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Surprise! Health care bill won't reduce health costs

Health Care 2009

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#1 Palisades

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Posted 17 July 2009 - 09:26 AM

http://www.cnn.com/2...ysis/index.html

Quote

Douglas Elmendorf, chief of the Congressional Budget Office, said this of the leading Democratic health care proposals in the House and Senate: "In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount and, on the contrary, the legislation significantly expands the federal responsibility for health care costs."

Translation: The bills, as they stand, do not meet the president's promise to reduce the long-term drain of health care spending on the federal budget.

Health reform bills won't reduce costs
Congressional Budget Office director tells Senate panel that 2 health reform bills would increase government spending and not do enough to contain costs.
http://money.cnn.com...sion=2009071614

Quote

NEW YORK (CNNMoney.com) -- The health reform bills released so far would increase government spending on health care without sufficiently reining in health care costs.

And at least initially they aren't likely to significantly lower premiums for the majority of Americans with employer-sponsored health insurance.

That's the sobering takeaway from testimony Thursday by Congressional Budget Office Director Douglas Elmendorf.

Elmendorf's preliminary conclusions were based on a bill jointly released by three committees in the House this week and another bill passed by the Senate health committee on Wednesday.

"The creation of a new subsidy for health insurance ... would by itself raise federal spending on health care. ... [T]o offset that there have to be substantial reductions (on the tax or spending sides of the ledger]," Elmendorf told the Senate Budget Committee. "The changes we've looked at so far don't represent the fundamental change on the order of magnitude that would be necessary."

Edited by Palisade, 17 July 2009 - 09:31 AM.

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#2 Mark

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Posted 17 July 2009 - 09:47 AM

View PostPalisade, on Jul 17 2009, 08:26 AM, said:

http://www.cnn.com/2...ysis/index.html

Quote

Douglas Elmendorf, chief of the Congressional Budget Office, said this of the leading Democratic health care proposals in the House and Senate: "In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount and, on the contrary, the legislation significantly expands the federal responsibility for health care costs."

Translation: The bills, as they stand, do not meet the president's promise to reduce the long-term drain of health care spending on the federal budget.

Health reform bills won't reduce costs
Congressional Budget Office director tells Senate panel that 2 health reform bills would increase government spending and not do enough to contain costs.
http://money.cnn.com...sion=2009071614

Quote

NEW YORK (CNNMoney.com) -- The health reform bills released so far would increase government spending on health care without sufficiently reining in health care costs.

And at least initially they aren't likely to significantly lower premiums for the majority of Americans with employer-sponsored health insurance.

That's the sobering takeaway from testimony Thursday by Congressional Budget Office Director Douglas Elmendorf.

Elmendorf's preliminary conclusions were based on a bill jointly released by three committees in the House this week and another bill passed by the Senate health committee on Wednesday.

"The creation of a new subsidy for health insurance ... would by itself raise federal spending on health care. ... [T]o offset that there have to be substantial reductions (on the tax or spending sides of the ledger]," Elmendorf told the Senate Budget Committee. "The changes we've looked at so far don't represent the fundamental change on the order of magnitude that would be necessary."

Mark: Well of course it won't really lower any prices until they get to root of the matter that is costing private citizens, and will end-up costing our government too much money...The pharmaceutical and insurance companies.
As long as those two entities have control of the root pricing of good health care, it's gonna cost anybody too much who's trying to achieve good health care. I don't understand how any any plan by our government can determine it's going to save us all from paying a lot of money without making those two controllers of the game back off their pricing. It's like, "OH, here Joe, let me pay for that part to save you some money."  Then Joe ends up paying more in taxes every year anyway because it's the pay me now or pay me later scenario. I hate our government.
I don't approve of any Robin Hood plan either. If this package is taxing the majority of the people so the minority of people can have health care...that's just socialism. America wasn't supposed to be based on a socialism-type government for anything but the most minor of things. A huge health care bill isn't gonna be minor.
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#3 Omega

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Posted 17 July 2009 - 10:32 AM

I've referenced this before in other discussions, but I'd like to direct you to my blog post about this subject.  As a summary:

According to the McKinsey & Company report, if medical expenditures in the US are quantified by dollars per person per dollar GDP, the US spends $1645 more per person than other comparable countries.  These cost overruns are broken down into various categories, the four largest of which are: doctors profiting from recommending more procedures, higher prescription drug costs, malpractice insurance and defensive medicine costs, and higher administrative costs.  Fixing these four categories would bring US health care costs much closer to being in line with the rest of the world.  The first three could easily be eliminated without spending any money at all.

