[Toby]

Hey, credit where credit's due. The French influence in the culture and food of the southeast is undeniable. Come to think of it, pack up a peace maker, a muffaletta, some red beans and rice and send it my way, would ya?

Those are all more NOLA specific rather than French necessarily. NOLA is considered 'Creole' in general, which is a mainly a mix of French, Spanish, Irish, African, and Italian influences. NOLA culture is in many ways similar to the other big traditional port city (NY). AAMOF, the NOLA accent is nearly indistinguishable from NY. My people are a completely different matter. Gumbo is considered one of our dishes, but it's somewhat borrowed from the African culture. I could maybe be convinced to trade some stuff in late October if there was something interesting in it for me.

[Toby]

And I never stated that a Federalist view was never upheld - just pointing out that, just because an individual doesn't recognize the legal existence of implied powers doesn't mean that the law always agrees.

What makes you think that clemgrad85 doesn't recognize the existence of implied powers? Implied powers do not mean that the Federal Government can do whatever it pleases.

I don't think anyone said that rights of citizens are only those enumerated in the Constitution...I responded to an argument that the rights of the federal government are only those explicitly stated in the Constitution.

The Federal Government does not have rights. It has enumerated powers, and implied powers which allow it to execute those enumerated powers.

My premise, which you claim is flawed, was simply that the Supreme Court has frequently ruled (in examples I cited above) against such a strict interpretation.

I stated that your premise is flawed because the Federal Government does not have rights. The decisions you noted deal with the rights of citizens. Citizens have rights. The rights enumerated in the Bill of Rights were only there because some of the states that bought into the Anti-federalist views would not ratify the Constitution unless it was there. Hamilton argued against them in the Federalist Papers since he thought that if they enumerated certain rights, it might imply that other rights didn't exist. Some so-called 'strict constructionists' like Scalia fall prey to this implication (at least in speeches even if not on decisions so far).

Whether you agree with the Supreme Court's decision is one issue, but it's another to state definitively that the law supports a strict originalist stance. It currently does not.

I did not say that I disagreed with those decisions per se, and I'm confused as to how you'd draw that conclusion. However, the Supreme Court does not operate in a vacuum. Clemgrad85's link to a background on the court stacking scandal is a decent read on such an instance (I finally had a chance to read it, although I was already aware of the history). The Supreme Court only ruled the way they did since their alternative was to have Roosevelt keep adding Justices until he got what he wanted.

[davidra]

It could get pretty complicated fairly quickly. Just as a for example, what is Medicare's policy for prenatal and childbirth care?

You picked an easy one (prenatal care) for which guidelines currently exist and have been very successful, and that's SCHIP, which is federally supported but administered through the states. Obviously, guidelines also exist for child care through SCHIP but not coverage of deliveries. That's easy to add, though. Many of the issues you might raise are already covered by Medicaid, which ideally would go away and be replaced by Medicare, so guidelines already exist.

[Bujin#IM]

What makes you think that clemgrad85 doesn't recognize the existence of implied powers? Implied powers do not mean that the Federal Government can do whatever it pleases.

This statement certainly makes the strict 10th amendment argument, and doesn't take into account the existence of implied powers:

In my response to my friend I told him that my problem with ANY federal government run health care plan was that it was unconstitutional. The issue should NOT be if H.R. 676 (Rep. John Conyers Health Care Bill, which is one of several being considered) is good or bad for America, but whether or not the Congress has authority under Article I, Section 8 of the Constitution. The same is true for the bailout and/or stimulus legislation passed by Congress in 2008 and 2009, with the take-over of the banking, insurance, financial and automotive industries. The answer is, of course, none of these bills are constitutional.

You'll note that I didn't argue as to whether the Feds had a role here, but was simply stating that a strict originalist stance isn't that cut and dried under the law as it's currently being interpreted by the Supreme Court. That's a simple statement of fact, with case law to support it. Not everything requires an argument.

