Healthcare reform

[kapkomet]

That seems like a great point. But I wonder if those uninsured are simply using the ER instead of a less costly clinic. Perhaps the system will see only a slight increase in patients, but a huge drop in uncollected treatments.

There is absolutely no way that we do not have MASSIVE wait times. There's too much of a shortage CURRENTLY - let alone when we "flood the system" (right) with all these new people (which they admit ALREADY that they can't get insured until past 2012 anyway!!!!). So why are they doing this again? To get uninsured people on the insurance plans? Riiiiiiiiiiight. Oh, to control costs? Yea, because they've done SO well on Medicare. The only way they get costs in line to Medicare (again, they admit this) is to cut the s*** out of the services offered. But it doesn't matter, they're all old and going to die anyway, so f*** 'em, who needs 'em?

 

[BearSox]

There is absolutely no way that we do not have MASSIVE wait times. There's too much of a shortage CURRENTLY - let alone when we "flood the system" (right) with all these new people (which they admit ALREADY that they can't get insured until past 2012 anyway!!!!). So why are they doing this again? To get uninsured people on the insurance plans? Riiiiiiiiiiight. Oh, to control costs? Yea, because they've done SO well on Medicare. The only way they get costs in line to Medicare (again, they admit this) is to cut the s*** out of the services offered. But it doesn't matter, they're all old and going to die anyway, so f*** 'em, who needs 'em?

 

Grandparents are overrated.

[Texsox]

There is absolutely no way that we do not have MASSIVE wait times. There's too much of a shortage CURRENTLY - let alone when we "flood the system" (right) with all these new people (which they admit ALREADY that they can't get insured until past 2012 anyway!!!!). So why are they doing this again? To get uninsured people on the insurance plans? Riiiiiiiiiiight. Oh, to control costs? Yea, because they've done SO well on Medicare. The only way they get costs in line to Medicare (again, they admit this) is to cut the s*** out of the services offered. But it doesn't matter, they're all old and going to die anyway, so f*** 'em, who needs 'em?

 

The way seems to me to take people out of the ERs for non emergency procedures. I keep reading, at least here where a large percentage of the population is uninsured, wait times in ERs can reach 10 hours or more. How can it not be an advantage to get them out of the ERs and into lower cost, and more appropriate for their ailment, clinics?

[StrangeSox]

There is absolutely no way that we do not have MASSIVE wait times. There's too much of a shortage CURRENTLY - let alone when we "flood the system" (right) with all these new people (which they admit ALREADY that they can't get insured until past 2012 anyway!!!!). So why are they doing this again? To get uninsured people on the insurance plans? Riiiiiiiiiiight. Oh, to control costs? Yea, because they've done SO well on Medicare. The only way they get costs in line to Medicare (again, they admit this) is to cut the s*** out of the services offered. But it doesn't matter, they're all old and going to die anyway, so f*** 'em, who needs 'em?

 

Let's get the AMA to stop artificially limiting the supply of doctors then.

[ChiSox_Sonix]

Switching topics, here's another look at global health systems and how much better France and the Netherlands do at health care than us. Good read. Somehow they manage to avoid doing exactly what 2k5 says is unavoidable.

 

What works in Country A does not necessarily mean it would work in Country B. But whatever.

 

[NorthSideSox72]

What works in Country A does not necessarily mean it would work in Country B. But whatever.

Which of course works both ways. Some things that work elsewhere would fail here, but some things that are problems overseas might not be an issue here.

 

[ChiSox_Sonix]

Which of course works both ways. Some things that work elsewhere would fail here, but some things that are problems overseas might not be an issue here.

 

Right but making the argument of such and such works one place so it must work here is one that comes up way too often. We are not Europe, but they are used all the time for comparison. Denmark, for example, can work a lot of social programs largely because they are a small country with a lot of high earning jobs in a place largely devoid of natural disasters and the top earners pay roughly 60% in tax. A lot of what they can do can not be done here. We're very similar to Europe in some ways, but also so very different in others you (not you) can't just say "well look at so and so, they do it so well" and expect the same situation if applied here. That's all.

