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Surprise! Health care bill won't reduce health costs

Health Care 2009

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#21 Mark

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Posted 19 July 2009 - 04:27 AM

Captain Jack:

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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.

Mark: I hope that sentence wasn't aimed at me. What I've been trying to tell people is this particular health care reform bill ISN'T the one we need to be backing. Their are too many socialist ideals in it's concept.



CJ, how in the world can we create competition in fields where big businesses rule?

Should we force big business to be more like the NFL, and put earning caps on them (to keep them competitive, and able to produce each year)? Should we split the bigger businesses into 2 conferences, with several divisions each, or something similar? Should we let companies who are behind in their earnings keep their new patents longer to catch up with the rest in the cap's race? And I say "cap's race" because once companies do reach their peak potential, shouldn't we reward them with bonuses of some sort? If a company's R&D comes up with a revolutionary new drug...let's say one that cures every form of cancer, shouldn't we be sending them to Disney World, so-to-speak? Shouldn't those special few who have done something special get to get to decide if they're the ones lying on beaches, having champagne and living the easy life, instead of the greedy corporate executives who's only talents are being hard-asses, taking money behind the table, and making good decisions with his stock options? (I'm stereotyping...sorry. I'm sure there are CEO's who are genuinely good people that are trying to make a difference for the better in our society, but right now I'm having a hard time seeing that aspect of it)

I'm just saying...possibly put earnings cap on them before having to split off into another team...or rather company, give them the tools and incentives to compete with the other companies, and thoroughly reward those companies or individuals who do something completely outstanding.

I'm gonna shut up now. It's 3:26 a.m. here, and I probably shouldn't be typing out loud.

Edited by Mark, 19 July 2009 - 06:59 AM.

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#22 Aric

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Posted 19 July 2009 - 07:00 AM

Mark, in regards to your Robin Hood worry, it's actually take from a small minority to give to a slightly less small minority.  The House bill is talking about increasing taxes on people making over $280K, families over $350K.  I would tend to disagree with your notion about socialism, but I already posted about it in the Professor is a genius thread, so I would hope you get a chance to read my post in that thread to you.

I agree with some of your arguments, Omega, though I have read about hospitals and doctors maintaining pay per procedure but adopting a patient-first, collaborative, holistic culture to practising medicine, that vastly improved patient care quality while dramatically reducing costs.  I'm uncertain if eliminating pay per procedure alone can improve quality of care, though I'd agree that costs would go down if implemented.

In regards to pharmaceuticals, I think it's unnecessary to import drugs if instead the US adopted a regulator comparable to the Patented Medicine Prices Review Board in Canada (discussed in detail in the Obama goes thread).  The mandate of the PMPRB is to ensure Canadians are not gouged by drug companies.  The US, as the largest market for pharmaceuticals, could theoretically have massive purchase and bargaining power, but Medicare is prohibited from adopting the same approach as the VA does, which definitely needs to change.  I think in exchange for the patent, having a PMPRB-style regulator assign a pricing strategy that accounts for the costs of development and marketing, but doesn't allow the drug companies to gouge US people, would be a better idea than imports.

The reason why single payer systems have such small administrative costs is because unlike with the US system, there's only one insurance provider (the government), and there's nobody in the single payer system comparable to a private insurer approving or declining to pay for services billed.  Administrative simplicity alone would still save Medicare 9% more than private insurance companies if Medicare paid the same price per procedure as a private insurer (they don't even come close).  A properly assembled public insurer, as in formed based on Medicare, would have the clout to bargain for lowest prices for treatments with hospitals, and be able to reduce the cost growth of health care.  

I think Omega that although universality is the driving force of this reform, long term cost sustainability is also a clear objective.  While it's true the cost of treating the uninsured now will be less than what it costs to insure them, a lot of that has to do with the fact that the uninsured receive insufficient care, and this is still a worthwhile investment, since the economic losses incurred by having so many uninsured far exceeds the cost of insuring them.  And because of the externalities created by the lack of universality, solving this problem is the first step towards solving the sustainability issue.

Palisade, based on my readings, I found that Medicare had a set payment per treatment process by which they paid hospitals and clinics, which does not necessarily match what it costs a hospital to perform that treatment.  As for prescription drugs, that depends on the plan, it's not standardised, the Medicare client chooses which prescription plan he wants, and will know what it covers, and by how much, etc.

I'm curious, Mark, why are you not rioting in the streets over the outrageous and unamerican rationing of health care that's going on right now, just like they used to have in the USSR?  For different reasons, of course.  I mean, are you okay with the principle that instead of a system of equality and equal access to treatment that rations by need, you're getting rationing based on capacity to pay?  I mean it's a valid point of view, I just want to make sure there's no confusion, here.  And just for the record, it was not just socialism itself that did anything to the USSR, it was the result of their command system of government, a pure socialist system would never have been run in the manner in which the USSR was.

