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  1. #41  
    So now that universal healthcare is essentially solved, whats next?

    The department of housing and urban development say on any given night between 700,000 and 2 million Americans are homeless. Temporary shelter is not enough, it's merely a bandaid (kinda like hospital ERs for uninsured, its expensive and doesn't solve the problem). Why provide free healthcare to a person who leaves his doctors office and goes back to his cardboard box behind a walmart. Why not provide universal housing using re-distributed tax dollars?
  2.    #42  
    Quote Originally Posted by joshaccount View Post
    So now that universal healthcare is essentially solved, whats next?

    The department of housing and urban development say on any given night between 700,000 and 2 million Americans are homeless. Temporary shelter is not enough, it's merely a bandaid (kinda like hospital ERs for uninsured, its expensive and doesn't solve the problem). Why provide free healthcare to a person who leaves his doctors office and goes back to his cardboard box behind a walmart. Why not provide universal housing using re-distributed tax dollars?
    Except for rare cases in the winter, people don't die from homelessness. They do die from lack of health care. Economic development, local and state, would help housing. But local and state governments have shown they cannot provide quality care to all, hence the need for national reform. I have no problem with prioritizing health care above housing. I readily agree that priorities have to be made (guess that means I favor rationing).
  3. #43  
    Quote Originally Posted by davidra View Post
    Except for rare cases in the winter, people don't die from homelessness. They do die from lack of health care. Economic development, local and state, would help housing. But local and state governments have shown they cannot provide quality care to all, hence the need for national reform. I have no problem with prioritizing health care above housing. I readily agree that priorities have to be made (guess that means I favor rationing).
    If people don't die from homelessness (and I agree by the way, with exceptions for extreme situations), why not offer universal healthcare only for emergent and critical cases (that if left untreated would lead to death or disability) instead of universal healthcare?
  4.    #44  
    Quote Originally Posted by joshaccount View Post
    If people don't die from homelessness (and I agree by the way, with exceptions for extreme situations), why not offer universal healthcare only for emergent and critical cases (that if left untreated would lead to death or disability) instead of universal healthcare?

    Because chronic diseases account for the vast majority of health care costs. Not treating them chronically is unethical, in my opinion. You really want someone with chronic lung disease to be unable to get out of bed until they have a respiratory arrest so that they can be treated? You would deny proven preventive medicine interventions until people actually got sick from their cervical cancer which had metastasized? Health care includes much more than heroic care when done correctly.
  5. #45  
    Quote Originally Posted by davidra View Post
    Because chronic diseases account for the vast majority of health care costs. Not treating them chronically is unethical, in my opinion. You really want someone with chronic lung disease to be unable to get out of bed until they have a respiratory arrest so that they can be treated? You would deny proven preventive medicine interventions until people actually got sick from their cervical cancer which had metastasized? Health care includes much more than heroic care when done correctly.
    Re-read my post.

    Why not healthcare for conditions that if left untreated would lead to death or disability, which would include your examples...as opposed to universal healthcare?
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    #46  
    Quote Originally Posted by tcrunner View Post
    Nibbling at low, single-digit percentage points with their proposals to trim costs doesn't recognize the true cost issues that exist, just as davidra has already outlined, nor does it address the unsustainable cost issue of continuing to provide uncompensated care for the uninsured.

    In the face of 'a difference of opinion', Dems did the right thing by breaking arms to get this done now before even more economic harm is felt by us all.
    Those low single digits of savings add up though - if each bill only saves 2% that adds up to 16% cost savings - not an insignificant amount. Some of the bills btw are essentially free to impose - allowing insurance to be sold across state lines for example is very very inexpensive to implement.

    I would argue the Dems did do the wrong thing, but so did the Republicans Both sides took a "our way or the highway" approach. For the sake of the discussion, assume we had the bill that past and some of the cost saving measures proposed by Republicans - there would have been savings on top of increasing access through the Democrats' bill. Some of the Republican ideas and those of the Democrats are not mutually exclusive - you can have both exist within the same reform. That fact that the Democrats wouldn't consider Republican ideas and, equally bad, that the Republicans wouldn't consider Democratic ideas is more indicative of a complete failure of our government than an indication of who is right or wrong.

