Destroying Healthcare in America

[piaband]

Originally Posted by KAM1138

Are you unaware that the government DOES in fact already regulate these things? I know this might burst your bubble, but these horrible things are happening with the government's full knowledge. They ARE regulating it, and letting all these horrible things happen.

Of course, you just seem to want to attack insurance companies, so why would I imagine you'd care about these other facts.

KAM

No they arent. thats why the legislation would give them control over these things. because they dont have it right now.

There is no real regulation right now. Thats a fact. you are just flat out lying. If you mean they can scold the companies for their fraudulent practices, then you are right. Is that what you mean by regulation?

Originally Posted by piaband

You also say how dangerous letting the governemtn be the third party arbiter. You make no sense from one post to the next. You say ont thing on one post, then completely contradict yourself two posts later. Are you John Boehner?

No--I think if you actually go back and read, you will find that I said that the government is the proper third party arbiter (several times).

I'm not contradicting myself at all--which you will find if you just bother to read what I actually said. It's all there--go back and read it.

KAM Said:That's why it is so important to have the government in a proper role--as arbiter, NOT as insurer.

See--I said the government SHOULD be the Arbiter. Just like I said all along. Now, it really can't get more simple than this, so if you still don't get it...well, then I cannot help you.

KAM

Originally Posted by piaband

No they arent. thats why the legislation would give them control over these things. because they dont have it right now.

There is no real regulation right now. Thats a fact. you are just flat out lying. If you mean they can scold the companies for their fraudulent practices, then you are right. Is that what you mean by regulation?

There are other regulations as well, but yes, prosecuting fraud is one means of stopping this. For whatever reason, the government isn't doing a good job at that, and if someone wanted to strengthen the ability to streamline this to protect consumers from fraud, I'd be all for it.

Here's a suggestion...slow down a bit, and you will perhaps find that I'm not the villain you are looking for.

KAM

[piaband]

The American people have spoken. They have elected democrats to a majority in every part of government. The american people want healthcare reform and we're gonna get it.

You can complain all you want, but my guess it will surprise you how well it works.

See you in the future, a better one with better healthcare for everyone, not just your privileged, sliver-spoon self.

[piaband]

Originally Posted by KAM1138

No--I think if you actually go back and read, you will find that I said that the government is the proper third party arbiter (several times).

I'm not contradicting myself at all--which you will find if you just bother to read what I actually said. It's all there--go back and read it.

KAM Said:That's why it is so important to have the government in a proper role--as arbiter, NOT as insurer.

See--I said the government SHOULD be the Arbiter. Just like I said all along. Now, it really can't get more simple than this, so if you still don't get it...well, then I cannot help you.

KAM

the government will still be the arbiter when the legislation passes. Nothing will change. The government wont be owning the exchanges they are setting up. the is no public option. What are you talking about? There is NO government owned healthcare plan in the talks. No public option.

[piaband]

Originally Posted by KAM1138

There are other regulations as well, but yes, prosecuting fraud is one means of stopping this. For whatever reason, the government isn't doing a good job at that, and if someone wanted to strengthen the ability to streamline this to protect consumers from fraud, I'd be all for it.

Here's a suggestion...slow down a bit, and you will perhaps find that I'm not the villain you are looking for.

KAM

Thats exactly what you are. you're a sheep propagating misinformation like the repubs do. Thats more dangerous than the insurance companies saying it, because they;ve gotten you to believe it.


bottom line is this....the democrats healthcaer legislation is good for america, its good for americans, its good for businesses. I'm tired of hearing people complain about it. Its not perfect, nothing ever is. But its a BIG step in the right direction. People shouldnt be campaigning against something that will help so many people

Originally Posted by piaband

We've already agreed that healthcare is a right so your arguing it makes you sound very ignorant. If not, we wouldnt have medicaid.

Really? we dont have a right to get something we NEED? Then why do we give out food stamps? Why do we give out welfare? Why does every single modern country in the world have universal healthcare except us? Are they all idiots? Wow, those suckers dont know what they're missing, huh?

If we had universal healthcare for 10 years, you would think it was crazy how long we didnt have it. I promise you that.