Actually, Captain Jack, this is far from an epic fail, this is in fact good progress.  Now your point is rather similar to what you posted in the Obama goes there thread, and so I'll just copy and paste my rebuttal, since you never returned to engage my points, hopefully you'll have a chance to do so this time.  I think you may have misunderstood the nature of the reforms being presented. First off, the government is not going to provide health care any more than they do now. There will be no nationalisation of private clinics and hospitals. Doctors and nurses will not become government employees.  The new rules and regulations do not expand government, they define the scope of the private sector in the market.  A public insurer is meant to increase competition and reduce externality.

I'm curious, Captain Jack  How well do you truly understand socialism?.  Did you know that there are some tenants of socialism and US philosophy that are actually not that different?  Equality of opportunity.  That all men are equal.  That any man should be able to achieve his fullest potential.  Do any of these sound incompatible with what the US is about?  So what parts of Obama's universal health care are incompatible with US principles?  Because anyone making an honest and fair comparison of what the House and Senate have proposed, will realise this is not a socialist system.  It's not even a social insurance system.  It mandates universality by creating a health exchange so that all people can buy insurance from any number of private companies, and creates a new public insurer to compete with private insurers.  Do you think this would impress a real socialist?  No socialist with any certainty of conviction would approve of the plan proposed.

Unfortunately, Captain Jack, if you pay taxes, and if you pay insurance premiums, you already are paying for other people's health care, their meds, etc.

Really, Mark?  What parts of Obama's plan sounds like socialism at its finest to you?  Allowing private insurers?  Creating state/regional/national health exchanges where people can buy (serious emphasis) insurance from a private company or a public insurance provider?  I asked it of Captain Jack, but I'd invite you to offer a reply, as well, because as far as I can tell, there's nothing here that is socialism at its finest.  And requiring people to have insurance hardly sounds like the second coming of the USSR to me, seeing as how any auto on the road needs insurance.  Perhaps you can elaborate on these regulations on people and their health care choices?  Seems to me that he's left you with all the choices you already had, plus another one.

I would agree with Nick, Omega, preventative care will in the long run achieve a level of cost savings, not unsubstantial, and it can hardly be called free if hospitals get federal and state dollars to offset their costs of treating the uninsured/unable to pay, as well as raising prices on their treatments to those who can pay, which inevitably leads to higher insurance premiums for the insured.

I'm not sure if you're serious, Captain Jack, I'm suspicious the deliberate misspell is an indicator of that, but I'll proceed nonetheless.  First off, governments should not be regulating what, exactly?  The standards of safety and quality that keep the people safe from harm?  Or how about we consider the effects the absence of regulations had on the ongoing unpleasantness in the economy of late?  As to your comment on the USPS, I offered a rebuttal on that last time, but I'll offer it again.  Because the USPS maintains unprofitable routes and subsidises the cost of shipping letters (a stamp today is pretty much the same inflation adjusted cost as it was more than half a century ago).  I remember a large fuel surcharge for all the FedEx shipments I sent last year, all the plane tickets I bought also had fuel surcharges, prices were going up rather quickly in my area, which was overheating due to the oil boom, but Canada Post didn't raise the cost of mailing a letter at all.  Did the USPS?  Maybe by a penny?  

I'm going to assume now that the capital letters is a definite indication that you're not serious, so I won't endeavour to refute the notion that governments should not be regulating any business, and I won't point out that the US while relatively close to a pure capitalist system, is still a long ways off from that.  If you are in fact sincere, let me know, and I'll offer a reply.

So Captain Jack, if the solution to the health care problems the US faces is competition, please describe what this entails.  Competition where, exactly?  There are lots of doctors, clinics, hospitals, insurance companies, already, though.  Where do we encourage more competition?  And how do we do this without regulations?  I'm very interested in hearing about your proposal, as I had also asked Mark to describe a capitalist solution to the health care issues the US faces.

On another note, Captain Jack, I saw your post to me in the AQG thread, thanks.

Aric

#23 Mark

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Posted 19 July 2009 - 07:21 AM

Mark: So much to answer, and I don't like writing those lengthy replies, so I'll keep it simple.

Actually, you answered one of your questions to me in your own first post. It's gonna cost us more...maybe not right away, but in the long run I do think it would.

Changing any big system is going to cost a LOT of money in and of itself. What's gonna happen to those people who work in our current system? Let's see...do we reassign them? Where? Does that mean they have to me? Who's gonna pay for that? What if they don't wanna move? What if they won't move if they need to? Let's take a little time to discuss it before we sign-off on it.

Also, I AM for keeping it where the people who can afford it, pay for it as needed. That keeps us all trying to achieve and keep pushing forward. Second, people who cannot afford it can currently get health care by going to any emergency room. Third, there are current programs for those of us needing help for one reason, or another. Medicare/Medicaid. I personally am on Medicaid for a disability reason. I don't get very much at all, but it's better than nothing, and I DO have access to free medical care, and prescriptions during my disability. Medicaid benefits currently come from Social Security, and the monthly money I get is based on how much I've paid off on S.S. during my working lifetime (actually, not even that long).
So, I could not live indefinitely on the amount of money I currently get, but it has been enough to get me through. So I cannot say it doesn't work at all. Like most things, it could work better.