    Quote Originally Posted by davidra View Post
    But in fact kids are denied care every day, even when their families have Medicaid, because many pediatricians won't take it. If they don't, they're even more in trouble. Spend a little time in a free clinic and see how many of those people are "scamming the system for freebies". I have no problem with a hybrid system. I have no problem with any system that provides care promptly to those that need it, and I've said that many times. The truth is, though, that I think we are unlikely to be able to afford that unless we have a single payor system. I'd be glad to be wrong about that, but that's the way it looks to me.
    And I agree - no kids should be denied healthcare PERIOD. I used that example more so to illustrate why I differ in opinion from most of my conservative colleages.

    A single payor system could reduce costs but I honestly believe the cost savings would be canceled out by massive increases in bureaucratic costs and inefficiencies that are typical in such large systems, especially those operated by government or entities with no competition. One effect of allowing insurance to be sold across sate lines is that we will see some mergers and acquisitions in the insurance industry which will increase the insured pool of those larger companies, allowing for reduced premiums. This way we get some , admittedly not all, of the benefits of a large single payer while still providing competitive pressures to decrease costs of coverage.

    Of course as I've said, not everyone will be covered, so there should be a complete overall of the current Medicare system and a new system that operates a little more like a government sponsored entity is put in place to provide healthcare for those that cannot afford it or have "pre-existing conditions".
    Last edited by solarus; 07/09/2010 at 06:43 PM.
  7.    #47  
    Quote Originally Posted by joshaccount View Post
    Re-read my post.

    Why not healthcare for conditions that if left untreated would lead to death or disability, which would include your examples...as opposed to universal healthcare?

    Not exactly sure what you're implying here, but I'm assuming you mean that episodic care wouldn't be covered (like urinary tract infections or upper respiratory infections). OK, but 75% of all health care costs are due to chronic disease, and much of the rest is due to heroic care. Outpatient episodic care certainly costs money, but not much compared to the rest. And pretty much everybody agrees that appropriate screening tests should be covered as they save money in the end.
  8.    #48  
    Quote Originally Posted by solarus View Post
    A single payor system could reduce costs but I honestly believe the cost savings would be canceled out by massive increases in bureaucratic costs and inefficiencies that are typical in such large systems, especially those operated by government or entities with no competition. One effect of allowing insurance to be sold across sate lines is that we will see some mergers and acquisitions in the insurance industry which will increase the insured pool of those larger companies, allowing for reduced premiums. This way we get some , admittedly not all, of the benefits of a large single payer while still providing competitive pressures to decrease costs of coverage.

    Of course as I've said, not everyone will be covered, so there should be a complete overall of the current Medicare system and a new system that operates a little more like a government sponsored entity is put in place to provide healthcare for those that cannot afford it or have "pre-existing conditions".
    And I think that the cost of paying premiums to insurance companies is essentially giving money away to a middleman who provides no direct services at all. With even moderate control of "inefficiencies", those costs would probably offset. When it gets right down to it, please tell me why part of your hard-earned money that you want to spend on your health care should go to an entity that does not provide any services directly? Is that really logical?
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    #49  
    Quote Originally Posted by tcrunner View Post
    If only healthcare economics were dependent on simple arithmetic, it would have been solved decades ago. Of course, duplication of costs and/or services have to be incorporated as well as the administrative costs associated with each of these disconnected ala carte "solutions". Regardless, the heart of the rising costs were not being addressed, though I'll grant that it's something. Just not a plan.
    The only thing "disconnected" is that they weren't part of a single bill. And as I said, they by themselves are not the solution. They are only part of the solution. We don't agree on the overall all encompassing methods to achieve reasonable coverage for everyone but at least you now acknowledge the Republicans did have ideas even if you think they are bad ones.

    It's called leadership at a time when required...
    And I'm sure you acknowledged the same when our last President pushed through medicare prescription coverage with little influence from the Democrats. Somehow I highly doubt it - I certainly didn't myself (not a fan of GWB at all). I may respect your beliefs for what they are, but that doesn't mean you can sit there and claim that somehow, partisan behavior by your party is leadership while identical partisan behavior by another party is simply partisan behavior - that's just disingenuous - no better than "I know you are but what am I"!