Doctors should never, ever be placed in a situation where they could conceivably profit from giving care that is less than what is best for their patient.  Pay-by-procedure does exactly that.  This is an inherent conflict of interest, and should be forbidden by ethical guidelines.  If the AMA won't do it, the government should.

Higher prescription drug costs only exist because by definition, there is no free market for a patented good.  A patent is a government-granted temporary monopoly.  This monopoly could easily be revoked, limited, or altered to lower drug prices.  Making it easier to import prescription drugs from other countries would also help bring market forces to bear on lowering prices here.

Tort reform, making it more difficult to sue doctors without good evidence of actual malpractice and limiting damages to reasonable levels, would lower malpractice insurance premiums and reduce the tendency of doctors to practice defensive medicine.

Making these changes would eliminate over half of the US medical care industry's cost overruns.  Almost all of the rest would be accounted for by reducing administrative overhead.  That one's not as simple to solve at a government level, unfortunately, at least not without knowing more than I do about why things cost so much.  Obviously single-payer has the potential to reduce administrative overhead, but I have little faith that potential would ever be realized in a US government bureaucracy.  A public option in the private sector would actually make this worse, since it would add even more administrators to an overstressed system.  The best idea I have so far is for the government to mandate standard forms and electronic records, but that's distasteful to me.  Does anyone have better ideas?

I want to make this clear: the point of this health care bill is not to save money.  The administration may say that's the case, but they're not stupid, they have this same report.  Their goal is not to save money, it's to insure the uninsured.  (That won't save money either, BTW.  According to the report, indigent care is actually cheaper than insuring all the uninsured at present rates would be.)  Making sure everyone has higher quality medical care is a noble goal, though its practicality may be debated.  But paying for it now, in this way, is not the most effective way to go about it.  If insuring the uninsured is your goal, the best first step would be to lower costs and premiums for everyone with the simple steps I've outlined above.  That will put the entire economy in much better shape, reduce the number of uninsured, and lower the cost of insuring those uninsured who are left.

Edited by Omega, 17 July 2009 - 10:34 AM.


#4 Rhea

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Posted 17 July 2009 - 11:15 AM

Thanks, Omega. You're right. The first three would substantially reduce medical costs, except for one thing: malpractice insurance. It's not just the insurance companies, it's the ease with which people scream "malpractice" and sue these days. That's what has driven up the costs - the insurance companies have taken advantage and raised the rates far too high. I think some sort of review board should be set up so that any malpractice case is reviewed before it goes to court (something like binding arbitration). If patients had to sign something like that and knew they had a panel set of people familiar with medical pratices, then the incidence of nuisance suits would drop.

Edited by Rhea, 17 July 2009 - 11:16 AM.

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#5 Omega

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Posted 17 July 2009 - 12:41 PM

You're correct that high numbers of malpractice suits are what drives up premiums.  That's why I said that "tort reform, making it more difficult to sue doctors without good evidence of actual malpractice and limiting damages to reasonable levels, would lower malpractice insurance premiums". :)

Your arbitration review board sounds like a very reasonable approach.  There might be some issues with binding arbitration clauses, but I imagine congress could handle that.  At least, I don't see why any law to the effect that binding arbitration clauses are legal in some circumstances would be unconstitutional.

#6 Mark

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Posted 17 July 2009 - 05:38 PM

Mark: I just found this article.  

Obama to Congress: Don't lose heart.

By DAVID ESPO, AP Special Correspondent David Espo, Ap Special Correspondent   – 17 mins ago

WASHINGTON – President Barack Obama, worried about growing resistance to his health care plan, exhorted Congress not to "lose heart" Friday and urged deeper cost cuts to calm concern over the huge expense of covering millions of uninsured Americans.