So from experience, our system DOES work, it just doesn't work as well as it could/should. You've heard some of our other members talk about Medicare, and how all the confusion within that system hurts them, the doctors, and everyone involved. So obviously, there are some changes needing to be made in that system. It needs a revamping. You've said how much the VA needs changing. Heck, the VA is terrible. I am also speaking from experience on that. I used to take one of my vet friends (who's wheelchair-bound for the rest of his life) to the VA, and I saw how much crap they have to go through. The VA was often more than a day's worth of waiting too.

We'll talk more about socialism on another thread.

Edited by Mark, 19 July 2009 - 07:27 AM.

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#24 Aric

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Posted 19 July 2009 - 08:41 AM

Let me clarify, Mark.  Over the next decade, absent intervention, the US will spend what, about $28 trillion on health care?  With Obama's efforts to provide universality, we're up to what, now $29 trillion?  So short term yes an increase, but if the proposals are done right, in the long term we're going to see that $29 trillion turn into $26, $27 trillion.  So short term increase in cost in exchange for long term sustainability and a decrease in the cost growth, that's what's at stake with this proposal.  And if things like the public option work well, electronic records, billing simplicity, maybe even less than $26 trillion.  Objective well worth seeking, especially since it now covers everyone.

I'm afraid I'm actually unsure about what exactly you want to take a little time to discuss.  Who are these people who need to move, and why do they need to move?  Can you clarify, perhaps give an example?

The problem Mark with uninsured getting treatment at ERs is that studies show (I can refer them to you) that they receive insufficient treatment, as in too little, too late, most often due to people having waited until they are far more ill than if they had sought previous treatment, or because they could not afford the medical treatments (like drugs, for instance) that would have made them better at an earlier stage.  One of Dr. Reinhard's papers described the fact that about 18 000 people die every year because they lack insurance and timely medical care.  Maybe that's only a small percentage of all the uninsured and underinsured, but I know I wouldn't risk that if I didn't have to.

Unfortunately my lack of firsthand experience in the US health care system precludes me from being able to discuss anything more than aggregates, so that while I'm sure there are elements of Medicare that need improving, based on aggregates, it produces equally good if not better health care results, higher patient satisfaction, at less cost than private insurance.  As for the VA, again I can only speak to the aggregates, and while they were in a very bad sort about 15 years ago, over the last decade they have seen a massive increase in the number of patients, quality of care, cost growth per patient, and patient satisfaction, so much so that VA's quality of care is actually exceeding private insurance/Medicare in some respects.

By all means, Mark, we can discuss socialism, but I would suggest it's a distraction, and I would recommend instead looking at the improvements in the VA, and the cost advantages it and Medicare have over private insurance.

Aric

#25 Mark

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Posted 19 July 2009 - 09:33 AM

Mark: ^ I just heard two Dems talking about the proposal on TV. The Senator from Ark. said he would rather wait, and let us pilfer through the people who are abusing the current system for some reason. The other said the new healthcare package would cost Americans $1 trillion over the 10 years. I didn't hear exactly (because I was on the phone) but I thought I heard him say it was $550 billion each year it WILL cost the taxpayers. Since we're already in an economic depression, I can't approve. I mean, when is the straw gonna break the camel's back? It could be in just one more major expenditure by our government.
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#26 Omega

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Posted 19 July 2009 - 09:47 AM

I'd like to mention that one force behind some of my proposals is the preference for market forces instead of direct government intervention.  That's why I don't support actual profit caps on pharmaceutical companies.  I believe that the market is fully capable of reducing costs, and that government's role in the process need not be terribly intrusive to accomplish this.  I don't trust people to do anything but what is in their own best interest.  I trust Tyr to be Tyr.  Trying to alter this tendency on a large scale is just asking for a disappointment.  It's better to alter what is actually in peoples' best interest.

The market is not truly free, and never has been.  Patents are, by definition, a modification of the market to create a temporary monopoly for the good of all.  It is well within the government's prerogative to determine when patents granted by the government benefit society as a whole and when they do not.  As such, Aric's mention of Canada's Patented Medicine Prices Review Board actually sounds not unreasonable to me.  It would be perfectly reasonable for there to be some regulation on the prices of patented prescription drugs; the patent is a gift from society, and exists for society's benefit.  If it ceases to benefit society, the patent should vanish.

However, while I'm not familiar with how it works in Canada, I would propose something I suspect would be a little different.  I would base patent renewal fees on some combination of the declared R&D investment, total profit recouped to date, and the time length of the patent.  Obviously this would require some well-regulated bookkeeping on the part of the company doing the patenting, but it would cause patents to end naturally as they cease to be profitable for the patent-holder.  The higher the prices they charge, the shorter time that is.

#27 RobL

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Posted 19 July 2009 - 10:02 AM

View PostAric, on Jul 19 2009, 05:00 AM, said:

Mark, in regards to your Robin Hood worry, it's actually take from a small minority to give to a slightly less small minority.  The House bill is talking about increasing taxes on people making over $280K, families over $350K.  I would tend to disagree with your notion about socialism, but I already posted about it in the Professor is a genius thread, so I would hope you get a chance to read my post in that thread to you.