You have no right to healthcare, if you did, there would be no healthcare debate--you'd simply have it. So, obviously, this is not the case.

KAM

Originally Posted by piaband

The American people have spoken. They have elected democrats to a majority in every part of government. The american people want healthcare reform and we're gonna get it.

You can complain all you want, but my guess it will surprise you how well it works.

See you in the future, a better one with better healthcare for everyone, not just your privileged, sliver-spoon self.

Ok, you enjoy whatever it is you imagine has been said. I was under the impression I was talking to a coherent person.

KAM

Originally Posted by rfceo

Do you have a right to have Health insurance that you pay for?

If you are asking if I have a right to be provided the services that I pay for, then the answer is yes.

Originally Posted by rfceo

Right now insurance companies cherry pick who they cover, that is not right, that is not an insurance company. Insurance is purchased and the company providing it is taking the risk. What they are doing now is skirting the risk factor.

Yes, they do this, however, they remain an insurance company.

I think the problem is this: Insurance companies are outside of a reasonable insurance model. Basically, you insure a group of people that has a relatively small chance of the insured event occurring. So, when it does--to a minority, it can be paid for. Problem is--someone along the line decided that we aren't insuring against something that is unlikely to happen, but that they are paying for common things that WILL happen...or that are highly likely.

I use this analogy. Medical insurance is like trying to have Auto-insurance for gasoline. It simply will not work, because you need Gasoline regularly. You cannot insure against what is essentially a definite, regular cost, and attempting to do so is why prices have skyrocketed.

KAM

[rfceo]

Originally Posted by KAM1138

If you are asking if I have a right to be provided the services that I pay for, then the answer is yes.



Yes, they do this, however, they remain an insurance company.

I think the problem is this: Insurance companies are outside of a reasonable insurance model. Basically, you insure a group of people that has a relatively small chance of the insured event occurring. So, when it does--to a minority, it can be paid for. Problem is--someone along the line decided that we aren't insuring against something that is unlikely to happen, but that they are paying for common things that WILL happen...or that are highly likely.

I use this analogy. Medical insurance is like trying to have Auto-insurance for gasoline. It simply will not work, because you need Gasoline regularly. You cannot insure against what is essentially a definite, regular cost, and attempting to do so is why prices have skyrocketed.

KAM

But the question here then comes to, what do we do with the people that they will not insure? Just write them off? If they are dead we don't have to worry about them, seems to be the attitude.

[ChristopherB]

Originally Posted by groovy

This is exactly the reason that I keep harping on the WHO's failed ranking system. People still use it to support arguments like this. The WHO itself even admits that they've stopped this ranking system because of the inherent difficulties involved. Yet that doesn't stop people from using the number... 37. Below Morocco, below Saudi Arabia, below Oman. Really?

Can you please point me to where the WHO said that about their rankings? I would love to read that on their site.

[clemgrad85]

Originally Posted by davidra

I thought you actually knew something about the industry you work in. With managed care, you won't have the opportunity to use the $85 a month drug, which is a good thing (unless you are employed by a drug company). You shouldn't have that opportunity UNLESS there is firm evidence that it is better than the alternative. 95% of the time, it isn't. Managed care would have prevented, if done properly, the inappropriate use of a stress test as well. So would a good doctor.

Hey there davidra....the sleeping giant has been awakened! Good to "see" you back. As to the above statement, at least you are finally admitting there are simply some not so good doctors out there. Actually, she isn't a bad doctor, she was simply looking out for her and recommending a test that would do that. That goes back to the tort reform issue that you liberals are so against. As a physician, I don't see why you don't recognize that, but, whatever. As for the medication, I think we are in agreement, sort of. I should be able to get the $85 medication if I want it, but, it should be something that if the generic will do just as well (it seems to be doing the job!) I should be willing to pay the difference for the higher cost medication. That way, it isn't costing the healthcare system any more, just me the user.

