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Health care reform: good article on it

Health care Health Care Reform 2009

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#1 Spectacles

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Posted 22 July 2009 - 11:01 AM

This article does a good job of concisely showing how much health care costs us, how the cost is increasing, how ideological approaches to solving it are flawed, and how lobbyists (including former lawmakers from BOTH parties, like Gephardt and Armey) are profiting from their efforts to help the big insurers preserve the status quo.

http://www.nytimes.c...onhardt.html?hp

Quote

The United States now devotes one-sixth of its economy to medicine. Divvy that up, and health care will cost the typical household roughly $15,000 this year, including the often-invisible contributions by employers. That is almost twice as much as two decades ago (adjusting for inflation). It’s about $6,500 more than in other rich countries, on average.

We may not be aware of this stealth $6,500 health care tax, but if you take a moment to think, it makes sense. Over the last 20 years, health costs have soared, and incomes have grown painfully slowly. The two trends are directly connected: employers had to spend more money on benefits, leaving less for raises.

In exchange for the $6,500 tax, we receive many things. We get cutting-edge research and heroic surgeries. But we also get fabulous amounts of waste — bureaucratic and medical.

One thing we don’t get is better health than other rich countries, whether it’s Canada, France, Japan or many others. In some categories, like emergency room care, this country seems to do better. In others, like chronic-disease care, it seems to do worse. “The fact that we spend all this money and don’t have better outcomes than other countries is a sign of how poorly we’re doing,” says Dr. Alan Garber of Stanford University. “We should be doing way better.”


Also, Obama is to give an address/press conference this evening on health care reform. I may even watch it.

A side-drama to this battle that's interesting to me is the opposition Obama is getting from some within his own party who are frustrated because, according to this article, they can't get a firm sense of where he stands.

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

The Clinton health care reform ran into resistance from within their party also, with a Democratic senator from Tennessee doing his best not only to derail their health care reform plan but also trashing Hillary personally. When she first appeared before Congress to present the plan, her press was great. Everyone was impressed by her intelligence, her articulateness, her command of information. But the image of the competent, intelligent Hillary was replaced almost overnight by the image of Hillary as Lady Macbeth. (Several major insurers have their home offices in Nashville and are major contributors to Tennessee politicians. He was defending his major benefactor.)

So something to keep in mind as we read the debates on health care is how governance in the U.S. has become thoroughly corrupted because of the exorbitant cost of winning and remaining in office. Politicians in BOTH parties are for sale to the highest bidders. This means far too many will support policies that actually harm average citizens if those policies benefit the industries that bankroll their political careers.

But it's also interesting to look at this as a defining moment of the Obama presidency. Where will he draw the line? What is non-negotiable? We'll learn more about him from how he handles this.

Edited by Spectacles, 22 July 2009 - 11:03 AM.

"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#2 QueenTiye

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Posted 22 July 2009 - 01:43 PM

Thank you, Specs - this is truly some moment in our nation.  I find it riveting, scary and exciting, all at the same time.  Like him or no, disagree with him or no, I happen to be glad that President Obama is the president in this time.  I don't feel like he's sinking under the weight of it all, and given how momentous so much of it is - that's saying something.

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#3 Themis

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Posted 22 July 2009 - 02:04 PM

There's an article in today's Tennessean about how our "Blue Dog" Democrats are at work to block health reform bills.  My first reaction was "gee, could it be because so many insurance companies and for-profit health care operations have headquarters here?"

Address tonight?  One of those all-network things?  What time?
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#4 Nittany Lioness

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Posted 22 July 2009 - 03:23 PM

quote:
"how much health care costs us, how the cost is increasing, how ideological approaches to solving it are flawed,"

So a big issue is cost?  But the latest from the proponents of this massive thing is - costs will not go down.
Now they're only touting -- health insurance will be available to everyone.  
The fantasy of reducing the cost of diagnosing and healing people isn't going to be a benefit, afterall.
Tail is wagging the dog, and Obama hasn't even read this whole thing.
But shove, shove, shove.

