Healthcare reform

[lostfan]

Medicare has a forced cost control mechanism that private doesn't have, thus any comparisons between the two are null and void -- as you are comparing apples to oranges.

 

IE, the government often just decides it's not paying what it promised to the doctors via Medicare, or pays less...and there isn't anything they can do about it. The private industry, however, doesn't get away with that.

It wasn't a comparison.

[Y2HH]

It is also going to prove a lot towards what government run health care would look like, as fewer and fewer medical facilities and doctors are willing to accept Medicaid patients because of the lower payouts The idea that the medical profession will do a lot more work, for a lot less money is the central pillar of this plan, and it is false.

 

Right, and I don't see why people don't seem to get that. But it is what it is.

[Y2HH]

It wasn't a comparison.

 

Yes, it was.

[Y2HH]

You are all outright comparing the rising costs of medicare to private insurance, then saying it's not a comparison.

 

Nevermind.

 

This is once again, as I said from the VERY beginning of this discussion years ago -- to those who believe, no explanation is necessary, to those who don't believe, no explanation will do.

[lostfan]

WTF are you talking about, no, I wasn't making a comparison, I linked a chart that said "X amount is spent on private insurance and increases at this rate and Y amount is spent on public insurance and increases at this rate" and then I explained WHY I linked it and then I said what exactly I meant when I posted it (i.e. not a comparison, I was talking about how fast public health insurance was growing) more than once and you still are making my points for me? What color is the sky where you live?

Edited March 10, 2010 by lostfan

[Y2HH]

WTF are you talking about, no, I wasn't making a comparison, I linked a chart that said "X amount is spent on private insurance and increases at this rate and Y amount is spent on public insurance and increases at this rate" and then I explained WHY I linked it and then I said what exactly I meant when I posted it (i.e. not a comparison) more than once and you still are making my points for me?

 

I never said you, in specific.

[Y2HH]

I think you and I see the graph in question and come to an opposite conclusion

 

1990 expenditures (all values approximate):

 

Private insurance: $200 billion

Medicare: $100 billion

Out of Pocket: $130 billion

Medicaid (Federal + State) $75 billion

 

2007 expenditures:

Private Insurance; $670 billion

Medicare: $400 billion

Out of Pocket: $275 billion

Medicare + Medicaid: $300 billion

 

There are a few trends I get from that. Yes, the government share has gone up, but the slope of "Private insurance" is higher than the slope of Medicare by quite a bit. Private insurance has gone up by a lower percentage, but that's only because the starting values were so different. Medicare has gone up by quite a bit less than private insurance overall and per year.

 

The thing that has really, really shot upwards other than private insurance is Medicaid. In other words, it's the cost of covering the uninsured, which is, as I keep saying, a big reason to motivate this, because there are cheaper and better ways to do that.

 

There is the comparison I'm talking about. Let's not pretend it WASN'T a comparison now.

[lostfan]

You said "you are all" when it was me and Balta talking, what else am I supposed to deduce from that? I mean really now. I go out and I look at these graphs on my own, I don't listen to the rabbling because it's mostly worthless. To me, by far the most depressing thing about the last 18 months or so of this debate is that it shows me how intellectually lazy people in this country are. (Y2HH this last sentence doesn't apply to you)

Edited March 10, 2010 by lostfan

[Y2HH]

You said "you are all" when it was me and Balta talking, what else am I supposed to deduce from that? I mean really now. I go out and I look at these graphs on my own, I don't listen to the rabbling because it's mostly worthless. To me, by far the most depressing thing about the last 18 months or so of this debate is that it shows me how intellectually lazy people in this country are. (Y2HH this last sentence doesn't apply to you)

 

Well, I defiantly cannot argue what you said there. While I may not agree with all aspects of Healthcare reform with the users on Soxtalk, at the very least they are informed in SOME WAY. It's really amazing to me when you discuss this issue with random people how uninformed they are, about EVERYTHING to do with this subject. Most of them repeating things they've heard from either side, without ever bothering to research or read up on their own.

[lostfan]

Well, I defiantly cannot argue what you said there. While I may not agree with all aspects of Healthcare reform with the users on Soxtalk, at the very least they are informed in SOME WAY. It's really amazing to me when you discuss this issue with random people how uninformed they are, about EVERYTHING to do with this subject. Most of them repeating things they've heard from either side, without ever bothering to research or read up on their own.

Yeah usually within about 10 seconds I can tell whether someone actually tried to learn about it or they just skimmed TV or went to an echo chamber on the internet. Actually not just healthcare but about politics in general. People love to rant about things, but if something is complicated they don't bother to learn, that's too much work.

[Balta1701]

Medicare has a forced cost control mechanism that private doesn't have, thus any comparisons between the two are null and void -- as you are comparing apples to oranges.

 

IE, the government often just decides it's not paying what it promised to the doctors via Medicare, or pays less...and there isn't anything they can do about it. The private industry, however, doesn't get away with that.

If health insurance companies have no cost control mechanism, then what exactly are they good for?

[Y2HH]

If health insurance companies have no cost control mechanism, then what exactly are they good for?