    Quote Originally Posted by davidra View Post
    And I think that the cost of paying premiums to insurance companies is essentially giving money away to a middleman who provides no direct services at all. With even moderate control of "inefficiencies", those costs would probably offset. When it gets right down to it, please tell me why part of your hard-earned money that you want to spend on your health care should go to an entity that does not provide any services directly? Is that really logical?
    The difference is that insurance companies do provide a service - they reduce the cost of healthcare to the individual by spreading risk and reducing the end costs to the individual through a large pool of insured customers. I know you know how it works - its not giving money away. The cost of a week stay in hospital for example, lets say $20,000 just for sake of argument, is paid for by the insurance company even if I've only paid a total of $3,500 in monthly payments. Even if I have a fairly high deductible and co-pay say $2,000 each, I'm still ahead of the game. Insurance saved me $12,500 - that's the service.

    Is the system perfect - no b/c some can't afford insurance and "pre-existing" conditions" are sometimes used as an excuse to not treat people who get sick again from the same illness that was originally treated under their insurance. That's where the morality kicks in for me - i.e. where government needs to step in and provide coverage to those people as a fundamental issue of ding the right thing for one's citizens.
    Last edited by solarus; 07/09/2010 at 07:52 PM.
  10.    #50  
    Quote Originally Posted by solarus View Post
    The only thing "disconnected" is that they weren't part of a single bill. And as I said, they by themselves are not the solution. They are only part of the solution. We don't agree on the overall all encompassing methods to achieve reasonable coverage for everyone but at least you now acknowledge the Republicans did have ideas even if you think they are bad ones.



    The difference is that insurance companies do provide a service - they reduce the cost of healthcare to the individual by spreading risk and reducing the end costs to the individual through a large pool of insured customers. I know you know how it works - its not giving money away. The cost of a week stay in hospital for example, lets say $20,000 just for sake of argument, is paid for by the insurance company even if I've only paid a total of $3,500 in monthly payments. Even if I have a fairly high deductible and co-pay say $2,000 each, I'm still ahead of the game. Insurance saved me $12,500 - that's the service.

    Is the system perfect - no b/c some can't afford insurance and "pre-existing" conditions" are sometimes used as an excuse to not treat people who get sick again from the same illness that was originally treated under their insurance. That's where the morality kicks in for me - i.e. where government needs to step in and provide coverage to those people as a fundamental issue of ding the right thing for one's citizens.
    Let's just say there's a much greater spreading of risk with a larger health plan....like a single-payor plan. And of course there's the obvious....regardless of the risk distribution, almost all insurance companies make a profit (yes, there are some non-profits, but relatively few). So yes, you are paying for the distribution of risk....and the obvious question is do you want to do that when it's not necessary? You're also paying for double digit versus single digit overhead (in the case of Medicare, in spite of the arguments about how that is calculated).

    Again, I am in favor of any system that provides quality care to all, private or non-private. Just don't kid yourself into thinking that a for-profit system will save a lot more money than a reasonably-run government program....that hasn't proven true in other countries.
    Last edited by davidra; 07/09/2010 at 07:58 PM.
  11. solarus's Avatar
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    #51  
    Quote Originally Posted by davidra View Post
    Let's just say there's a much greater spreading of risk with a larger health plan....like a single-payor plan. And of course there's the obvious....regardless of the risk distribution, almost all insurance companies make a profit (yes, there are some non-profits, but relatively few). So yes, you are paying for the distribution of risk....and the obvious question is do you want to do that when it's not necessary? You're also paying for double digit versus single digit overhead (in the case of Medicare, in spite of the arguments about how that is calculated).
    The problem is that a single payor system has no incentive to improve service or actually decrease inefficiencies b/c there's no competition - this has happened in Britain in certain districts (Staffordshire is the most memorable one), with the net effect of a reduced level of healthcare. Its one of the reasons why Medicare costs, which were originally estimated to be much lower back when it passed, are so much higher than anticipated now.

    Profits allow for expansion of services and the hiring of new doctors, opening of more facilities etc...If the insurance industry was pulling in 10%-20% margins I would have to agree that there was an issue, but we're talking quite low profit margins here - about 3% - 3.5%, not exactly abusive.

    The overhead % is a little misleading too - as a lot of the overhead is fixed, i.e. it doesn't change drastically as revenues/cost of sales do. This means that since the Medicare system is so much larger compared to individual insurance companies their overhead as a percentage is lower but in reality the fixed dollars aren't that different. Also Medicare doesn't have a lot of the overhead that insurance companies do - state insurance premium taxes, extra costs associated with doing business in states with different regulations, marketing costs etc...