Edited by Nittany Lioness, 22 July 2009 - 03:24 PM.

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#5 Cardie

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Posted 22 July 2009 - 04:58 PM

I see this heading down the path that immigration reform took.  In that instance, people were not interested in what to do with undocumented workers living here until they knew the borders were secure.  Now I think we need to separate the effort to rein in healthcare costs from the desire to guarantee that everyone can obtain insurance.

The problem is that reining in those costs requires actions that government can't control.  It sounds like hospitals putting doctors on salaries, finding some way through tort reform and new payment structures to reimburse per illness, for example, rather than what procedures are run would establish norms for what tests, procedures, and other sorts of care look to be the standard for good outcomes.  Disincentivize the piling on of the above to maximize profits or avoid lawsuits. (And stop prescription drug advertising, for heavens' sake.  Patients end up pressuring their doctors for expensive meds they don't really need.)  But I don't know how you do this unless every insurer, public and private, simply says they won't pay for the excesses currently rampant.

And I'd start out with the health co-op idea, with a commission describing the sorts of plans and premiums they consider acceptable and then allowing any insurer who will meet them to compete in this market.  To keep large employers from dumping people into the co-operative, I would require that they contribute some sum per employee to a fund that subsidizes premiums for the co-op based on a sliding income scale if they choose not to offer their employees a health plan.

But one simple benefit that could be enacted fairly easily is for Congress to pass a law that says 1) insurers may not refuse coverage/treatment or charge different rates because of pre-existing conditions and 2) once you've ever had insurance and have not defaulted on your premiums, you can sign on to another insurance plan with guaranteed acceptance.

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#6 Spectacles

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Posted 22 July 2009 - 06:49 PM

The press conference begins at 8 ET (ten minutes) and you can watch it live here:

http://www.cnn.com/live/


I think the major networks are carrying it, too.
"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#7 Shalamar

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Posted 22 July 2009 - 09:38 PM

I think that this is going to be the sword over Obama's head his entire presidency - no, not health care, but people having no idea where he stands - until his stance is bought and paid for.

However lets talk health care:

government-funded public health insurance option - Check - I'm for it

mandates for people to be insured - Check - I'm for it

Employers to provide coverage - Very Modified Check - I've got conditions and reservations as to how it would impact small businesses

No more lack of coverage due to a pre-existing condition.- Check - I'm for that  

Those put me on the side away from the Republicans

limits on medical malpractice lawsuits - Check - Hell yes

Puts me away from the Democrats

Cleaning up inefficiency and out and out waste in hospital, insurance company and other health care beaucracy - Absolutely!!! This is - in my eyes - one of the biggest areas of spending failure in America today - to heck with Defense contractors and their 600 dollar wrenches - what about $3500 MRI's and the additional $3000 for a doctor to interpert the results.

Yes that is the rounded down figures I was quoted to get an MRI.

My doctors want me to have two a year...
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#8 Jorgasnarova

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Posted 22 July 2009 - 11:39 PM

The recent PBS documentary "Frontline:  Sick Around the World", which I'm sure can be viewed at the pbs.org site,  compared and contrasted several national health care systems in various asian and european countries.  

Are we stubbornly trying to re-invent the wheel here, or are the Obama proposals based in part on what has been proven to work and not work with our neighbors?

#9 QueenTiye

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Posted 22 July 2009 - 11:55 PM

View PostJorgasnarova, on Jul 23 2009, 12:39 AM, said:

The recent PBS documentary "Frontline:  Sick Around the World", which I'm sure can be viewed at the pbs.org site,  compared and contrasted several national health care systems in various asian and european countries.  

Are we stubbornly trying to re-invent the wheel here, or are the Obama proposals based in part on what has been proven to work and not work with our neighbors?


This is America.  Of COURSE we're reinventing the wheel. It has to be a uniquely AMERICAN wheel, or else we might become socialist, or French or something.  Maybe French Canadian.  