"What we want to do is force the Congress to make sure that they are acting" on recommendations to hold down Medicare and Medicaid spending, the president said, rather than allowing reports to sit unused on a shelf.

Aiming to rally lawmakers, he spoke from the White House near the end of a week of tumult for the legislation atop his domestic agenda.

"Now, I realize that the last few miles of any race are the hardest to run, but I have to say now is not the time to slow down, and now is certainly not the time to lose heart," he declared.

A few hours earlier, two House committees approved their portions of the sweeping health care bill over Republican objections.

That left one more panel to act, but conservative Democrats were rebelling, demanding additional measures to hold down skyrocketing costs.

Given the complexities, as well as fresh calls for delay in the Senate, House Speaker Nancy Pelosi, D-Calif., opened the door to pushing off a vote past the early August timeline she and Obama laid out weeks ago.

Whatever the difficulties, she predicted legislation would pass that will transform the nation's health care system, extending coverage to millions who lack it while slowing the growth in costs generally. "It is really historic. It's transformation. It's momentous," she told reporters at a news conference.


Mark:
Woah boy, are we in trouble. Even Pelosi said it would just "SLOW the costs generally" In other words, it's still gonna cost Americans in the long run, because we'll be paying taxes for all of it.

I also noticed that they've already started trying to talk about cutting it by cutting costs in Medicare and Medicaid, our two already established means of help! Since I'm currently on Medicaid, I CANNOT find anything good about their words.

Edited by Mark, 17 July 2009 - 05:39 PM.

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#7 Bad Wolf

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Posted 17 July 2009 - 05:45 PM

View PostOmega, on Jul 17 2009, 10:41 AM, said:

You're correct that high numbers of malpractice suits are what drives up premiums.  That's why I said that "tort reform, making it more difficult to sue doctors without good evidence of actual malpractice and limiting damages to reasonable levels, would lower malpractice insurance premiums". :)

Your arbitration review board sounds like a very reasonable approach.  There might be some issues with binding arbitration clauses, but I imagine congress could handle that.  At least, I don't see why any law to the effect that binding arbitration clauses are legal in some circumstances would be unconstitutional.


There's a lot of restrictions in medical malpractice cases (such as damage caps) that you don't find in the average tort case.  And while I don't think malpractice suits are the ONLY thing driving up premiums (i.e., greed for profit is a large contributing factor) I'm all for tort reform.  And not just vis a vis medical malpractice.
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#8 Nick

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Posted 17 July 2009 - 05:48 PM

Omega, overall I'm pretty much in agreement with what you've said, though I have a few questions and counterpoints.

View PostOmega, on Jul 17 2009, 11:32 AM, said:

Doctors should never, ever be placed in a situation where they could conceivably profit from giving care that is less than what is best for their patient.  Pay-by-procedure does exactly that.  This is an inherent conflict of interest, and should be forbidden by ethical guidelines.  If the AMA won't do it, the government should.

Agreed.  Although, it's difficult to completely decouple a procedure from its variable costs.  Doctor compensation should most certainly not be based on procedures, however I don't know how to make that the case for hospitals or the actual doctor's office.  Patients don't pay subscription fees (aside from insurance), so how does the hospital/office get reimbursed for all the things that get "used up" by performing a procedure (supplies, pharmeceuticals, consumable equipment, etc)?

I want this implemented, but I don't want it implemented in such a way that actively DISincentivises performing necessary medical procedures.

Quote

Higher prescription drug costs only exist because by definition, there is no free market for a patented good.  A patent is a government-granted temporary monopoly.  This monopoly could easily be revoked, limited, or altered to lower drug prices.  Making it easier to import prescription drugs from other countries would also help bring market forces to bear on lowering prices here.

Big Pharma's out of control, you'll get no argument from me on that front.  I'm curious how you'd go about it, though.  Their argument is the huge amount of money invested in pharmaceutical research (*cough*andmarketing*cough*) justifies an exclusivity period to recoup some of that investment or the generics will get a free ride.  I know you're not talking about wiping out patents alltogether, but how would you want to reshape the industry?