 

Again, you blame health insurance when they aren't the ones sending the bills, but unlike the federal government, private industry can't just say, "we aren't paying you that", or they lose the business.

 

This is the same tireless argument about health care reform.

 

This isn't health care reform, it's health insurance reform.

 

The insurance companies are NOT the ones sending the bills.

 

The insurance companies are NOT the ones sending the bills.

 

The insurance companies are NOT the ones sending the bills.

 

Seems that no matter how many times I say that, people still don't get it...or don't want to get it.

Edited March 10, 2010 by Y2HH

[Balta1701]

It is also going to prove a lot towards what government run health care would look like, as fewer and fewer medical facilities and doctors are willing to accept Medicaid patients because of the lower payouts The idea that the medical profession will do a lot more work, for a lot less money is the central pillar of this plan, and it is false.

I could go through all the international data again but that's not worth doing. There's a key flaw in your line of thinking...you're assuming that there will always be a supply of customers from the private market that are willing to pay increasing prices through eternity. Your argument is correct in that case; if a doctor's office can choose between providing the same service to an equal number of patients at a higher cost and a lower cost, he's going to choose the higher cost group every time.

 

The flaw, of course, is that this is exactly what is happening in our current system, and it is directly related to it being broken; there is no downward pressure from any source. The insurance companies don't push prices down, Medicare does somewhat but only in a limited way, and thus, there's nothing to resist infinite cost increases until the system breaks fully.

 

The actual reality is that this market is much more likely to respond like a market. In other words, only so many doctors can say they won't treat patients if their insurance isn't willing to pay above a certain price level for a certain procedure before doctors start finding they have no customers remaining because their rates are too high.

 

The idea that the medical profession can grow infinitely forever is a central pillar of the opposition to this plan, and to how we've legislated for the last 20 years, and paying $15,000/family per year on health insurance is a direct result of it.

[Balta1701]

Again, you blame health insurance when they aren't the ones sending the bills, but unlike the federal government, private industry can't just say, "we aren't paying you that", or they lose the business.

Then your argument is that health insurance companies do nothing to hold down health care costs but add a nice additional layer of bureaucracy in there to increase costs.

[Y2HH]

Then your argument is that health insurance companies do nothing to hold down health care costs but add a nice additional layer of bureaucracy in there to increase costs.

 

Yes, that's exactly what I said.

 

That is the most senseless logic I've EVER heard on this board. I mean that...EVER. That's like saying the people who make car radios do nothing but increase the cost of cars. Health insurance, like any insurance, is a service. A necessary one in many regards, from life, to auto, to home. To pretend it's not, is just...well, f***ing stupid.

 

Insurance is a necessary thing in this world, to pretend it's not is naive. I'm not giving the insurance companies a free pass in this, they don't deserve one. That said, while there are many things that can be done to reign in insurance companies, attacking them and only them isn't the answer...the doctors, hospitals, and all that lies between, including the drug companies, need to be reformed, too.

 

I've made this point from the beginning.

 

You and many others who support Obamacare ignore this point...and continue to ignore this point.

Edited March 10, 2010 by Y2HH

[lostfan]

Insurance companies haven't really been helping but they aren't the problem all by themselves, it's probably the way we practice medicine in this country, and the fact that it's just bogged down by so much inefficiency.

[Balta1701]

Insurance is a necessary thing in this world, to pretend it's not is naive. I'm not giving the insurance companies a free pass in this, they don't deserve one. That said, while there are many things that can be done to reign in insurance companies, attacking them and only them isn't the answer...the doctors, hospitals, and all that lies between, including the drug companies, need to be reformed, too.

But what's the one thing that exists in most other markets that doesn't exist in the health insurance market...exactly as you've noted? A downward pressure on pricing. If some product you want gets too expensive, you either shop around or don't buy it. You can't do that in the health care market; you can't exactly decide to not buy heart surgery because it got too expensive (unless we follow the Republican plan /cheapshot). It's even difficult to shop around, if your insurer limits who you can go to.

 

Thus, you're told you need certain amounts of care, and you get it, and the bill is paid for by you indirectly through a lower salary. There is no point at which there is any downward pressure on prices anywhere in the system; it really is divorced at every step from normal capitalist tendencies.

 

The drug companies, doctors, hospitals, yes they need to be reformed. But this bill actually has multiple things in it that do that. It's not perfect and I'm not pretending it is, but steps like comparative effectiveness research, independent pricing committees for Medicare, and an exchange market where people can actually switch insurance if another plan is getting better results at lower costs...those are key steps in that direction, and those downward pressures 2k5 likes to say are impossible are the classic way normal economics would work to start pushing those other industries in the right direction as well.

[Y2HH]

Insurance companies haven't really been helping but they aren't the problem all by themselves, it's probably the way we practice medicine in this country, and the fact that it's just bogged down by so much inefficiency.

 

This I can agree with.

 

I'm for health care reform, I've said this many times. What I'm not for is just tossing a bunch of s*** on paper and passing it without even knowing what it stands for or how it will work when implemented. I consider this an intelligent country, overall, and we need to be smart about this. They want to call this "comprehensive", fine -- though this has become a bulls*** government word that does nothing more than make whatever issue we are discussing sound bigger.