 

 

[NorthSideSox72]

Right but making the argument of such and such works one place so it must work here is one that comes up way too often. We are not Europe, but they are used all the time for comparison. Denmark, for example, can work a lot of social programs largely because they are a small country with a lot of high earning jobs in a place largely devoid of natural disasters and the top earners pay roughly 60% in tax. A lot of what they can do can not be done here. We're very similar to Europe in some ways, but also so very different in others you (not you) can't just say "well look at so and so, they do it so well" and expect the same situation if applied here. That's all.

Just as often, I hear the argument that certain things won't work because "look at Canada!!!". Neither one sway me much.

 

[lostfan]

Right but making the argument of such and such works one place so it must work here is one that comes up way too often. We are not Europe, but they are used all the time for comparison. Denmark, for example, can work a lot of social programs largely because they are a small country with a lot of high earning jobs in a place largely devoid of natural disasters and the top earners pay roughly 60% in tax. A lot of what they can do can not be done here. We're very similar to Europe in some ways, but also so very different in others you (not you) can't just say "well look at so and so, they do it so well" and expect the same situation if applied here. That's all.

Just as often Europe is used as the example for what not to be (i.e. a socialist hellhole), also without any caveat.

 

 

Just as often, I hear the argument that certain things won't work because "look at Canada!!!". Neither one sway me much.

And Canada's problems are usually exaggerated for political purposes here. Their healthcare system is far from being the nightmare it's made out to be. Sure there's anecdotal examples of inefficiency or occasional failure but for every one of those you can probably come up with 3 or 4 here.

Edited July 7, 2009 by lostfan

[kapkomet]

Take the decisions out of the employers hands and give it back to the individual. That would help immensely.

[kapkomet]

Just as often Europe is used as the example for what not to be (i.e. a socialist hellhole), also without any caveat.

 

 

 

And Canada's problems are usually exaggerated for political purposes here. Their healthcare system is far from being the nightmare it's made out to be. Sure there's anecdotal examples of inefficiency or occasional failure but for every one of those you can probably come up with 3 or 4 here.

When people from Europe tell me how much better it is here, then I tend to believe it.

 

And it's more then "anecdotal" when so many people come here for their treatment of serious ailments. If you have a sinus infection, I'm sure that the system is fine to get a script of antibiotics.

[lostfan]

When people from Europe tell me how much better it is here, then I tend to believe it.

 

And it's more then "anecdotal" when so many people come here for their treatment of serious ailments. If you have a sinus infection, I'm sure that the system is fine to get a script of antibiotics.

Not really the point I was going for.

[southsider2k5]

The way seems to me to take people out of the ERs for non emergency procedures. I keep reading, at least here where a large percentage of the population is uninsured, wait times in ERs can reach 10 hours or more. How can it not be an advantage to get them out of the ERs and into lower cost, and more appropriate for their ailment, clinics?

 

Once again, to where? Where the heck are all of these empty clinics and doctors offices that I keep hearing about that people are going to flock to?

[southsider2k5]

Right but making the argument of such and such works one place so it must work here is one that comes up way too often. We are not Europe, but they are used all the time for comparison. Denmark, for example, can work a lot of social programs largely because they are a small country with a lot of high earning jobs in a place largely devoid of natural disasters and the top earners pay roughly 60% in tax. A lot of what they can do can not be done here. We're very similar to Europe in some ways, but also so very different in others you (not you) can't just say "well look at so and so, they do it so well" and expect the same situation if applied here. That's all.

 

The 50+% tax rate is a very relevant discussion point that is NEVER used when talking about places like Europe and Canada as well, and a very valid reason for their social programs. I doubt very many here want to see their taxes double/triple/quadruple, just so others can have insurance. Realistically that is the question at hand here. Do we want 50-60% effective tax rates?

[HuskyCaucasian]

For those fearful Obama is going to jam a public option down your throat, or is it up your ass?:

It is more important that health-care legislation inject stiff competition among insurance plans than it is for Congress to create a pure government-run option, White House Chief of Staff Rahm Emanuel said Monday.

 

"The goal is to have a means and a mechanism to keep the private insurers honest," he said in an interview. "The goal is non-negotiable; the path is" negotiable.