[clemgrad85]

David....just curious, I think I'll know your answer on this but I'll ask it anyway. Are the doctors that I see interviewed that seem to be opposed to government sponsored healthcare just lying? I keep seeing interviews with doctors that seem to have the opposite views of yours. What's up with them? Why do they seem concerned? I saw an interview last night where the physician said that we simply don't have enough primary care doctrors to handle the increase in demand. No truth to that? Are all your doctor friends on board with your way of thinking or do some of them also have reservations about government sponsored health care?

Also....have you heard much about the state sponsored universal healthcare plan for children in Hawaii that they had to stop after just 7 months?

Hawaii Ending Universal Child Health Care - CBS News

Apparently even people who could afford the coverage were dropping their private coverage to put their children on the subsidized plan and the system couldn't handle it. I think this is a great example of what will happen when employers have the choice of paying 72.5% of employee coverage (full and part time) and 65% of dependent coverage vs up to 8% of their payroll to put employees on the public plan. The 8% of payroll will be less than their portion of paying for group health coverage and so more people would end up on the public option. Does that not make sense?

Anyway, seems to be so many variables with this plan that are unknown. Also, has anyone seen specifics of how the public plan would work? What are the co-pays? Co-insurance? Deductibles? I could not find anything on this in the HR 3200 bill.

[clemgrad85]

As for the constitutional issue, not even worth going over anymore. Bujin and many others have their view, and I and many others have our view. Bujin, did you ever read that link I had regarding how social security originally got past the Supreme Court back in 1937? Interesting reading. It appears there was some pressure put on the Supreme Court that if they didn't approve the constitutionality of Social Security (in Helvering vs Davis), FDR was prepared to try and add an amendment to the Constitution that would have allowed for 6 more appointees to the court (from 9 to 15). Interesting history on that: Is Social Security Constitutional? by John Attarian

[Toby]

This statement certainly makes the strict 10th amendment argument, and doesn't take into account the existence of implied powers:

Sure it does. It specifically references Article I, Section 8, which includes the Elastic Clause. Again, the Elastic Clause does not mean that Congress can do whatever it wants. It means that it has some flexibility in exercising the enumerated powers. It's not a strict 10th amendment argument.

You'll note that I didn't argue as to whether the Feds had a role here,

I don't believe I claimed you did. It's really peripheral to the point.

but was simply stating that a strict originalist stance isn't that cut and dried under the law as it's currently being interpreted by the Supreme Court.

Except that he is not taking a 'strict originalist' stance (if there is such a thing). He's not saying that it can't be constitutional, just that there is nothing in the Constitution currently which enables it.

That's a simple statement of fact, with case law to support it.

Well, IANAL, so you'll have to help me on the case law (other than those extorted by FDR's court stacking threat) that says medical services are within the scope of the enumerated powers of Congress. The Elastic Clause would then give them the authority to create a system to implement such services.

Not everything requires an argument.

We're just having a discussion, AFAIC.

[Toby]

You picked an easy one (prenatal care) for which guidelines currently exist and have been very successful, and that's SCHIP, which is federally supported but administered through the states. Obviously, guidelines also exist for child care through SCHIP but not coverage of deliveries. That's easy to add, though. Many of the issues you might raise are already covered by Medicaid, which ideally would go away and be replaced by Medicare, so guidelines already exist.

Guidelines exist within other places, but how will those services be integrated into Medicare if it's the New New New Deal? That's my point about how things can get complicated. If Medicare takes over the process, will they leave SCHIP administration with the states, or will they try to absorb those guidelines into a Federal program? I think you may also be oversimplifying adding deliveries into the mix. And really, this is only one example.

[davidra]

Guidelines exist within other places, but how will those services be integrated into Medicare if it's the New New New Deal? That's my point about how things can get complicated. If Medicare takes over the process, will they leave SCHIP administration with the states, or will they try to absorb those guidelines into a Federal program? I think you may also be oversimplifying adding deliveries into the mix. And really, this is only one example.

I have no idea. Given the state/federal partnership on Medicaid and SCHIP, I would imagine that might be reasonable and allow state input on what happens in their states, but I have idea if that would just increase the cost over a pure Medicare type option.