I agree with some of your arguments, Omega, though I have read about hospitals and doctors maintaining pay per procedure but adopting a patient-first, collaborative, holistic culture to practising medicine, that vastly improved patient care quality while dramatically reducing costs.  I'm uncertain if eliminating pay per procedure alone can improve quality of care, though I'd agree that costs would go down if implemented.

In regards to pharmaceuticals, I think it's unnecessary to import drugs if instead the US adopted a regulator comparable to the Patented Medicine Prices Review Board in Canada (discussed in detail in the Obama goes thread).  The mandate of the PMPRB is to ensure Canadians are not gouged by drug companies.  The US, as the largest market for pharmaceuticals, could theoretically have massive purchase and bargaining power, but Medicare is prohibited from adopting the same approach as the VA does, which definitely needs to change.  I think in exchange for the patent, having a PMPRB-style regulator assign a pricing strategy that accounts for the costs of development and marketing, but doesn't allow the drug companies to gouge US people, would be a better idea than imports.

The reason why single payer systems have such small administrative costs is because unlike with the US system, there's only one insurance provider (the government), and there's nobody in the single payer system comparable to a private insurer approving or declining to pay for services billed.  Administrative simplicity alone would still save Medicare 9% more than private insurance companies if Medicare paid the same price per procedure as a private insurer (they don't even come close).  A properly assembled public insurer, as in formed based on Medicare, would have the clout to bargain for lowest prices for treatments with hospitals, and be able to reduce the cost growth of health care.  

I think Omega that although universality is the driving force of this reform, long term cost sustainability is also a clear objective.  While it's true the cost of treating the uninsured now will be less than what it costs to insure them, a lot of that has to do with the fact that the uninsured receive insufficient care, and this is still a worthwhile investment, since the economic losses incurred by having so many uninsured far exceeds the cost of insuring them.  And because of the externalities created by the lack of universality, solving this problem is the first step towards solving the sustainability issue.

Palisade, based on my readings, I found that Medicare had a set payment per treatment process by which they paid hospitals and clinics, which does not necessarily match what it costs a hospital to perform that treatment.  As for prescription drugs, that depends on the plan, it's not standardised, the Medicare client chooses which prescription plan he wants, and will know what it covers, and by how much, etc.

I'm curious, Mark, why are you not rioting in the streets over the outrageous and unamerican rationing of health care that's going on right now, just like they used to have in the USSR?  For different reasons, of course.  I mean, are you okay with the principle that instead of a system of equality and equal access to treatment that rations by need, you're getting rationing based on capacity to pay?  I mean it's a valid point of view, I just want to make sure there's no confusion, here.  And just for the record, it was not just socialism itself that did anything to the USSR, it was the result of their command system of government, a pure socialist system would never have been run in the manner in which the USSR was.

Actually, Captain Jack, this is far from an epic fail, this is in fact good progress.  Now your point is rather similar to what you posted in the Obama goes there thread, and so I'll just copy and paste my rebuttal, since you never returned to engage my points, hopefully you'll have a chance to do so this time.  I think you may have misunderstood the nature of the reforms being presented. First off, the government is not going to provide health care any more than they do now. There will be no nationalisation of private clinics and hospitals. Doctors and nurses will not become government employees.  The new rules and regulations do not expand government, they define the scope of the private sector in the market.  A public insurer is meant to increase competition and reduce externality.

I'm curious, Captain Jack  How well do you truly understand socialism?.  Did you know that there are some tenants of socialism and US philosophy that are actually not that different?  Equality of opportunity.  That all men are equal.  That any man should be able to achieve his fullest potential.  Do any of these sound incompatible with what the US is about?  So what parts of Obama's universal health care are incompatible with US principles?  Because anyone making an honest and fair comparison of what the House and Senate have proposed, will realise this is not a socialist system.  It's not even a social insurance system.  It mandates universality by creating a health exchange so that all people can buy insurance from any number of private companies, and creates a new public insurer to compete with private insurers.  Do you think this would impress a real socialist?  No socialist with any certainty of conviction would approve of the plan proposed.

Unfortunately, Captain Jack, if you pay taxes, and if you pay insurance premiums, you already are paying for other people's health care, their meds, etc.

Really, Mark?  What parts of Obama's plan sounds like socialism at its finest to you?  Allowing private insurers?  Creating state/regional/national health exchanges where people can buy (serious emphasis) insurance from a private company or a public insurance provider?  I asked it of Captain Jack, but I'd invite you to offer a reply, as well, because as far as I can tell, there's nothing here that is socialism at its finest.  And requiring people to have insurance hardly sounds like the second coming of the USSR to me, seeing as how any auto on the road needs insurance.  Perhaps you can elaborate on these regulations on people and their health care choices?  Seems to me that he's left you with all the choices you already had, plus another one.

I would agree with Nick, Omega, preventative care will in the long run achieve a level of cost savings, not unsubstantial, and it can hardly be called free if hospitals get federal and state dollars to offset their costs of treating the uninsured/unable to pay, as well as raising prices on their treatments to those who can pay, which inevitably leads to higher insurance premiums for the insured.