Shalamar - I don't think the president is opting for a bought solution - I think the congress is already bought.  I think the president is trying really hard to not out them too publicly, so that he can negotiate with them to get the job done, without them getting too much heat at home.  Whether this is what he should do or not - is debatable at this point, but that's the way it looks to me.  It looks like he's keeping quiet to let congress do something that straddles the fence, while articulating the goals of health care reform to the American people so as to sell it from the outside.

For better or worse - this is a president who firmly believes in talking to the people directly, and making the people pressure their elected officials.  That's his at home and away policy, born of being a community organizer.  I personally appreciate it, and at the same time recognize its limitations.  But if his method can't work - I wonder what it really says about democracy in the 21st century?

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#10 RobL

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Posted 23 July 2009 - 03:56 AM

Off the top of my head, I dont know why this is so complicated.

Set up a single, standard across-the-board premium and co-pay that most people can afford. Make that premium 100% deductable for the middle class and below so that you can get a dollar for dollar refund back at tax time. Make it so the provider can't cancel or deny service. That way, it would be in the provider's best interest to keep expenses down (i.e. not charging $10k for a MRI or $15 for a asprin).

If a dirt-poor citizen without a nickel to his name can't afford the premium, they can apply for a grant where the government pays their deductable, or, the provider can write off those deductables on their year end tax statements.

That way, instead of being on the backs of taxpayers, its on the back of the industry itself. They already make huge profits each year. If they can make it work for them now then they can tweak the system to make it work with more people enrolled.

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#11 Aric

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Posted 23 July 2009 - 06:16 AM

I've never seen the PBS program you describe, Jorgasnarova, but from what I know about health care systems, I would tend to agree with QT, the US is definitely taking an approach unlike Western Europeans, plus Canada/Japan.  Even if the US achieves universality, there remains a critical difference, and that has to do with the application of risk.  Older people (not under Medicare), the chronically ill, people with pre-existing conditions, etc, are higher risk than healthy people, and in the US, premiums reflect this reality, by placing more costs on those who are more likely to use the system.  In places like Switzerland, or Germany, the government assesses the risk factors of any particular individual, and based on that assessment, the insurance company that the individual chooses to purchase insurance from gets paid to insure that individual, based on his health risk factors by the government, not the individual.  The government collects from the individual an insurance premium that has usually next to nothing to do about his health factors, instead based on capacity to pay.  Any difference between what the government collects from the individual and what the government pays the insurer to cover him is subsidised.

So in that regard, by essentially de-linking an individual's premiums he pays from what his risk factors are, and instead linking them to his capacity to pay, we have then a system that maintains affordability for all individuals, while ensuring the insurance companies get paid properly to insure people based on their risk factors, and subsidising any difference.  This to my knowledge will not be happening in the US, which stands as perhaps the most significant difference that I can see, and exposes the risk that premiums will continue to rise and endanger the affordability of plans, even if insurers are not allowed to remove coverage, they can still price it out of reach, or if the government continues to step in to ensure affordability, it will continue health care's rapid cost growth.  Both options are very unfavourable, of course.

Aric

#12 Nittany Lioness

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Posted 23 July 2009 - 06:40 AM

Medicaid and Medicare have risen in costs 1/3 more than the private sector.  The U.S. government will NOT reduce the price of health.  That is a fantasy.

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#13 Themis

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Posted 23 July 2009 - 08:01 AM

What Cardie and Shalimar said.  

But you expect logic to prevail in a government run by lobbyists?

How much are insurance companies paying lobbyists to make sure their interests are taken care of?  And how much are we paying in our insurance premiums to pay for those lobbyists?
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#14 Aric

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Posted 23 July 2009 - 10:13 AM

I'll admit Nittany Lioness I've never really looked at the cost growth of Medicare vs private insurance, so I'll happily concede to your data, but I would ask you this question.  How exactly does private insurance control the cost growth of health care?  It's demonstrably true that Medicare pays significantly less per procedure than private insurance ( http://www.lewin.com...signOptions.pdf ).  Medicare also has significantly smaller administrative costs as private insurance.  So how does private insurance do it?  They can't bargain better rates from hospitals than Medicare can, and based on a CBO research document I browsed ( http://www.cbo.gov/f...sues.pdf#page=1 ), the bulk of Medicare's growth is not from the number of new enrollees, but in fact the costs of the procedures, treatments, etc, themselves.