[clemgrad85]

Once we get government health insurance, should we really stop there? I mean....what about Long Term Care? I've heard a rumor it is already being looked at, but is it fair that some can afford this coverage and others can't? Or what if you can afford it, but because of health problems you can't get it now....is that fair? Someone can go through all their assets just having to stay in a facility....is that fair?

And what about life insurance? If you are making $75k or $100k, shouldn't you be able to protect your family in the event of your death? What if you are a diabetic....or have had cancer....is it fair that you can't buy life insurance to protect your family....to stop them from going bankrupt? Wouldn't it save the system in the long run if we make sure that every family is properly protected? Should a family be kicked out of their home, or possibly not be able to send their children to college, in the event the main income earner in the family suffers an untimely death? Is this fair?

Seems like there is much more the government can do to protect us. Of course, this should only be paid for by folks making more than $250,000....but still....just seems like we should keep this government insurance moving forward!

[davidra]

David....just curious, I think I'll know your answer on this but I'll ask it anyway. Are the doctors that I see interviewed that seem to be opposed to government sponsored healthcare just lying? I keep seeing interviews with doctors that seem to have the opposite views of yours. What's up with them? Why do they seem concerned? I saw an interview last night where the physician said that we simply don't have enough primary care doctrors to handle the increase in demand. No truth to that? Are all your doctor friends on board with your way of thinking or do some of them also have reservations about government sponsored health care?

Also....have you heard much about the state sponsored universal healthcare plan for children in Hawaii that they had to stop after just 7 months?

Hawaii Ending Universal Child Health Care - CBS News

Apparently even people who could afford the coverage were dropping their private coverage to put their children on the subsidized plan and the system couldn't handle it. I think this is a great example of what will happen when employers have the choice of paying 72.5% of employee coverage (full and part time) and 65% of dependent coverage vs up to 8% of their payroll to put employees on the public plan. The 8% of payroll will be less than their portion of paying for group health coverage and so more people would end up on the public option. Does that not make sense?

Anyway, seems to be so many variables with this plan that are unknown. Also, has anyone seen specifics of how the public plan would work? What are the co-pays? Co-insurance? Deductibles? I could not find anything on this in the HR 3200 bill.

If you think doctors are any different than the general population in terms of their diversity of opinion about health care reform, you are mistaken. I would love to see, however, a breakdown of who actually supports a public option broken down by specialty. Health care reform THIS YEAR is supported by the AMA, the ACP (internists), AAP (pediatricians) and AAFP (family practitioners). Would it receive the same degree of support from highly specialized (and highly paid) surgical subspecialists who are making ten times what primary care docs are? Hey, maybe not.

The primary care issue is important. It's been stated that it will take seven years to train enough primary care docs for health care expansion. All we need to do is look to the early '90s to see what happened then. HMO's were in strict control of costs, and most insured had to go through "gatekeepers" who were primary care docs. There was a national pendulum swing toward primary care that was reflected in changes in training programs. Our institution actually set up a 6 month training program to train anesthesiologists and surgeons and others in primary care; the participants got a certificate that would enable them to serve as a gatekeeper. Specialty incomes dropped signficantly. At places like USCF (San Francisco) I remember that anesthesiologists who were finishing their training could not find jobs because they were being replaced by nurse anesthetists who worked under the direction of an anesthesiologist, so few people were hiring anesthesiologists. Market forces, right? Something you certainly believe in. Something like that has to happen. Costs were controlled during that time with no obvious impact on quality, but it made patients and doctors mad because they lost some independence, in some cases the independence to waste money and provide excessive unproven care.

A lack of primary care providers is no excuse for not moving ahead with reform. When highly trained specialties are getting reimbursed even only twice as much as primary care docs, there will be lots of people interested in primary care, as the training period is less time.

The children's program you mention just points out that unless insurance companies are willing to decrease their costs, a public option will pull patients away from them. No kidding. That's the reason for the public option. But I bet the employers, and their shareholders, don't mind a bit having to pay less for health care coverage. Improves the bottom line, don't you think?