I'm not sure if you're serious, Captain Jack, I'm suspicious the deliberate misspell is an indicator of that, but I'll proceed nonetheless.  First off, governments should not be regulating what, exactly?  The standards of safety and quality that keep the people safe from harm?  Or how about we consider the effects the absence of regulations had on the ongoing unpleasantness in the economy of late?  As to your comment on the USPS, I offered a rebuttal on that last time, but I'll offer it again.  Because the USPS maintains unprofitable routes and subsidises the cost of shipping letters (a stamp today is pretty much the same inflation adjusted cost as it was more than half a century ago).  I remember a large fuel surcharge for all the FedEx shipments I sent last year, all the plane tickets I bought also had fuel surcharges, prices were going up rather quickly in my area, which was overheating due to the oil boom, but Canada Post didn't raise the cost of mailing a letter at all.  Did the USPS?  Maybe by a penny?  

I'm going to assume now that the capital letters is a definite indication that you're not serious, so I won't endeavour to refute the notion that governments should not be regulating any business, and I won't point out that the US while relatively close to a pure capitalist system, is still a long ways off from that.  If you are in fact sincere, let me know, and I'll offer a reply.

So Captain Jack, if the solution to the health care problems the US faces is competition, please describe what this entails.  Competition where, exactly?  There are lots of doctors, clinics, hospitals, insurance companies, already, though.  Where do we encourage more competition?  And how do we do this without regulations?  I'm very interested in hearing about your proposal, as I had also asked Mark to describe a capitalist solution to the health care issues the US faces.

On another note, Captain Jack, I saw your post to me in the AQG thread, thanks.

Aric

This post made my eyes bleed.

Dude, page breaks (or better yet, quoting what you are responding to) and not jumping back and forth works wonders.

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#28 Mark

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Posted 19 July 2009 - 10:06 AM

Mark: ^ Well stated about the patents, Omega. To add to that, however, I would DEMAND pharmaceutical companies stop advertising prescription drugs on national television unless it's a public service announcement of some sort. For instance, "We now have a medicine which cures certain types of diabetes in most patients"...or something to that affect, and scale. As it us, we the people have to sit through many commercials each day advertising something to us that we cannot use unless prescribed by a doctor. It's not the pharms place to push those meds on us. If we really want to know something about a drug our doctor has prescribed, I would say it's our responsibility as individuals to ask our pharmacist, doctor, or go to the library, online, or find another way to find the facts for ourselves, and speak with our doctor if we don't approve of his decision regarding our treatment.

The pharmaceutical companies could save HUGE amounts of money every year by stopping those TV ad campaigns.
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#29 Mark

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Posted 19 July 2009 - 10:19 AM

RobL:

Quote

This post made my eyes bleed.

Dude, page breaks (or better yet, quoting what you are responding to) and not jumping back and forth works wonders.

Mark:  :lol: Also, well stated RobL.

Those really are harder to read and respond to, Aric.
Mark
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#30 Spectacles

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Posted 19 July 2009 - 11:40 AM

Link to the health care act that is being discussed, debated, shaped thus far in Congress:

http://energycommerc...;Itemid=55#toc1

It's organized in a user-friendly way. If you have particular concerns about some aspect, like Medicare or private health insurance, you can click the links.

The fairly conservative AMA supports this bill.

The CBO data is still shifting regarding the cost-benefits.

All in all, this looks promising to me. But I remain skeptical until I see the final product.
"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

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#31 Themis

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Posted 19 July 2009 - 02:52 PM

Random thoughts.

As Aric is responding to specific people who should be able to remember what they posted, there shouldn't be a problem.  However, for the rest of us who may have given it 24 hours between reading the thread, perhaps some quoting of what is being responded to would be in order.

Most people currently working for big insurance could probably be transferred to similar jobs with a government-sponsored plan.  Most of these jobs are in cities anyway.  Nashville, as Omega knows, is the hub of a jillion insurance and for-profit healthcare providers and employs a lot of people in fill-out-the-form capacities.

I also would take away drug company advertising to consumers (not only tv but also magazines and newspapers).  It might give people a prod to go to their doctor (assuming they can afford to have one) since they know now there is a treatment.  I suspect most of the time it makes people ask for a new, patented drug that isn't any better than a generic they're already taking.   You can't advertise alcohol on tv; how come you can advertise a drug that could kill you with the side effects and that you can't go out and buy in the first place???

Speaking of advertising, in this part of the country (I noted this from when I moved here - it wasn't something I'd seen in LA) the hospitals advertise.  I don't get it.  Usually you go to a specific doctor by recommendation from a friend or insurance company or a referral from another doctor, not by what hospital they have privileges at.  Likewise, in an emergency, you go to the closest ER.  You give birth where your obstetrician practices.  But Vanderbilt and St. Thomas are forever advertising (on tv) their special programs.  As Vanderbilt already gets most of the can't-pay patients, plus all the serious trauma cases, I don't see why they're spending money on tv spots to brag on their heart program...