The theory I'm going to advance is this...  Private insurance controls their cost growth by rationing services by ability to pay.  Raising premiums, disallowing certain charges, limiting scope of coverage, denying coverage to people with pre-existing conditions, crafting policies that provide coverage for a hospital room but no actual medical procedures, higher deductables/co-pays, etc.  Because private insurance needs to produce a profit, unlike Medicare or Medicaid, they have a compelling interest to reduce their cost growth by minimising how much they pay out, along with maximising how much they take in.  Private medical insurance premiums go up faster than GDP for sure, a report I browsed showed it grew 6.1% in 2007, and a total of 78% for family coverage since 2001, compared to wage growth of 19% and inflation of 17% ( http://www.kff.org/i...hbs091107nr.cfm ).  I can envision a very persuasive argument demonstrating that due to the age factor of Medicare clients, they may potentially require more treatments, and ultimately higher costs per capita, but I'm not altogether convinced it would reflect in such a significantly higher cost growth, unless a disproportionate amount of the newest and most expensive treatments were being used by Medicare.  I'd be willing to be persuaded as to that reality, but on face I don't see how that's likely.

So is it a fantasy that government will be able to reduce the cost of health care?  Maybe.  After all, private insurance, hospitals, pharmaceuticals, none of them are really willing or prepared to give up their profits, and are fighting a particularly vicious campaign to try to stop any reform.  But on balance, closing this private insurance rationing and ensuring all US people are properly insured, covered by either a public insurer or a comprehensive private plan, is the first critical step to establishing control over costs.

Aric

#15 Themis

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Posted 23 July 2009 - 03:27 PM

View PostAric, on Jul 23 2009, 03:13 PM, said:

The theory I'm going to advance is this...  Private insurance controls their cost growth by rationing services by ability to pay.  Raising premiums, disallowing certain charges, limiting scope of coverage, denying coverage to people with pre-existing conditions, crafting policies that provide coverage for a hospital room but no actual medical procedures, higher deductables/co-pays, etc.  Because private insurance needs to produce a profit, unlike Medicare or Medicaid, they have a compelling interest to reduce their cost growth by minimising how much they pay out, along with maximising how much they take in.

...private insurance, hospitals, pharmaceuticals, none of them are really willing or prepared to give up their profits, and are fighting a particularly vicious campaign to try to stop any reform.  But on balance, closing this private insurance rationing and ensuring all US people are properly insured, covered by either a public insurer or a comprehensive private plan, is the first critical step to establishing control over costs.

Aric

Does anyone have any statistics to refute these statements?  To me they make far too much sense and it seems logical that if healthcare is doled out by entities trying to make profits for CEO's and stockholders, this can't be a good thing for the patient.
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#16 Aric

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Posted 23 July 2009 - 05:28 PM

Themis, I recommend reading some thoughts on the issue from Professor Reinhardt...

http://economix.blog...t-does-it-mean/

Aric

Edited by Aric, 23 July 2009 - 05:30 PM.


#17 Themis

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Posted 24 July 2009 - 11:44 AM

Printed to read shortly.

Meanwhile, people who object to reform proposals talk about waits to see doctors in other countries...it's a three-month wait to see a specialist at Vanderbilt!  My internist wants me to see two specialists and neither can see me until October...

I assume that there is a triage system at work and people with immediately life threatening conditions are seen sooner or at the ER.   Just as happens inother countries with universal health care.  Neither of my possible problems will be hurt by a wait.
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#18 Aric

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Posted 24 July 2009 - 03:26 PM

Krugman's latest in the NYT is also a good read on the situation...

http://www.nytimes.c.../24krugman.html

Aric

#19 Palisades

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Posted 24 July 2009 - 04:15 PM

Obama, I choose whichever color of pill does not result in this:
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Edited by Palisade, 24 July 2009 - 04:17 PM.

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