[davidra]

Once we get government health insurance, should we really stop there? I mean....what about Long Term Care? I've heard a rumor it is already being looked at, but is it fair that some can afford this coverage and others can't? Or what if you can afford it, but because of health problems you can't get it now....is that fair? Someone can go through all their assets just having to stay in a facility....is that fair?

And what about life insurance? If you are making $75k or $100k, shouldn't you be able to protect your family in the event of your death? What if you are a diabetic....or have had cancer....is it fair that you can't buy life insurance to protect your family....to stop them from going bankrupt? Wouldn't it save the system in the long run if we make sure that every family is properly protected? Should a family be kicked out of their home, or possibly not be able to send their children to college, in the event the main income earner in the family suffers an untimely death? Is this fair?

Seems like there is much more the government can do to protect us. Of course, this should only be paid for by folks making more than $250,000....but still....just seems like we should keep this government insurance moving forward!

Long term care insurance in the current system is a bad deal financially, from everything I have heard and read. I don't have it.

I do understand your trying to compare insuring someone's access to health care to protection against bankruptcy with life insurance (sardonically). Sorry. To me they are very different. And it's very possible there will be fewer deaths from diabetes or cancer if the 47 million people without health insurance actually had access to health care. By the way, I don't think the government should insure cars, either.

[clemgrad85]

If you think doctors are any different than the general population in terms of their diversity of opinion about health care reform, you are mistaken. I would love to see, however, a breakdown of who actually supports a public option broken down by specialty. Health care reform THIS YEAR is supported by the AMA, the ACP (internists), AAP (pediatricians) and AAFP (family practitioners). Would it receive the same degree of support from highly specialized (and highly paid) surgical subspecialists who are making ten times what primary care docs are? Hey, maybe not.

It seems that members of the AMA are quite divided over this endorsement: Milwaukee Live: American Medical Association in Disarray after Supporting Health Care Bill

The primary care issue is important. It's been stated that it will take seven years to train enough primary care docs for health care expansion. All we need to do is look to the early '90s to see what happened then. HMO's were in strict control of costs, and most insured had to go through "gatekeepers" who were primary care docs. There was a national pendulum swing toward primary care that was reflected in changes in training programs. Our institution actually set up a 6 month training program to train anesthesiologists and surgeons and others in primary care; the participants got a certificate that would enable them to serve as a gatekeeper. Specialty incomes dropped signficantly. At places like USCF (San Francisco) I remember that anesthesiologists who were finishing their training could not find jobs because they were being replaced by nurse anesthetists who worked under the direction of an anesthesiologist, so few people were hiring anesthesiologists. Market forces, right? Something you certainly believe in. Something like that has to happen. Costs were controlled during that time with no obvious impact on quality, but it made patients and doctors mad because they lost some independence, in some cases the independence to waste money and provide excessive unproven care.

We had one of the head guys at Med Univ of SC (MUSC) speak to us at Rotary a few months ago and he was clearly against the government plan. Your 7 year period to get doctors through the system to be ready to practice as a primary care doctor is dead on with what he said. He said that with the amount of debt the avg physician has at the end of that period (he used $240k?), going primary care is tough (vs a specialty) and so he doesn't believe the % going into primary care will change that much. Just his opinion, but, another doctor weighing in there.

Just curious....did your institution make any money on the training of those physicians to get credentials?

A lack of primary care providers is no excuse for not moving ahead with reform. When highly trained specialties are getting reimbursed even only twice as much as primary care docs, there will be lots of people interested in primary care, as the training period is less time.

As a patient, I would disagree with you because I would not want to feel like my wait times would be jeopardized because of a shortage of primary care doctors. Again, this would be from a patients concern. From a doctor's view, I would see where this would be irrelevant as you are now seeing more patients and likely making more money?

The children's program you mention just points out that unless insurance companies are willing to decrease their costs, a public option will pull patients away from them. No kidding. That's the reason for the public option. But I bet the employers, and their shareholders, don't mind a bit having to pay less for health care coverage. Improves the bottom line, don't you think?