Quote

Tort reform, making it more difficult to sue doctors without good evidence of actual malpractice and limiting damages to reasonable levels, would lower malpractice insurance premiums and reduce the tendency of doctors to practice defensive medicine.

I agree with you, but any sort of tort reform makes me nervous.  True malpractice does happen, and a victim may suffer for the rest of their life as a result, be unable to work again, or not survive at all.  I'm wary of just putting up barriers to starting a lawsuit.  Determining if the doctor was malpracticing is what the trial is for, and the jury should have at least some say in how much a victim can get awarded on a case by case basis--I want as little set in stone as possible.

Quote

Making these changes would eliminate over half of the US medical care industry's cost overruns.

Not to cast doubt (I believe you), I'm just wondering where you're getting "over half" from.

Quote

Almost all of the rest would be accounted for by reducing administrative overhead.  That one's not as simple to solve at a government level, unfortunately, at least not without knowing more than I do about why things cost so much.  Obviously single-payer has the potential to reduce administrative overhead, but I have little faith that potential would ever be realized in a US government bureaucracy.

One huge advantage is a standardized claims process.  One form.  One system, rather than dozens of byzantine rules and procedures set by the various insurance companies with a strong incentive to pay out as little in claims as possible.  I would posit that insurance companies *deliberately* make the claims process difficult for healthcare providers to create "gotchas" to get out of paying.

Quote

A public option in the private sector would actually make this worse, since it would add even more administrators to an overstressed system.

I'm with you there.  A private-run "public option" defeats the entire point, imo.

Quote

I want to make this clear: the point of this health care bill is not to save money.  The administration may say that's the case, but they're not stupid, they have this same report.  Their goal is not to save money, it's to insure the uninsured.  (That won't save money either, BTW.  According to the report, indigent care is actually cheaper than insuring all the uninsured at present rates would be.)

I don't think it's valid to compare indigent care to insuring the uninsured.  Not all uninsured are indigents.  I think great cost savings can be realized by expanding the pool of participants, and providing affordable access to "routine maintenance" that can prevent and/or more quickly detect future more expensive problems.

We already bear the costs of a great deal of uninsured urgent care in the prices WE and our insurance companies pay for our care to cover those who can't.

#9 Mark

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Posted 17 July 2009 - 06:00 PM

Mark: It's NOT the research and development at pharmaceutical companies. It's mostly greed of the companies executives, and share-holders. See my post on the subject. It's really terrible how we're getting fleeced.
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#10 Palisades

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Posted 17 July 2009 - 06:17 PM

Mark, maybe it's just me being cynical, but I suspect that their plan to 'cut' Medicare and Medicaid is just a sham to claim they've paid for a proposal when really they haven't. That is, Medicare and Medicaid will get the money, the cost-saving measures will make people feel good but accomplish nothing substantive, and health care costs will continue to spiral out of control, feeding into the ridiculously high, completely unsustainable deficit that's only going to get worse as the Baby Boomers start drawing their Social Security and Medicare benefits.

Alternatively, if they do cut Medicare and Medicaid, what happens? Currently, my understanding is that Medicare pays fairly well for hospital procedures, but pays out-of-hospital specialists an insultingly low amount that in many cases isn't even enough to pay their expenses. When you combine that with Medicare's red tape, there's a growing number of doctors who won't take Medicare -- although I don't know how large of a percentage these doctors currently represent.

Also, it's my understanding that doctors and hospitals aren't permitted to bill Medicare more than the least amount they bill any of the insurance companies they've contracted with. I'm not sure how Medicare determines the cost it will pay for prescription drugs.
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#11 Mark

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Posted 17 July 2009 - 06:37 PM

View PostPalisade, on Jul 17 2009, 05:17 PM, said:

Mark, maybe it's just me being cynical, but I suspect that their plan to 'cut' Medicare and Medicaid is just a sham to claim they've paid for a proposal when really they haven't. That is, Medicare and Medicaid will get the money, the cost-saving measures will make people feel good but accomplish nothing substantive, and health care costs will continue to spiral out of control, feeding into the ridiculously high, completely unsustainable deficit that's only going to get worse as the Baby Boomers start drawing their Social Security and Medicare benefits.