    I think its fair to say I understand where you are coming from and certainly agree with the end goals of what you believe. Hopefully you understand where I am coming from too. I'm not sure we'll convince each other of the details but we do at least share once common belief - that government has an obligation to be involved in ensuring everybody gets adequate healthcare, and that it shouldn't just leave it to the private sector to run.
    Last edited by solarus; 07/09/2010 at 08:18 PM.
  12. #52  
    Quote Originally Posted by davidra View Post
    Not exactly sure what you're implying here, but I'm assuming you mean that episodic care wouldn't be covered (like urinary tract infections or upper respiratory infections). OK, but 75% of all health care costs are due to chronic disease, and much of the rest is due to heroic care. Outpatient episodic care certainly costs money, but not much compared to the rest. And pretty much everybody agrees that appropriate screening tests should be covered as they save money in the end.
    What I'm trying to articulate is my wish for an alternative between no healthcare and universal coverage. It seems like there should be some middle ground between having no insurance to having everything covered on someone elses dime. I have no problem with universal coverage for minors and the elderly (who have paid into the system throughout their working lives, like you and I), but I have a problem with the breadth of the new system as it applies to ALL uninsured people regardless of why they need care (career smokers who suffer respiratory illness, people who eat themselves into obesity, career drug and alcohol abuse, etc) and what they choose to spend their money on prior to shopping for health insurance (cell phones, large TVs with satellite, cigarettes, alcohol, expensive clothes and accessories, travel, etc). Probably an unpopular opinion, but I fear the universal healthcare will turn into a blank check with little in the way of "conditions".
  13.    #53  
    Quote Originally Posted by solarus View Post
    The problem is that a single payor system has no incentive to improve service or actually decrease inefficiencies b/c there's no competition - this has happened in Britain in certain districts (Staffordshire is the most memorable one), with the net effect of a reduced level of healthcare. Its one of the reasons why Medicare costs which were originally estimated to be much lower back when it past are so much higher than anticipated.

    Profits allow for expansion of services and the hiring of new doctors, opening of more facilities etc...If the insurance industry was pulling in 10%-20% margins I would have to agree that there was an issue, but we're talking quite low profit margins here - about 3% - 3.5%, not exactly abusive.

    The overhead % is a little misleading too - as a lot of the overhead is fixed, i.e. it doesn't change drastically as revenues/cost of sales do. This means that since the Medicare system is so much larger compared to individual insurance companies their overhead as a percentage is lower but in reality the fixed dollars aren't that different. Also Medicare doesn't have a lot of the overhead that insurance companies do - state insurance premium taxes, extra costs associated with doing business in states with different regulations, marketing costs etc...
    Not quite true. There are indeed incentives to improve the quality of care with a single payor system. You only need to look at Medicare reimbursement and the use of DRG's for reimbursing hospitals. Increasing efficiency of care results in a financial incentive for hospitals. More recently, Medicare has refused to pay for hospital-acquired infections and other preventable causes of morbidity. The result? Hospitals now have an incentive to reduce hospital-acquired infections, because they will not be paid for the treatment.
  14. #54  
    The problem with a single payer system is that it would be NO different than we have now. For any system to work participants need to pay into it, not just collect the benefits.
  15. #55  
    Quote Originally Posted by davidra View Post
    Not quite true. There are indeed incentives to improve the quality of care with a single payor system. You only need to look at Medicare reimbursement and the use of DRG's for reimbursing hospitals. Increasing efficiency of care results in a financial incentive for hospitals. More recently, Medicare has refused to pay for hospital-acquired infections and other preventable causes of morbidity. The result? Hospitals now have an incentive to reduce hospital-acquired infections, because they will not be paid for the treatment.
    Which in turn increases care costs, and if after steps are taken and an infection still occurs? Swallow the loss or jack up your prices for the next patient?
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    #56  
    Quote Originally Posted by tcrunner View Post
    Being uncoordinated segments which likely overlap services and duplicate costs is, by definition, less than the sum of their parts.