LOL....I know money is not a concern to you when it comes to the government (aka, taxpayers)....but....the reason the program was closed is because they weren't allocating enough to the program per child to allow it to work! Don't you get that? Think about that. At least Hawaii didn't continue to go further into debt, they made the proper decision as they simply couldn't afford to keep subsidizing the amount per child! I guess there is no getting through to you on this, LOL. Perhaps what it did prove was that the private insurance companies knew what had to be charged to make it work! And why wouldn't the average Joe decide to go with the lower cost program? That's part of the issue here that keeps escaping people when they say "but it is only for those that want it". Well, if someone is paying $300 for their coverage to a private insurance company, and the public plan is $150 (even though that contribution isn't enough, but doesn't matter to the government, right?)....why not change? The next thing you know, more going on the public plan, costs have to be increased or benefits decreased as the system/doctors can't handle the additional load.

[davidra]

LOL....I know money is not a concern to you when it comes to the government (aka, taxpayers)....but....the reason the program was closed is because they weren't allocating enough to the program per child to allow it to work! Don't you get that? Think about that. At least Hawaii didn't continue to go further into debt, they made the proper decision as they simply couldn't afford to keep subsidizing the amount per child! I guess there is no getting through to you on this, LOL. Perhaps what it did prove was that the private insurance companies knew what had to be charged to make it work! And why wouldn't the average Joe decide to go with the lower cost program? That's part of the issue here that keeps escaping people when they say "but it is only for those that want it". Well, if someone is paying $300 for their coverage to a private insurance company, and the public plan is $150 (even though that contribution isn't enough, but doesn't matter to the government, right?)....why not change? The next thing you know, more going on the public plan, costs have to be increased or benefits decreased as the system/doctors can't handle the additional load.

Sorry. If you are saying that "insurance companies know how much money needs to be charged to make it work", you're missing the entire point of reform. We cannot pay for what insurance companies think it should cost. We need to pay for what will work, we need to pay as little overhead as possible, and we need to arrange for more direct payment to providers instead of through middlemen. And that includes the government. Take 20-25% of every insurance company bill and leave it with the enrollee...or with the company providing insurance. Think that's inconsequential? Yes, you are right. Costs have to be decreased either way....why do you feel somehow that private insurers will be willing to do that? Are you kidding? They will get additional support, no doubt, because their profit need and excessive overhead will have to be paid for, but they will not be able to compete until they decrease their own costs. What's funny is that you really seem to think that there is some difference between the amount of control exerted over medical care by private insurers as compared to the government plans, and you're totally wrong. If anything, there is more flexibility with government plans, including the VA, than there is with an HMO.

So if you believe so strongly in decreasing costs, how do you intend to do that? Decrease doctor's reimbursements but maintain 25% overhead and ridiculous CEO salaries for private insurers? Does that really make sense?

[clemgrad85]

Just saw video of Maxine Waters (HR-D, CA) and at her town hall meeting and she was screaming, "we will get this by taxing the wealthiest people in America". Of course, her audience was applauding like crazy. This is what bothers me.....why shouldn't the people who actually get the benefit not have to pay something? I mean come on. To penalize success just doesn't make sense...well...I guess it does if you aren't successful....but it sure doesn't make being successfull look all that wonderful when with all the taxes (fed, fica, futa, state, and now what, health care tax?) you end up paying 55% to 60% in taxes. Crazy! One word: redistribution. I almost pulled a Biden and said, "one word....redistrubution of wealth".

[clemgrad85]

Sorry. If you are saying that "insurance companies know how much money needs to be charged to make it work", you're missing the entire point of reform. We cannot pay for what insurance companies think it should cost. We need to pay for what will work, we need to pay as little overhead as possible, and we need to arrange for more direct payment to providers instead of through middlemen. And that includes the government. Take 20-25% of every insurance company bill and leave it with the enrollee...or with the company providing insurance. Think that's inconsequential? Yes, you are right. Costs have to be decreased either way....why do you feel somehow that private insurers will be willing to do that? Are you kidding? They will get additional support, no doubt, because their profit need and excessive overhead will have to be paid for, but they will not be able to compete until they decrease their own costs. What's funny is that you really seem to think that there is some difference between the amount of control exerted over medical care by private insurers as compared to the government plans, and you're totally wrong. If anything, there is more flexibility with government plans, including the VA, than there is with an HMO.