Alternatively, if they do cut Medicare and Medicaid, what happens? Currently, my understanding is that Medicare pays fairly well for hospital procedures, but pays out-of-hospital specialists an insultingly low amount that in many cases isn't even enough to pay their expenses. When you combine that with Medicare's red tape, there's a growing number of doctors who won't take Medicare -- although I don't know how large of a percentage these doctors currently represent.

Also, it's my understanding that doctors and hospitals aren't permitted to bill Medicare more than the least amount they bill any of the insurance companies they've contracted with. I'm not sure how Medicare determines the cost it will pay for prescription drugs.

Mark: That's the biggest problem with Medicaid...the red tape. Medicare should be overhauled so everybody (including the doctors and patients) knew what it paid before all those papers had to be sent in. I've known doctors that didn't just stop taking Medicare patients, but decided to retire from the medical field all together.

My last doctor did that, and only saw a few of his neediest patients just one or two days a week, instead of working there from 8-5 p.m. everyday, and paying a whole office staff. It was just he and his wife running his medical practice.
Mind you, that was in a small county seat, and that part of the woods really didn't need to lose a good doctor that had been practicing there since the 60's. Small town folk depended on the home-town doc.

However, people getting bills from med procedures months or even years after they occurred because Medicaid decided it wasn't going to pay the doctor what he thought is ridiculous. Too many forms for office personnel to fill-out, too many IF'S regarding the patient's final bill. It's a disaster that needs overhauling...but I don't think that's what Obama has in mind. I think he'll either wipe-out Medicare and Medicaid completely, or in a agreement to keep down the cost of the bill Medicare/Medicaid patients won't get their usually cost of living updates. In fact, Medicaid had already put a hold on the usual cost of living pay increases they give their recipients. I remember reading that letter very carefully.

Obama's socialist ideas are gonna hurt us all in the end. We weren't founded on it, we're not set up for it, and we are still supposed to be a country based on capitalism the last time I checked. Look what socialism did to the Soviet Union...and nearly a million of their scientists still live in "CLOSED" cities. It's time to hit the streets with picket signs, I'm afraid. The 1960's all over again.
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#12 Rhea

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Posted 17 July 2009 - 10:44 PM

^On the other hand, look what capitalism has done to the practice of medicine. I remember doctors that were ceasing to practice as early as the late '60's and early 70's because their malpractice insurance was so high. I can't imagine how doctors stay in practice given the cost of malpractice insurance today.

Obama has not endorsed socialism in any way, shape or form - just universal health care, which ironically enough was one of Eleanor Roosevelt's dearest causes. We've come a long way, baby - NOT.

Edited by Rhea, 17 July 2009 - 10:45 PM.

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Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.  - RAH

#13 Mark

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Posted 17 July 2009 - 10:58 PM

View PostRhea, on Jul 17 2009, 09:44 PM, said:

^On the other hand, look what capitalism has done to the practice of medicine. I remember doctors that were ceasing to practice as early as the late '60's and early 70's because their malpractice insurance was so high. I can't imagine how doctors stay in practice given the cost of malpractice insurance today.

Obama has not endorsed socialism in any way, shape or form - just universal health care, which ironically enough was one of Eleanor Roosevelt's dearest causes. We've come a long way, baby - NOT.

Mark:
I don't think it was so much capitalism that made our malpractice insurance go so high, it was more of lack of responsibility of our executive, and judicial system for not taking steps to keep malpractice and it's lawsuits from happening.
Now capitalism is directly responsible for our high cost of medicine, and medical supplies. However, our country's government has dealt  successfully with companies who have practiced unfairly in the past. First they should limit the amount of profit that can be made by overcharging directly. Most of those med companies could save 30-40% of their expenditures by cutting out advertising. I mean do we really need to be told all the side effects of drugs on television? NO. And all those TV ads are expensive. We're bombarded by them every day! That's what I pay my doctor for...to prescribe the best meds for me. I shouldn't have to be asking my doctor about say, Lunesta. Good God. Do we really need to hear Viva Viagra on TV everyday? NO In fact, it's darn disturbing to me to be given all this information about PRESCRIPTION DRUGS when I can't prescribe them for myself.
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#14 Rhea

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Posted 18 July 2009 - 10:21 AM

I hate them too, Mark.