 

What we've done thus far isn't smart. It's flat out dumb. It's kneejerk garbage that we usually get as of late. Quickfix after quickfix, when the underlying problem is still there. You can stick a huge bandaid on a gaping wound, but unless you heal that wound, you've done nothing but cover the real problem that lies beneath.

 

If they're going to reform this, they need to reform ALL of it.

 

* Doctors

* Hospitals

* Drug companies

* Generic drug companies

* Pharmacy's

* Hospitals

* Administration

* Insurance

 

THAT is comprehensive reform.

 

What we have right now is this:

 

2000+ pages of lawyer speak bulls*** about one thing and one thing only...

 

* Insurance

 

That, ladies and gents, is a bandaid over a huge f***ing gaping wound...nothing more.

[Balta1701]

Honestly, between as many things as we've seen demonized in this bill and as many lectures as we've heard about it being 2000 pages of government takeovers, do you actually think it would be possible to write and pass a bill that directly reformed every single thing on your list all at the same time?

 

There's a reason why this one is aimed at reforming insurance companies. Because there's only so many lobbies you can take on at once. If this bill makes things better, then it's worth passing. The phrase "Don't let the perfect be the enemy of the good" applies here.

[lostfan]

Honestly, between as many things as we've seen demonized in this bill and as many lectures as we've heard about it being 2000 pages of government takeovers, do you actually think it would be possible to write and pass a bill that directly reformed every single thing on your list all at the same time?

 

There's a reason why this one is aimed at reforming insurance companies. Because there's only so many lobbies you can take on at once. If this bill makes things better, then it's worth passing. The phrase "Don't let the perfect be the enemy of the good" applies here.

Not without creating a national healthcare system which in this country is a non-starter.

[Balta1701]

Not without creating a national healthcare system which in this country is a non-starter.

I'd be game.

[Y2HH]

Honestly, between as many things as we've seen demonized in this bill and as many lectures as we've heard about it being 2000 pages of government takeovers, do you actually think it would be possible to write and pass a bill that directly reformed every single thing on your list all at the same time?

 

There's a reason why this one is aimed at reforming insurance companies. Because there's only so many lobbies you can take on at once. If this bill makes things better, then it's worth passing. The phrase "Don't let the perfect be the enemy of the good" applies here.

 

And there in lies the rub.

 

That's quite a big "IF".

 

Now, for just a second, let's stop pretending our government does anything right the first, second, third or nine hundredth time and recognize that they almost always do it wrong, with more inefficiencies than any other entity in the known universe. Therefore the odds are against this being better than what we currently have.

 

In that case, it's NOT worth passing. While both are big IF's...going by their modern track record...this is doomed to fail.

Edited March 10, 2010 by Y2HH

[jasonxctf]

here's what i dont understand...

 

why wouldn't creating a very, very, very generic basic plan, that has high deductibles that would really only be used in emergency situations for all citizens be a bad idea? Then you and i can go to a BCBS or Humana, etc and buy riders that would cover us the way that we'd like to be covered.

 

So the govt basic plan, would cover anyone/everyone who say gets into a car accident and has no other insurance. (but not for day-to-day stuff) That eliminates those uninsured rolling into emergency rooms without insurance and getting jacked on costs that gets passed along to taxpayers. This plan, the govt would not manage but coordinate and sell off into pools with existing insurance companies. (basically allowing all citizens to buy in bulk at lower costs.)

 

Then, either employers or individuals would get rider insurance to cover things like Dentist Costs, Periodic Checkups, General Practioner Stuff, Flus/Colds, OBGYN, etc.

 

At the end of the day, everyone is insured for the catastrophic stuff that costs the most. We still have individual control to get better plans, upgrades, riders to provide us with the coverage we all want.

[Balta1701]

And the answer is...the bill actually does. Betcha didn't know that.

 

It does so only on a temporary basis, but it does create one. There's a reason why they only are doing so temporarily, because that model has been tried before and it failed for a very good reason; it gives the insurance companies a place to put the unhealthy/expensive. So it winds up being a budget buster unless you team it with a requirement that the insurance companies can't reject people in some way. At which point, you're back at this bill.

Rick Curtis with the Institute for Health Policy Solutions in Washington says he expects this program to run into the same problems as California's did: Waiting lists. Tight restrictions on eligibility. State officials worry the states will end up paying. Curtis says it lets insurance companies off the hook.

 

CURTIS: Insurers still don't have to take the high-risk, and we'll take the high-risk and then you have to pay for it with tax revenues.

[kapkomet]

That's not a reason to agree with Pelosi, whose point in this case is vapid and obnoxious. Vote for it to see what's in it? Seriously? That's a load of crap, no matter what you think of the bill or its parts.

 

What this is, is a reason to be frustrated with the media.

 

 

No it's not. NO ONE knows what's in the bill because they are still negotiating what they are going to do or not do. That's ok, though, we have to listen to Barackus the Great campaign about health care for the 1,346,234,365,356,457,927th time. Hey f***tard, what part of NO do you not understand? And ironically, the deficit is even higher then his campaign trips on health care.