    I'm firmly against government giveaways to the Insurance goons regardless of who wraps the present. I was against Bush's Part-D gift at the time it was being considered. Just as I was for the public option and believe that the same Insurance goons squeezed it out of serious consideration through fear and lies.
    Duplication of costs is one of the reasons I threw out the % savings some the bills said they would accomplish and used a much more conservative figure of 2% per bill. Anyway like I said, a private only solution isn't the way to go.

    One thing we agree on then is we are both against givaways to lobbyist goons - its a part of our political system that needs to be addressed be it the insurance goons (healthcare) or maybe the trial lawyer goons (big tobacco lawsuits financed by the government).
  17. solarus's Avatar
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    #57  
    Quote Originally Posted by davidra View Post
    Not quite true. There are indeed incentives to improve the quality of care with a single payor system. You only need to look at Medicare reimbursement and the use of DRG's for reimbursing hospitals. Increasing efficiency of care results in a financial incentive for hospitals. More recently, Medicare has refused to pay for hospital-acquired infections and other preventable causes of morbidity. The result? Hospitals now have an incentive to reduce hospital-acquired infections, because they will not be paid for the treatment.
    Point taken, but just one last point , private insurance companies could also refuse to pay for hospital borne illnesses if rules preventing hospitals going after the patient or their estate for payment were in place. This is another example of how a partnership between government regulations/coverage and private industry gets to the same result you illustrated.
  18.    #58  
    Quote Originally Posted by cjgem View Post
    Which in turn increases care costs, and if after steps are taken and an infection still occurs? Swallow the loss or jack up your prices for the next patient?
    Sure, if you assume that there are no savings from decreasing the number of infections. And that's not the case. To say nothing about the fact that you've prevented patients from getting life-threatening infections. How much does that count in your view, or does that make a difference?

    Decrease in expenditures and selected nosocomial i... [Clin Perform Qual Health Care. 1997 Oct-Dec] - PubMed result

    This study was undertaken to document the costs of nosocomial infections in the intensive care unit (ICU) and the impact of programs to reduce risks and costs of these infections. MEDLINE was searched from 1990 to 2000. The search strategy was: costs OR economics AND intensive care unit AND nosocomial infection 'AND guidelines' was added in a secondary search. The overall additional costs associated with hospital-acquired infections in the ICU varied from $3000 to $40,000 per patient and is associated with an additional length of stay of 5 days to roughly 3 weeks. The mean cost of antibiotics has been estimated from $1000 to $16,000. Implementing guidelines and screening and isolation programs reduced the rate of infection and the costs both of both antiinfectious agents and hospital days. The expected savings from reduction in the rate and severity of nosocomial infections offset the costs of implementing prevention programs.
    Costs of Nosocomial Infections in the ICU and Impact of Prog... : Clinical Pulmonary Medicine
  19. #59  
    Quote Originally Posted by davidra View Post
    Sure, if you assume that there are no savings from decreasing the number of infections. And that's not the case. To say nothing about the fact that you've prevented patients from getting life-threatening infections. How much does that count in your view, or does that make a difference?



    1990 to 2000 = more recently? Thought you were talking about something other than using Spartan Chemicals latest bug killing formula. Sorry.

    Again our Hospital must be ahead of the curve.
  20.    #60  
    Quote Originally Posted by cjgem View Post
    1990 to 2000 = more recently? Thought you were talking about something other than using Spartan Chemicals latest bug killing formula. Sorry.

    Again our Hospital must be ahead of the curve.
    Actually, I doubt that based on their employee's perspectives. True, using current dollars the savings are much more. But you can continue to discount that it makes a difference if you want.

    This report uses results from the published medical and economic literature to provide a range of estimates for the annual direct hospital cost of treating healthcare-associated infections (HAIs) in the United States. Applying two different Consumer Price Index (CPI) adjustments to account for the rate of inflation in hospital resource prices, the overall annual direct medical costs of HAI to U.S. hospitals ranges from $28.4 to $33.8 billion (after adjusting to 2007 dollars using the CPI for all urban consumers) and $35.7 billion to $45 billion (after adjusting to 2007 dollars using the CPI for inpatient hospital services). After adjusting for the range of effectiveness of possible infection control interventions, the benefits of prevention range from a low of $5.7 to $6.8 billion (20 percent of infections preventable, CPI for all urban consumers) to a high of $25.0 to $31.5 billion (70 percent of infections preventable, CPI for inpatient hospital services). SUmmARY
    http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf
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