Especially the man and woman on the beach side by side in matching bathtubs. What do they think Grandpa is going to do? As a friend of mine said, jump Grandma's bones and break a hip? So stupid. I don't think should advertise at all, but if they do, then they SHOULD be forced to list side effects - otherwise they can make their drugs sound hunky dory without ever mentioning, say, the high incidence of stroke.  :unsure:

Too bad they can't ban prescription drug commercials (and add in sanitary napkins and tampons while they'e at it).  :suspect:
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#15 Nick

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Posted 18 July 2009 - 02:35 PM

View PostRhea, on Jul 18 2009, 11:21 AM, said:

Too bad they can't ban prescription drug commercials (and add in sanitary napkins and tampons while they'e at it).  :suspect:

Theoretically they could, they did it for tobacco.  It might even be a good idea.

What are some other options for reigning in pharmaceutical companies?  Increasing federal research grants might help.  If we can get more pharmaceutical R&D in the public domain then it'll reduce the incentive of big pharma to pursue its own research and marketing.  It won't end it, but it could be a step in the right direction.

#16 Captain Jack

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Posted 18 July 2009 - 02:59 PM

Quote

Translation: The bills, as they stand, do not meet the president's promise to reduce the long-term drain of health care spending on the federal budget.

EPIC FAIL

No excuses about this, guys.  I'm sick of the excuses.  The Fed's can NOT, and will NOT find a way to create "affordable health care" as they simply lack the capacity of doing so without bloating even more spending and taxing.  This whole thing spells out DOOM.  Hello big government...where the left hand won't know what the right hand is doing more than evah, and YOU'RE going to pay for it.  ;)  Anyone who wants the government to regulate everything (including banning) is going down a slippery slope to the land of socialism.
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#17 Captain Jack

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Posted 18 July 2009 - 03:04 PM

View PostRhea, on Jul 17 2009, 08:44 PM, said:

^On the other hand, look what capitalism has done to the practice of medicine. I remember doctors that were ceasing to practice as early as the late '60's and early 70's because their malpractice insurance was so high. I can't imagine how doctors stay in practice given the cost of malpractice insurance today.

Obama has not endorsed socialism in any way, shape or form - just universal health care, which ironically enough was one of Eleanor Roosevelt's dearest causes. We've come a long way, baby - NOT.

So, you're against capitalism?  And Obama HAS endorsed socialism. Passively, but he has.  This "universal healthcare" is a prime example of it, but you will refuse to see it until it is too late.  Anything that allows a government to regulate a part of your life in a big way for the good of the masses is socialism.  I refuse to pay for your meds, and I refuse to have my meds paid for by the republik.

Edited by Captain Jack, 18 July 2009 - 03:05 PM.

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#18 Mark

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Posted 18 July 2009 - 05:07 PM

Captain Jack:

Quote

Anyone who wants the government to regulate everything (including banning) is going down a slippery slope to the land of socialism.

Mark: Well, our government already regulates a lot of things, and I don't consider that in itself, socialism.

However...this new health care idea Obama is pushing so hard DOES look and sound like socialism.
If it looks like a duck, and quacks like a duck, it must be a goose? Is that what some of you are trying to tell us? I won't buy into that theory, sorry. The concepts that are being proposed in Obama's new health care bill looks and sounds like socialism at it's finest to me. The government needs to be regulating the big businesses that are making health care cost so much for the people, NOT regulating the people or their health care choices. The Judicial branch of our government needs to be speaking out on this too, IMO.