Wait times?  My internist yesterday ordered a dermatologist consult.  So I call Vandy's dermatology department.  First appointment - October 12!!!  And this is to look at a new wart cluster that might be a melanoma!  She said I could wait a couple of months (to save for the $50 co-pay) but geez.  This will be 3 months...  I'm not going for acne, for heaven's sake, it's for a possible melanoma!   This is me with decent insurance.  (I temped in a Vandy academic office for 10 months and ended up with most of my doctors there, not least because they're on every insurance plan. When I first had a gastric problem, the Vandy doctors had a 2-3 month wait so they got me an appointment with someone at another hospital...)  This is in a town that is chock full of specialists of every kind...

I think universal health care will be the end result of health care reform in this country, one that is sorely needed, imo.  But I think it's going to take several stages to get there to get over the stubborn individualism that is our heritage.  I doubt it will happen in my  lifetime.

Meanwhile, I could just say "What Aric said."
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#32 Mark

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Posted 19 July 2009 - 03:34 PM

Mark: Please note, I'm only addressing the parts of the plan I'm having direct conflict with. I am not addressing the parts that DO sound good to me. Most of the stuff that does sound good are things we should be trying to do to our current system. Why did the government wait until the tire was completely flat, when they've known we've had a pretty good hissing sound coming from that particular tire for a LOOOONG time?

Individual responsibility.
Except in cases of hardship, once market reforms and affordability credits are in effect, individuals will be responsible for obtaining and maintaining health insurance coverage. Those who choose to not obtain coverage will pay a penalty of 2.5 percent of modified adjusted gross income above a specified level.

Employer responsibility. The proposal builds on the employer‐sponsored coverage that exists today. Employers will have the option of providing health insurance coverage for their workers or contributing funds on their behalf. Employers that choose to contribute will pay an amount based on eight percent of their payroll. Employers that choose to offer coverage must meet minimum benefit and contribution requirements specified in the proposal.


Mark: There's gonna be backlash if they make people who choose not to obtain coverage through the government pay 2.5% of their modified adjusted gross income.  
second paragraph...How is that beneficial to employers? Employers have an option whether or not to contribute, and if they do they have to pay 8% of their payroll?  I don't see a benefit or incentive there for the employers.

SUBTITLE E – GOVERNANCE
Sec. 141. Health Choices Administration; Health Choices Commissioner. Establishes The Health Choices Administration, an independent executive branch agency. The Health Choices Commissioner is appointed by the President.
Sec. 142. Duties and authority of Commissioner. The Health Choices Commissioner carries out functions including: establishment of qualified plan standards, the establishment and operation of the Health Insurance Exchange, the administration of affordability credits, and additional functions as laid out within the bill. The Commissioner can collect data necessary to carry out his or her duties and to promote quality and value and address disparities in health care. Such information can also be shared with HHS. The Commissioner also has oversight and enforcement authority including the authority to impose sanctions and suspend enrollment of a plan. This authority requires the Commissioner to coordinate with the Department of Health and Human Services, the Department of Labor and state insurance regulators.


Mark: Okay, instead of TRYING to reform our current system, this one creates a whole new government entity, who has very broad ranging power. I don't like that part. I REALLY don't like the President being chosen to pick the new Commissioner of that agency, since it's going to be a whole new independent part of the executive branch for the first time in how many years? HECK NO. Not sure why Obama, or any President thinks they're qualified to choose the head of an "independent executive branch agency". If it's so danged independent, why is it even associated with the President? The President doesn't get to pick Supreme Court Justices, but I really don't like our President (whoever he may be now or in the future, being able to pick someone who has control over the very health of our entire nation. (which means he can fire him too) HECK NO!!!

Sec. 143. Consultation and coordination.
Requires the Health Choices Commissioner to consult with other regulatory bodies and state and federal agencies in carrying out his duties and to ensure appropriate oversight and enforcement.


Mark: Does "consulting" mean the new Commissioner is really those other agencies' boss, too? I mean someone has to answer to those other regulatory bodies, state and federal agencies. I doubt that is going to include the new Commissioner. He is probably not going to have to answer to anybody but THE PRESIDENT. Why shouldn't he answer to the Senate first, or one of their committees on health care?

Also, on a related note...of course the AMA wants this to happen. They'll (doctors) will be getting more business than they've ever had!

This new agency is going to have to be BIG to handle all these things. That means new offices for them or even new building construction! I mean the high Health Commissioner should have his own building, right?  :sarcasm:

That is all for now...but I've only begun.

Edited by Mark, 19 July 2009 - 05:29 PM.

Mark
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#33 Mark

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Posted 19 July 2009 - 03:52 PM

Mark: I don't like this whole section.

Sec. 203. Benefits package levels.

The Health Choices Commissioner specifies the benefits that must be made available in each year – including a requirement that each participating plan provide one basic plan in each service area in which they operate. It is then optional for the plan to offer one enhanced and one premium plan. The differences between the three main plans (e.g. basic, enhanced and premium) are the levels of cost-sharing required, not the benefits covered. The Commissioner shall establish a permissible range of cost-sharing variation that is not to exceed plus or minus 10 percent with regard to each benefit category.