So if you believe so strongly in decreasing costs, how do you intend to do that? Decrease doctor's reimbursements but maintain 25% overhead and ridiculous CEO salaries for private insurers? Does that really make sense?

I just can't keep saying it over and over again. Arggghhhh. But some things thrown out for helping to reduce costs are things like opening insurance up across states (which increases competition), tort reform (which I know you say won't work, but I've heard other doctors say it would help), becoming more efficient (this might can be addressed better by Micael who works at the corporate level), just to mention a few. In addition, I have said that I have no problem with a state run program for those that cannot get coverage (pre-ex issues) and paid by a combination of participant premiums and state tax (gas tax? sales tax? something along those lines). This gets coverage for those people so we don't have hospitals paying for those without insurance and, according to many, this would get costs down.

I don't care for the state option, but not sure it can work any other way....but...at least this doesn't throw out the whole system to help 15% of those needing help.

So no comment on the uproar with doctors against the AMA endoresement?

[davidra]

I just can't keep saying it over and over again. Arggghhhh. But some things thrown out for helping to reduce costs are things like opening insurance up across states (which increases competition), tort reform (which I know you say won't work, but I've heard other doctors say it would help), becoming more efficient (this might can be addressed better by Micael who works at the corporate level), just to mention a few. In addition, I have said that I have no problem with a state run program for those that cannot get coverage (pre-ex issues) and paid by a combination of participant premiums and state tax (gas tax? sales tax? something along those lines). This gets coverage for those people so we don't have hospitals paying for those without insurance and, according to many, this would get costs down.

I don't care for the state option, but not sure it can work any other way....but...at least this doesn't throw out the whole system to help 15% of those needing help.

So no comment on the uproar with doctors against the AMA endoresement?

First, the AMA. That article just points out that doctors are not immune to absurd hyperbole. The opponents haven't come up with "death panels" yet, because they have a lick of sense, but the other fearmongering in those comments is just as absurd, IMHO.

I'm not arguing at all with your laundry list of cost controls. In fact, it will take everything you've mentioned and more....but without significant competition and/or the total dismantling of for-profit big insurance, it will not be enough. I do NOT want to throw out the whole system if there is any reasonable way to provide timely reasonably-priced (and yes, regardless of how you interpret what Waters says, I do think everyone should pay something toward their health care and I bet she does too) health care to all. It doesn't have to mean that everyone gets the same level of care, but it should mean that the kid I saw in a clinic last night who needs ongoing asthma care and who's family had no insurance won't develop a bill of $3-4000 just for initial testing and to be seen in a peds clinic. Or my friend's mother who just had a shunt for hemodialysis; she and her husband have run restaurants for many years, worked hard all their lives, and have insurance, but it only covers inpatient expenses; that was all they could afford for themselves. So her shunt procedure is listed as an outpatient procedure, and costs $8000. Where are they supposed to come up with that money? Luckily she will be able to get Medicare (she's only 55) when she starts hemodialysis because otherwise she couldn't afford it. I'm sorry, but until you've actually dealt with people like this, who are hard working people who didn't contribute to their own diseases, and may lose everything they've worked all their lives for, then I think you should have no right to determine whether they get treated or not...and you think you do. Sorry if that appears egocentric, as I've said before, but I'm also not apologetic. Take a trip south and I'll gladly introduce you to them and let you make up your own mind.

[Micael]

I just can't keep saying it over and over again. Arggghhhh.

Our ideas do not matter, Clem. They could care less. It isn't about cost saving ideas or improvements in healthcare. For them, this is only about getting socialized medicine for all Americans. Single payer is the goal, not fixing anything.