And Captain Jack...I don't wanna pay for your meds either. I have enough trouble trying to pay for my own.  :lol:
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#19 Omega

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Posted 18 July 2009 - 05:13 PM

View PostNick, on Jul 17 2009, 10:48 PM, said:

View PostOmega, on Jul 17 2009, 11:32 AM, said:

Doctors should never, ever be placed in a situation where they could conceivably profit from giving care that is less than what is best for their patient.  Pay-by-procedure does exactly that.  This is an inherent conflict of interest, and should be forbidden by ethical guidelines.  If the AMA won't do it, the government should.

Agreed.  Although, it's difficult to completely decouple a procedure from its variable costs.  Doctor compensation should most certainly not be based on procedures, however I don't know how to make that the case for hospitals or the actual doctor's office.  Patients don't pay subscription fees (aside from insurance), so how does the hospital/office get reimbursed for all the things that get "used up" by performing a procedure (supplies, pharmeceuticals, consumable equipment, etc)?

I want this implemented, but I don't want it implemented in such a way that actively DISincentivises performing necessary medical procedures.

The purpose of my suggestion is not to make what the patient pays invariable with things like procedures and supplies.  Only the doctor's compensation should be decoupled from the procedures recommended.  The doctor shouldn't get paid more for recommending procedures, but the patient should pay more if appropriate for the procedure.  Does that make sense, and address your concern?

View PostNick, on Jul 17 2009, 10:48 PM, said:

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Higher prescription drug costs only exist because by definition, there is no free market for a patented good.  A patent is a government-granted temporary monopoly.  This monopoly could easily be revoked, limited, or altered to lower drug prices.  Making it easier to import prescription drugs from other countries would also help bring market forces to bear on lowering prices here.

Big Pharma's out of control, you'll get no argument from me on that front.  I'm curious how you'd go about it, though.  Their argument is the huge amount of money invested in pharmaceutical research (*cough*andmarketing*cough*) justifies an exclusivity period to recoup some of that investment or the generics will get a free ride.  I know you're not talking about wiping out patents alltogether, but how would you want to reshape the industry?

I definitely don't want to eliminate patent protections all together.  But twenty years is too long, and it's definitely not helpful when they can patent what is essentially the exact same drug for another twenty years.  Terms should be shortened to more like two or three years, with renewals having exponentially increasing fees.  I would also add incentives to license the drug to other manufacturers.  That, combined with allowing prescription drug imports from countries with lower prices, would help bring our prices down to levels seen elsewhere in the world.  And I love the idea of outlawing prescription drug ads to the general populace.  It's not exactly a libertarian thing to do, but if we're going to outlaw tobacco ads, outlawing prescription drug ads would be perfectly consistent.  No good comes of these ads.

View PostNick, on Jul 17 2009, 10:48 PM, said:

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Tort reform, making it more difficult to sue doctors without good evidence of actual malpractice and limiting damages to reasonable levels, would lower malpractice insurance premiums and reduce the tendency of doctors to practice defensive medicine.

I agree with you, but any sort of tort reform makes me nervous.  True malpractice does happen, and a victim may suffer for the rest of their life as a result, be unable to work again, or not survive at all.  I'm wary of just putting up barriers to starting a lawsuit.  Determining if the doctor was malpracticing is what the trial is for, and the jury should have at least some say in how much a victim can get awarded on a case by case basis--I want as little set in stone as possible.

I think there should be maximum penalties in place on non-tangible damages, but I certainly agree that judges or juries (as applicable) should have wide latitude to determine tangible damages.  The idea of a malpractice case having to go before an arbitration board before reaching a court is a reasonable idea as well.  This would hopefully help weed out the more frivolous lawsuits.

View PostNick, on Jul 17 2009, 10:48 PM, said:

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Making these changes would eliminate over half of the US medical care industry's cost overruns.

Not to cast doubt (I believe you), I'm just wondering where you're getting "over half" from.

The report I mentioned by McKinsey and Company, which may be found here.  It appears that speaking from memory I have misstated the situation slightly, as in my blog I give a more precise value, an average of $700 savings per person, out of the $1645 per capita cost overage.  That's not over half, it's nearly half.  My apologies.