There is a fourth tier called premium-plus. In this package, plans can offer extra benefits like dental or vision coverage for adults, or other non-covered benefits. To ensure consumers know what they are paying extra for, these packages must detail the cost of the extra benefits separately. Plans may offer multiple premium-plus options.
States can require the application of state benefit mandates to all Exchange participating plans, but only if there is an agreement with the Commissioner that the state will reimburse the Commissioner for any additional costs of affordability credits in that state due to the State benefit requirements.


Mark: First, there may not be a difference the care people get, but there is a difference in cost, or "cost sharing". I don't even want the term "affordability credits". What is this "credit" crap? At any rate, the wording in this section has to go, as does creating "tiers" of cost sharing. We'll go into more of this later.

Sec. 204. Contracts for the offering of Exchange-participating health benefits plans.
Lays out the responsibilities for the Health Choices Commissioner’s contracting authority including the solicitation of bids, negotiation with plans and the entering into contracts with approved plans (that will be for at least one year of duration and can be automatically renewed). Requirements include that plans be licensed in the state in which they plan to do business, abide by data reporting requirements as outlined by the Commissioner, provide for the implementation of affordability credits, and additional requirements.
The Commissioner is required to establish processes to oversee, monitor, and enforce requirements on the plans. The Commissioner has the authority to terminate plans that fail to meet the required standards.


Mark: Nope! That means the Commissioner is in complete control, and the President is in complete control of him. NO, NO, HECK NO! Obama picks the new Commissioner who gets to create negotiate all the contracts (in other words decide which companies and other business gets the money). NO NO NO I don't think I would've trusted Walter Cronkite to be given that much potential for corruption! ((((((((((Walter))))))))))
This bill is giving our President, and his minions broad-ranging power over us, an entire industry, and they're gonna fine us if we don't participate. I was wrong earlier...that's not just socialism, that's communism, with a touch of dictatorship thrown in. :headshake:

Sec. 2402 – Assistant Secretary for Health Information.
Creates a Bureau of Health Information, headed by a new Assistant Secretary for Health Information (established under this section), to provide full and complete statistics on key health indicators and to facilitate better data sharing.
Sec. 2403 -- Authorization of Appropriations. Authorizes an additional $300 million for quality improvement and data-related activities to be appropriated from the Public Health Investment Fund (under Sec. 2002). (Such funds are over and above the level of appropriations provided for FY 2008.)


Mark: I doubt I should have to say I'm already appalled that yet another Federal Bureau is being created here, and $300 million is going to a very vague quality improvement (what, more $300 for a hammer deals?), and "data related activities" which I've already stated somewhere else that our government should already have! This on top a a new census questionnaire? They're going to know everything about each individual for health care service, and this IS AN INVASION OF OUR PRIVACY, as stated by others elsewhere.

All the Republicans are crying "JOB KILLER", but I don't think so. I think it will create jobs, but guess who gets to pick who gets those jobs? So, I'm not having a problem with it creating jobs, just who gets to choose who chooses, etc...

I've written enough for y'all to chew on for a couple of days.

Who drafted this bill? If this is the best we've got to offer in this nation, then I and a few others from this website who I consider much more intelligent than the people (whoever they were) who wrote this bill, need to be going to Washington helping draft these things. The current draft is pitiful! Especially considering the importance of and broad ranging implication of such a bill!!
And take note I edit nearly every post I write on this website. At least I'm willing to concede if and when I make a mistake.

Edited by Mark, 19 July 2009 - 04:51 PM.

Mark
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#34 Mark

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Posted 19 July 2009 - 06:18 PM

Mark: I point everyone to this article I found earlier, that interviews several key administration people, along with economy experts.

Obamas' Rosy Scenario Turns Thorny

Please read the whole thing, but here is a bit from the article...

“They used a rosy forecast, and that’s understandable because a quick recovery makes the rest of the agenda possible. It creates the basis for the revenues you need for health care and climate change,” said Robert Shapiro, a former Clinton economic adviser.

“But it’s also dangerous and risky because if the forecast doesn’t come true, you’ve undermined the basis for the rest of your policies,” he added.

White House officials note that at the time of their forecasting, the depth of the crisis was less clear. For instance, the global reach of the downturn wasn’t fully apparent late last fall.

Another challenge was that the slowdown “was going from a relatively normal recession into something much worse, and we were at a pivot point, if not a turning point,” Romer said.

“There was just inherently a lot of uncertainty. None of us has a crystal ball, especially at a time when there is a lot of new information coming in. That’s when you have to be ready to update. That’s certainly what a lot of forecasters have done and what we will do, as well,” she added.

Those outside forecast adjustments have been almost universally in a downward trend.

White House officials began to lay the groundwork for the politically ill-timed revisions when Vice President Joe Biden recently conceded the administration had “misread” the economic indicators in January about how bad the economy actually was.

Obama later amended those remarks, saying the White House had “incomplete” information, which led to their miscalculations.