Originally Posted by davidra

And finally, do you really think that there is a difference among prices charged? Given most people accept Medicare assignment (specifically 75% of doctors), and Medicare reimburses at 80% of "usual allowed costs", by and large people are being charged very similar amounts if they have Medicare. If they have private insurance, most large companies mirror Medicare reimbursement and additionally most are contractually related to the provider, so the providers are limited as to what they can charge. For inpatient charges, DRG's determine what is charged. The amounts are high to make up for indigent care; you know, that thing that you think everyone can just keep on getting whether they have insurance or not, because "nobody's paying for it". Ridiculous. We are all paying for it. I'd be willing to bet that if you look at what insurers pay for identical procedures, there is very little variation in similar communities. In fact, that's one of the main problems. There are virtual price controls and they are irrational. An ophthalmologist should not be paid $8000 for doing a 20 minute cataract procedure and an internist $80 for an hour and a half visit with a complicated patient. Those rules need to be changed and that's one way to control prices....reduce payments for specialty care. Of course, that's socialist doctrine because it involves "redistributing" charges. So what? That's what is needed to change costs. It will also help prevent the uneven direction that medical manpower studies have shown, with a shortage of primary care docs and excessive numbers of specialists....who provide more expensive care and in many cases, have no better health outcomes.

As for comparing Medicare reimbursements to private insurance reimbursement, I will have to defer to you on that one as I will admit that I have no idea if the 2 are the same. As a doctor, you would see that before me, but I have never heard that Medicare reimbursement rates are the same as private reimbursements. That would make little sense since I do know that these contracts are negotiated. If an insurance company can bring a larger number of patients to the table, they can negotiate a lower rate vs another insurance company who doesn't have as many patients. So, that wouldn't make sense if they were negotiating the same reimbursement as Medicare.

As for the other part of your comment regarding specialists, I have no problem bringing what they charge down. But, I don't believe that should be the job of the government. That is simply a fundamental difference that you and I have that I don't see either of us changing our opinions on. You believe the government is the answer to everything, and I believe in limiting the government. We just disagree on that.

[clemgrad85]

Originally Posted by KAM1138

I think the problem is this: Insurance companies are outside of a reasonable insurance model. Basically, you insure a group of people that has a relatively small chance of the insured event occurring. So, when it does--to a minority, it can be paid for. Problem is--someone along the line decided that we aren't insuring against something that is unlikely to happen, but that they are paying for common things that WILL happen...or that are highly likely.

I use this analogy. Medical insurance is like trying to have Auto-insurance for gasoline. It simply will not work, because you need Gasoline regularly. You cannot insure against what is essentially a definite, regular cost, and attempting to do so is why prices have skyrocketed.

KAM

Exactly! I tend to use home owners insurance for my analogy. Imagine the cost for your home insurance policy if there was a $25 co-pay for a busted toilet, or a bad water heater? Or maybe a $1000 deductible if you needed a new roof? This would raise costs through the roof (pun intended). The goal of your home owners is to prevent against the catastrophic loss....the fire, the hurricane, the earthquake, etc. Somewhere along the line (I think when HMO's came along) we started having co-pays for everything, and suddenly, costs started going up. It isn't rocket science here....the more you expect, the more it is going to cost. Of course, there are also more procedures and medications available today than 20 or 30 years ago, correct davidra? It amazes me how many people are on drugs for anxiety or depression these days....and those drugs aren't cheap. I wonder how many of those people could fix their issues if they just got up and did some exercise? Again, people don't want to work on something, they just want the quick fix....pop a pill.

Originally Posted by rfceo

But the question here then comes to, what do we do with the people that they will not insure? Just write them off? If they are dead we don't have to worry about them, seems to be the attitude.

I think that you will find that insurance companies would be much more able to cover people if they weren't paying for hang-nails and colds, and returning insurance to an insurance model, instead of this fantasy "free" health care nonsense will help with that on many fronts. In short--I think it will be easier to cover high-risk and pre-existing condition patients if the bulk of costs are removed for all the common stuff--small in price individually, but very common (which makes it add up).

I know you might not like it, but just because an insurance company exists doesn't mean they have infinite money, and can make up for the cruelty of reality. If you have a heart condition for example--well, it is going to cost you more. I happen to disagree with a blanket pricing scheme and prefer a different way to deal with preexisting conditions for example, but we can't say "just cover everyone for the same price" and expect it to work. It will not.