 

His comments came as the Senate Finance Committee pushed for a bipartisan deal. To help pay for the package, the committee planned to announce an agreement Wednesday with hospitals and the White House for $155 billion over a decade in reductions to Medicare and charity-care payments for hospitals, according to a person familiar with the agreement. That will help pay for the legislation, expected to cost at least $1 trillion over 10 years.

 

One of the most contentious issues is whether to create a public health-insurance plan to compete with private companies.

 

Mr. Emanuel said one of several ways to meet President Barack Obama's goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own. He noted that congressional Republicans crafted a similar trigger mechanism when they created a prescription-drug benefit for Medicare in 2003. In that case, private competition has been judged sufficient and the public option has never gone into effect.

 

Mr. Obama has pushed hard for a vigorous public option. But he has also said he won't draw a "line in the sand" over this point.

[ChiSox_Sonix]

When people from Europe tell me how much better it is here, then I tend to believe it.

 

And it's more then "anecdotal" when so many people come here for their treatment of serious ailments. If you have a sinus infection, I'm sure that the system is fine to get a script of antibiotics.

 

I had a teacher in college for several history classes. He was Canadian (he said 'zed'!) and did much of his schooling in England. He moved back to Canada after graduation and taught at McGill (a very, very nice university). He said he loved it there. But, when he and his wife started a family he moved to New York and began teaching at a state school. He said the difference in health care systems was the primary motivation for them to leave and come to the States

[kapkomet]

For those fearful Obama is going to jam a public option down your throat, or is it up your ass?:

Right. He's just SOOOOOO truthful. He's going to come right out and say, hell ya, I'm taking away insurance!

 

His own administration, and HE HIMSELF say that they believe in a single payor system. And now, they are going away from that? Bulls***. Of course they are going to say that, it's the only way it will pass.

 

[HuskyCaucasian]

Right. He's just SOOOOOO truthful. He's going to come right out and say, hell ya, I'm taking away insurance!

 

His own administration, and HE HIMSELF say that they believe in a single payor system. And now, they are going away from that? Bulls***. Of course they are going to say that, it's the only way it will pass.

They would prefer a single payer system. As would I. But when you are trying to get things done, sometimes you need to take steps. Little by little. And make compromises. I think the ultimate goal is something close to a single payer system, but you cant get there in one big leap as many would like. It's too politicaly hard to do.

[Cknolls]

This is what I want:

 

http://www.boston.com/news/nation/washingt...ks_on_benefits/

 

 

This woman is clueless. Yeah everyone should have those benefits. Who will pay for it dips***?

 

[StrangeSox]

Take the decisions out of the employers hands and give it back to the individual. That would help immensely.

 

I better see a concurrent bump in pay.

[Balta1701]

Take the decisions out of the employers hands and give it back to the individual. That would help immensely.

To shoot past the annoying "The free market always works and is always better!" platitude here, there is actually serious discussion out there about whether or not this statement works correctly for health care, and in this case there are a number of specific reasons to believe it does not. Here's an old but good commonly cited paper on this discussion.

 

There are a number of particular issues. I can gather up the information on my own to decide what car to purchase, whether to purchase a car or not, etc. I can't do that for health care. If my doctor tells me I've blown my knee out and I need surgery, I can't exactly shop around for a better price. If my doctor tells me I have cancer, I don't have the option of deciding to suspend treatment until my personal economics are better. Alternatively, insurance companies have even less information; they don't know how your knee actually feels, they don't know whether or not treatment that you feel you need is appropriate; they're making decisions based entirely on their models, and their models say "It's unprofitable to insure people over 65". So we get stuck with a gaping hole in the market, no one will insure anyone over 65, until Medicare comes along and forces the issue; the government steps in back in the 60's because so many of the elderly are winding up bankrupt and in poverty because of health care costs.

 

Another example...let's shoot back to the cancer issue. In an ideal economic situation, prices are set such that you maximize profitability without driving away customers. You have to lose some customers though, because if everyone buys your good, then you have it priced too cheaply. Standard supply and demand curves. Apply that now to life and death situations. The ideal price for a good will be the one that maximizes profits without driving away too many customers; that'd be the most profitable method right? So what happens to the people who would normally be left out? The people who don't buy the expensive item because it's more than they're willing to pay for it? Do they not treat their illness? Are they allowed to die? The Supply and Demand curve applied correctly kills people; the penalty is so high that the equilibrium supply and demand curve intersection runs almost to infinity, because you can keep pushing the price upwards as the penalties for avoiding care are so bloody high.

