bclinger View Post
    And you definitely cannot run government run health care the way Nancy wants to do it. No competition at all. Everything decided for you by the government. Changing providers? Not a chance. Really now - die early - save the tax payers big money - that is the government's answer to your health care. Also what makes cheats and lairs like Nancy, Barney, Chris and the other crack pots any different? You think they have your interests at heart? You did hear one at a town hall meeting insist that regardless of what his constituents wanted, he was going to vote for it, the way he saw fit.

    Is that any better than what you are quoting below?
    And just what government run health care are you talking about? Medicare? There is absolutely nothing about Medicare that fits with your description, now, is there? Medicare patients have their choice of providers, their choice of hospitals, and guess what? There are no death panels in Medicare. Go figure.

    The easiest and least painful way to do this is simple. Just expand Medicare downward, a little at a time, along with cost controls. That will give insurance companies time to move on to something else to insure other than your health. I've already posted data showing that Medicare beneficiaries are more happy with their coverage than those with private insurance. Combined with cost controls and drug cost reductions, there is no reason it couldn't be instituted economically.

    Oh...yeah, I heard that. I also heard Grassly say that he wasn't going to vote for a bill no matter what it contained. There is no vision here, no commitment to providing for the population. From the republican side, it's all about promoting failure, and the health of the country be damned. It's truly transparent and pathetic, but not unexpected. That's what happens when you try and be bipartisan. No matter what you give up, it's not enough.
  19. Micael's Avatar
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       #1339  
    Quote Originally Posted by palandri View Post
    Here's what it's all about Micael:

    Blue Cross CEO's pay rose 26% - The Boston Globe

    He's just one healthcare executive in one state. Think about how many procedures could be done for $4.3 million. This doesn't even include what was paid to shareholders.

    Blue Cross gave chairman $16.4m in retirement pay

    Blue Cross gave chairman $16.4m in retirement pay - The Boston Globe

    Think of how many procedures could be done with 16.4 million.

    You can't run the nations healthcare that way. This barely touches the tip of the iceberg
    So this is about sticking it to the man? We hate CEO's so lets collapse the industry?

    Whats mind boggling is that this whole debate suddenly shifted from "lets change healthcare" to "lets destroy private health insurance companies". Meanwhile, how many doctors do you see riding around in anything LESS than a 60k car, and living in the wealthier neighborhoods? How many medical lawsuit lawyers do you see "just getting by"? Know of any pharmaceutical companies nearing bankrupcy?

    Yeah... it's all the insurance companies fault that account for POINT SIX PERCENT of the entire industry's profits. Jeez ppl. Get a grip already.

    I'm for changing lots of stuff about insurance companies, but not by destroying them.

    Oh, and as for that "S" word.... yes, the agenda of the left here *IS* national socialism. That's the point of single payer. Government controls because Government knows best.

    Thanks, but no thanks.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  20. Micael's Avatar
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       #1340  
    Quote Originally Posted by palandri View Post
    So you can dish it out? but you can't take it? How many times have you called me a Marxist or a Socialist for simply being in a Labor Union?
    I take it all back. Please accept my apologies.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.

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