KAM

Originally Posted by clemgrad85

Exactly! I tend to use home owners insurance for my analogy. Imagine the cost for your home insurance policy if there was a $25 co-pay for a busted toilet, or a bad water heater? Or maybe a $1000 deductible if you needed a new roof? This would raise costs through the roof (pun intended). The goal of your home owners is to prevent against the catastrophic loss....the fire, the hurricane, the earthquake, etc. Somewhere along the line (I think when HMO's came along) we started having co-pays for everything, and suddenly, costs started going up. It isn't rocket science here....the more you expect, the more it is going to cost. Of course, there are also more procedures and medications available today than 20 or 30 years ago, correct davidra? It amazes me how many people are on drugs for anxiety or depression these days....and those drugs aren't cheap. I wonder how many of those people could fix their issues if they just got up and did some exercise? Again, people don't want to work on something, they just want the quick fix....pop a pill.

Or lawn Maintenance, or painting.

We've somehow lost track of the economic reality that services cost money, and just expect that somehow magically, it will all get paid for, and that it won't raise rates. It will (and has). It doesn't matter how much sympathy we have for people with horrible ailments--none of it changes the economic issues, and while people don't like that...well, neither do I, but to pretend it doesn't matter...well, that leads us to somewhere...like we have now--skyrocketing prices for everyone--such that the entire system is problematic.

KAM

[rfceo]

As more and more people lose their health insurance, because it becomes too expensive.
Businesses are already dropping health insurance as a benefit. There will become a need for change, because once that point arrives it will effect everyone.
1. Doctors lose income because people have no insurance and cannot afford to go to doctor.
2. Current patients lose because fewer patients means prices go up.
3. Fewer insured means price of the insurance must go up.
4. People not getting preventative care means sicker people when they finally go to the ER for help. If they can not pay then that cost goes on to everyone.

It will become a necessity at that point to have some form of reform.
We as a nation rank 14th in preventable deaths.

Originally Posted by rfceo

As more and more people lose their health insurance, because it becomes too expensive.
Businesses are already dropping health insurance as a benefit. There will become a need for change, because once that point arrives it will effect everyone.
1. Doctors lose income because people have no insurance and cannot afford to go to doctor.
2. Current patients lose because fewer patients means prices go up.
3. Fewer insured means price of the insurance must go up.
4. People not getting preventative care means sicker people when they finally go to the ER for help. If they can not pay then that cost goes on to everyone.

It will become a necessity at that point to have some form of reform.
We as a nation rank 14th in preventable deaths.

And what stops any of this? Only one thing--lower costs, and a price-manipulated system is what we have now, which has led to these skyrocketing costs. The answer in my view is to move away from a price-manipulated system and back to one that works--a market system. Again--that WSJ piece demonstrates the benefits in even a minor version of this.

The customer has been essentially removed from the equation, and that has resulted in skyrocketing prices (not the only issue however). I'll use another analogy. If you had a card that entitled you to "free" (or with a small co-pay) soda pop, would you bother to check to see what the price was? At one place it is $1.25, but another it is $2.00, but your Co-pay is 25 cents either way. Would you go out of your way to get the cheaper price? Maybe, but not likely--you'd do what was easy, because "you aren't paying for it." Except that you are...the costs are just hidden.

That is analogous to what is happening today with insurance. Costs are being charged to you that you likely don't even seen until the insurance claim comes. You do what benefits you, and shopping around or at a minimum asking about costs is much more likely to happen if you are the payer. Instead you get some statement weeks later that means little to you, and you say "Whew" I only have to pay $28 of that $340 as if you've got some sort of deal.

KAM

[piaband]

Noone is asking for a free handout. All we're asking is for the government to step in and fix a process that has spun out of control.

The reality is more american want healthcare reform than those that dont.

More americans voted for democrats than republicans.

Republicans are the minority. The minority doesnt rule in America. The minority doesnt speak for America.

The voted majority makes the rules and the minority SHOULD try to get the best deal they can for their minority, not just ruin it all for everyone.

Theres a real problem going on and I plan on getting everyone I know to fix it when the time comes to vote. We got rid of a lot of repubs in 06, alot more in 08. Now its time to finish them off in 2010. Lets rid ourselves of the disease that is the republican party.