[KAM1138]

Hello Everyone,

It seems to me that almost everyone agrees that medical costs are too high. First--where does that money go? I'd say three places--to pay medical care workers; to cover overhead (and waste and fraud) in these massive systems (government or insurance) and for actual material costs.

Let me deal with the last one first--material costs. It seems to me that in many, many other areas of the economy, a market approach works quite well. We might not be happy with it, when our gasoline costs go up, or food is most costly because someone wanted to toy around with Ethanol fuels, but it basically works. So, even though I don't know a lot about medical equipment, medication, supplies--they are material goods, and if left to a free market with competition, those costs will be realistic (if not what we might wish). However, I'm not sure there is a free market in regards to this. I'm not a medical expert, but I know of a child who recently got a vaccination (standard stuff) and they cost $100-125 each as I recall. Now, for vaccinations which are likely numbering in the millions each year (just a guess), that seems like a really high price. So, I'd love to be informed if that is reasonable or not.

Second--overhead costs. Why not eliminate both government and insurance from the bulk of medical interactions--those for common medical issues (non-catastrophic). Why not eliminate ALL of that middle man cost and simply let the patient and doctor work within the free market (lots of patients and lots of doctors) to pay for services directly. If I've got a cold or fever or a minor injury, why should an insurance company be involved? Why can't I simply pay for the service I need?

That brings us to the last point. In a family members recent office visits we paid $150--that's for about 10 minutes of time with the doctor. Now, like in any business, that Doctor has overhead too, but it would be instructive to know if that $150 is really reasonable or not. What goes into a doctor's costs in overhead that requires a price of $150 for 10 minutes? Remember that vaccination--there were additional costs for the nurse to administer these vaccinations which if memory serves was $40 for the first and $10 for the next two--that's $60 to administer 3 shots--less than 5 minutes of actual time (not sure about any prep time).

So, again--I don't know what drives these costs, but I suspect that only a small portion of that is going to pay the salary of the nurse, or even the doctor. So, what is causing the overhead here?

Anyway--to review--I'm asking about the overhead with providers--because I'm not sure what contributes to that, but insurance overhead for a big chunk can be eliminated totally, simply by taking insurance and government out of the picture completely and returning common health care to the free market.

Major medical is a somewhat different story. I keep hearing about massive prices that no average person can afford--and that's true, but again--why do these things cost so much? Do tests actually cost hundreds of dollars or is there a lot of hidden overhead that we know nothing about. I'm not declaring--I'm asking.

A less specific example--recently a friend who was pregnant was sent to the hospital (total time there 26 hours) which cost just about $5000. The care involved some blood tests, and administration of two different medications (relatively common to my knowledge--meaning not some super recent advanced medication) via injection. There were also two monitoring devices attached (one to the mother one for the baby (external) for most of that time (again common to my knowledge--BP, heart rate, etc) $5000--does that seem like a reasonable cost for what was provided? As it turns out there was no problem at all--a false alarm (the Doctor's call, not the patients). So, it seems likely that there is a lot of overhead involved here, because $5000 for essentially one day without any particularly advanced care (no surgery, or anything like that) seems to be quite high. What drives costs such that a relatively minor hospital visit costs $5000?

I forgot to mention. The pregnant woman was also told she had to wear these stockings--which I understand are to help circulation issues. She didn't want them, and wasn't there for days (she was there a few hours at that time) and was charged $126. I went to a medical supply store (different issue) some weeks later, and decided to look for those--they cost $40 (retail). So, back to those material costs from above--clearly, someone is charging extra here--and I am not aware of any reason that would be justified.

Sorry--another point. Costs. The buying power of the individual can be instantly increased by making every dollar spent for medical costs tax deductible. Currently, you have to meet some threshold (I recall 7% of yearly income, but don't quote me on that).

KAM

[davidra]

Our ideas do not matter, Clem. They could care less. It isn't about cost saving ideas or improvements in healthcare. For them, this is only about getting socialized medicine for all Americans. Single payer is the goal, not fixing anything.

And precisely what is it you know about improvements in health care as someone who works in an insurance agency? You are the implementation of your sigline.