Either way, those admissions appear to pave the way for a significant rewrite of the White House’s economic outlook, starting with it growth predictions.

“Those numbers will prove to be much, much too optimistic,” said J.D. Foster, a former economic adviser in the Bush administration.

To appreciate the potential problems that can arise once those numbers are changed, consider this:

The White House projected revenues for 2012 are forecast at $3.1 trillion. But if growth is just 2 percent, rather than around 4 percent, as some economists now expect, that income would hover around $2.4 trillion — adding another $700 billion to the projected deficit of $581 billion.

“That would be a significant change in the deficit,” said Foster, who did the math.

Mark
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Peace is not the absence of conflict, but the ability to cope with it.
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#35 Captain Jack

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Posted 19 July 2009 - 07:04 PM

http://www.ibdeditor...332548165656854

Quote

It's Not An Option

By INVESTOR'S BUSINESS DAILY | Posted Wednesday, July 15, 2009 4:20 PM PT

Congress: It didn't take long to run into an "uh-oh" moment when reading
the House's "health care for all Americans" bill. Right there on Page 16 is a provision making individual private medical insurance illegal.

When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee. It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

The full article is in the link.

The more I read, the more I do NOT like this cr*p...
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#36 Dev F

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Posted 19 July 2009 - 10:29 PM

View PostMark, on Jul 19 2009, 03:34 PM, said:

Not sure why Obama, or any President thinks they're qualified to choose the head of an "independent executive branch agency". If it's so danged independent, why is it even associated with the President? The President doesn't get to pick Supreme Court Justices, but I really don't like our President (whoever he may be now or in the future, being able to pick someone who has control over the very health of our entire nation.
How's that? The president does get to pick Supreme Court justices (we're having the confirmation hearings for his first pick right now!), just as he gets to select any number of other government officials who are supposed to serve in an independent capacity. I mean, who but the head of the executive branch would be in a position to select them?

And for the record, he doesn't get to just install whomever he wants as "health choices commissioner" without question; according to the text of the bill, he's required to secure "the advice and consent of the Senate," just as with any other appointment. This is not anything out of the ordinary.

View PostCaptain Jack, on Jul 19 2009, 07:04 PM, said:

http://www.ibdeditor...332548165656854

Quote

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.
This paragraph is from the section on "Grandfathered Health Insurance Coverage." It doesn't claim to prohibit all individual coverage, just "such coverage" as described in this particular section -- i.e., grandfathered coverage. I believe the idea is that to ease the transition, existing insurance plans would be made exempt from the "qualification" requirements of the new legislation. The paragraph just establishes that you can't grandfather in a plan that wasn't actually in existence before the new legislation becomes law. Presumably you'd still be able to purchase a new individual plan; it just wouldn't be exempt from whatever additional requirements this legislation would establish.

Edited by Dev F, 19 July 2009 - 11:33 PM.


#37 Mark

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Posted 20 July 2009 - 08:53 PM

View PostDev F, on Jul 19 2009, 09:29 PM, said:

View PostMark, on Jul 19 2009, 03:34 PM, said:

Not sure why Obama, or any President thinks they're qualified to choose the head of an "independent executive branch agency". If it's so danged independent, why is it even associated with the President? The President doesn't get to pick Supreme Court Justices, but I really don't like our President (whoever he may be now or in the future, being able to pick someone who has control over the very health of our entire nation.
How's that? The president does get to pick Supreme Court justices (we're having the confirmation hearings for his first pick right now!), just as he gets to select any number of other government officials who are supposed to serve in an independent capacity. I mean, who but the head of the executive branch would be in a position to select them?

And for the record, he doesn't get to just install whomever he wants as "health choices commissioner" without question; according to the text of the bill, he's required to secure "the advice and consent of the Senate," just as with any other appointment. This is not anything out of the ordinary.

View PostCaptain Jack, on Jul 19 2009, 07:04 PM, said:

http://www.ibdeditor...332548165656854

Quote

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.
This paragraph is from the section on "Grandfathered Health Insurance Coverage." It doesn't claim to prohibit all individual coverage, just "such coverage" as described in this particular section -- i.e., grandfathered coverage. I believe the idea is that to ease the transition, existing insurance plans would be made exempt from the "qualification" requirements of the new legislation. The paragraph just establishes that you can't grandfather in a plan that wasn't actually in existence before the new legislation becomes law. Presumably you'd still be able to purchase a new individual plan; it just wouldn't be exempt from whatever additional requirements this legislation would establish.

Mark:
How comforting.
Mark
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#38 Hibblette

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Posted 20 July 2009 - 10:11 PM

We can find the money for a war but we can't find the money for health care.

Wow!
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#39 Omega

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    Maktel shcree lotak meta setak Oz!

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Posted 21 July 2009 - 07:57 AM

Find, create, something like that anyway...

#40 RobL

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Posted 21 July 2009 - 09:10 AM

View PostHibblette, on Jul 20 2009, 08:11 PM, said:

We can find the money for a war but we can't find the money for health care.

Wow!

Bullets are cheaper. Especially when you buy them in bulk like the US government does.

Bring back Darthsikle!




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