[piaband]

Originally Posted by KAM1138

And what stops any of this? Only one thing--lower costs, and a price-manipulated system is what we have now, which has led to these skyrocketing costs. The answer in my view is to move away from a price-manipulated system and back to one that works--a market system. Again--that WSJ piece demonstrates the benefits in even a minor version of this.

The customer has been essentially removed from the equation, and that has resulted in skyrocketing prices (not the only issue however). I'll use another analogy. If you had a card that entitled you to "free" (or with a small co-pay) soda pop, would you bother to check to see what the price was? At one place it is $1.25, but another it is $2.00, but your Co-pay is 25 cents either way. Would you go out of your way to get the cheaper price? Maybe, but not likely--you'd do what was easy, because "you aren't paying for it." Except that you are...the costs are just hidden.

That is analogous to what is happening today with insurance. Costs are being charged to you that you likely don't even seen until the insurance claim comes. You do what benefits you, and shopping around or at a minimum asking about costs is much more likely to happen if you are the payer. Instead you get some statement weeks later that means little to you, and you say "Whew" I only have to pay $28 of that $340 as if you've got some sort of deal.

KAM

Yes KAM, we all get your point that you've made 10 times now. We understand that people arent shopping for healthcare the same way they do other things.

Our problem is how you intend to not solve this problem.

Getting people to have a stake in their healthcare is a start. I have heard this talked about a few times. I'm not sure if it is in the legislation, but it should be. It is a good idea.

The other good ideas ARE in the legislation. they are scored by the CBO (a neutral arbiter, thats for you) to lower healthcare costs by 14-20%, and reduce the deficit by 100 billion dollars over 10 years. Additionally lowering the deficit by $1 trillion dollars over the next decade.

so when you say we cannot afford it, how can we not afford something that is basically paying us $1 trillion dollars to implement it? ITs an oxymoron. Thats like me telling you that you cant afford the free $10 bill I am going to hand out.

Originally Posted by piaband

Yes KAM, we all get your point that you've made 10 times now. We understand that people arent shopping for healthcare the same way they do other things.

Oh do you get it now? Given that I had to repeat myself to correct you several times on another point, it is a bit strange to hear you complaining about the need to repeat oneself. I'm glad you get this though.

Originally Posted by piaband

Our problem is how you intend to not solve this problem.

Getting people to have a stake in their healthcare is a start. I have heard this talked about a few times. I'm not sure if it is in the legislation, but it should be. It is a good idea.

The other good ideas ARE in the legislation. they are scored by the CBO (a neutral arbiter, thats for you) to lower healthcare costs by 14-20%, and reduce the deficit by 100 billion dollars over 10 years. Additionally lowering the deficit by $1 trillion dollars over the next decade.

Well, as you may not know, the CBO scores only what they are given, which is a pile of assumptions chosen not objectively, but selectively. The CBO analysis isn't the problem, the honesty of the people providing the information is. Second, considering the track record of government programs, it is highly unlikely that these estimates will be accurate, and much more likely that they will be many times more expensive (like Medicare and Social Security are for example).

I know it is helpful to forward the PR that this will result in a savings, based on cherry picked numbers, selectively provided to the CBO, but its just that--PR. I'll tell you what though--how about they simply put a sunset provision on it. If it does what you say and reduces the deficit (without incurring additional costs) keep it--if not, it is discarded.

If you think can add millions of people who have no ability to pay into a system (know for fraud) and expect it to cost LESS, then great--let's prove it, and when it doesn't meet these ridiculously rosy predictions, we can trash the whole thing and start again, digging out of an even deeper hole.

Originally Posted by piaband

so when you say we cannot afford it, how can we not afford something that is basically paying us $1 trillion dollars to implement it? ITs an oxymoron. Thats like me telling you that you cant afford the free $10 bill I am going to hand out.

Oh I understand the promise and the claim. I'm just not naive enough to believe it.
Also--the hilarity of claiming a "free $10 bill" is too much to take. "No really--its a free lunch, trust me." Yeah, this ALWAYS happens with government--works out great doesn't it? How's that social security working out? How about Medicare? Medicaid? Oh right...insolvency around the corner. Good luck with that.

KAM