View PostNick, on Jul 17 2009, 10:48 PM, said:

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Almost all of the rest would be accounted for by reducing administrative overhead.  That one's not as simple to solve at a government level, unfortunately, at least not without knowing more than I do about why things cost so much.  Obviously single-payer has the potential to reduce administrative overhead, but I have little faith that potential would ever be realized in a US government bureaucracy.

One huge advantage is a standardized claims process.  One form.  One system, rather than dozens of byzantine rules and procedures set by the various insurance companies with a strong incentive to pay out as little in claims as possible.  I would posit that insurance companies *deliberately* make the claims process difficult for healthcare providers to create "gotchas" to get out of paying.

I'm quite sure that insurance companies purposefully make things complex and difficult.  I would almost propose that there should be two companies, one which processes claims, and another which pays them out.  That way you eliminate the conflict of interest.  However, if done badly, that could add vastly more paperwork.  I'm also not immediately seeing a tasteful way for the government to implement such a thing.  I'm bothered by the fact that the competitive forces of the free market haven't caused such obvious cost-saving measures to be implemented already.  There's some counter-market force at work here that I don't fully understand, and it's really starting to bug me.

View PostNick, on Jul 17 2009, 10:48 PM, said:

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I want to make this clear: the point of this health care bill is not to save money.  The administration may say that's the case, but they're not stupid, they have this same report.  Their goal is not to save money, it's to insure the uninsured.  (That won't save money either, BTW.  According to the report, indigent care is actually cheaper than insuring all the uninsured at present rates would be.)

I don't think it's valid to compare indigent care to insuring the uninsured.  Not all uninsured are indigents.  I think great cost savings can be realized by expanding the pool of participants, and providing affordable access to "routine maintenance" that can prevent and/or more quickly detect future more expensive problems.

We already bear the costs of a great deal of uninsured urgent care in the prices WE and our insurance companies pay for our care to cover those who can't.

The numbers I've seen indicate that covering the uninsured at present rates would actually cost more than the care they presently receive for free.  I've also seen numbers indicating that preventative care doesn't lead to great cost savings.  How reliable either of those figures are, I don't know.  I'm not opposed to either of those things, but I don't think they're going to have as significant an effect as the proposals I've made, and they'll certainly cost more in the short term regardless of their long-term effects.

#20 Captain Jack

Captain Jack

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Posted 18 July 2009 - 11:40 PM

View PostMark, on Jul 18 2009, 03:07 PM, said:

Captain Jack:

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Anyone who wants the government to regulate everything (including banning) is going down a slippery slope to the land of socialism.

Mark: Well, our government already regulates a lot of things, and I don't consider that in itself, socialism.

However...this new health care idea Obama is pushing so hard DOES look and sound like socialism.

Just because the guberment already regulates some things doesn't mean we should add more because of it.  They should not be regulating those things to begin with.

Look how well Social Security worked out.  Guberment takes out a piece of your check, but the likelyhood of you seeing it is essentially nil now.

Look at how "well" the guberment runs the postal service.  They lost over a BILLION dollars last year alone.

Look how well the guberment runs the DMV.  Love them lines and poor communication and slow, angry workers.

Ayup, train wreck just waiting to happen with health care...

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If it looks like a duck, and quacks like a duck, it must be a goose? Is that what some of you are trying to tell us? I won't buy into that theory, sorry. The concepts that are being proposed in Obama's new health care bill looks and sounds like socialism at it's finest to me. The government needs to be regulating the big businesses that are making health care cost so much for the people, NOT regulating the people or their health care choices. The Judicial branch of our government needs to be speaking out on this too, IMO.

And Captain Jack...I don't wanna pay for your meds either. I have enough trouble trying to pay for my own.  :lol:

What we're trying to tell you is the duck is QUACKING right before your eyes, but you keep finding ways to keep your eyes and ears shut as it isn't what you want to hear.  It isn't theory, it's fact, and until you realize that, it may be too late.  The government should NOT be regulating ANY business as this is a capitalist nation of FREE ENTERPRISE.  I believe in lowering health care cost, but not in this fashion.  You lower it by competition.  The government will be regulating YOU just as much, my friend.  How much you get, who you can see, how often, etc.
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