 

Third, the argument you're making is obviously that "Oh, people just use too much medical care. They don't need to go to the doctor for problem x". Which in fact, may be true. If I proposed something like that though, regulations regarding when people can see their doctor, wouldn't everyone else start screaming "OH THAT'S RATIONING AND WE CAN'T HAVE THAT!!!"? That is quite literally what you're proposing as your solution; increased rationing on the basis of income.

 

[NorthSideSox72]

To shoot past the annoying "The free market always works and is always better!" platitude here, there is actually serious discussion out there about whether or not this statement works correctly for health care, and in this case there are a number of specific reasons to believe it does not. Here's an old but good commonly cited paper on this discussion.

 

There are a number of particular issues. I can gather up the information on my own to decide what car to purchase, whether to purchase a car or not, etc. I can't do that for health care. If my doctor tells me I've blown my knee out and I need surgery, I can't exactly shop around for a better price. If my doctor tells me I have cancer, I don't have the option of deciding to suspend treatment until my personal economics are better. Alternatively, insurance companies have even less information; they don't know how your knee actually feels, they don't know whether or not treatment that you feel you need is appropriate; they're making decisions based entirely on their models, and their models say "It's unprofitable to insure people over 65". So we get stuck with a gaping hole in the market, no one will insure anyone over 65, until Medicare comes along and forces the issue; the government steps in back in the 60's because so many of the elderly are winding up bankrupt and in poverty because of health care costs.

 

Another example...let's shoot back to the cancer issue. In an ideal economic situation, prices are set such that you maximize profitability without driving away customers. You have to lose some customers though, because if everyone buys your good, then you have it priced too cheaply. Standard supply and demand curves. Apply that now to life and death situations. The ideal price for a good will be the one that maximizes profits without driving away too many customers; that'd be the most profitable method right? So what happens to the people who would normally be left out? The people who don't buy the expensive item because it's more than they're willing to pay for it? Do they not treat their illness? Are they allowed to die? The Supply and Demand curve applied correctly kills people; the penalty is so high that the equilibrium supply and demand curve intersection runs almost to infinity, because you can keep pushing the price upwards as the penalties for avoiding care are so bloody high.

 

Third, the argument you're making is obviously that "Oh, people just use too much medical care. They don't need to go to the doctor for problem x". Which in fact, may be true. If I proposed something like that though, regulations regarding when people can see their doctor, wouldn't everyone else start screaming "OH THAT'S RATIONING AND WE CAN'T HAVE THAT!!!"? That is quite literally what you're proposing as your solution; increased rationing on the basis of income.

I've brought up some of these issues in here before, where the current provider-insurer-consumer model interrupts and warps the usual consumer-provider economic structure. It means that certain aspects just do not marry well to free markets. There is of course plenty of debate to be had as to whether you fix the system to fit the market, or create a system not truly in that market.

 

[Balta1701]

They would prefer a single payer system. As would I. But when you are trying to get things done, sometimes you need to take steps. Little by little. And make compromises. I think the ultimate goal is something close to a single payer system, but you cant get there in one big leap as many would like. It's too politicaly hard to do.

A single-payer system is not necessarily the best way to go. Canada and Britain make it work effectively with government controlled costs, but they don't necessarily get the best overall health care outcomes. There really is benefit to competitiveness; private companies having to compete with a government-run plan will only be profitable if they can provide actually better quality health care, rather than the situation we're in now where they can become profitable by avoiding payment to anyone who actually gets sick. A hybrid model is employed very effectively in places like France, Germany, etc., and that situation is IMO likely the best balance. You just need an effective public plan combined with a purchasing mandate to make it work.

[kapkomet]

You're misunderstanding what I'm saying, I think.

 

INSURANCE should be something that's turned over to individuals. The tax breaks that employers get, individuals could get. Re: employers and that "bump in pay" - yea right. But really, your care is determined by your employer. Is that right? So is all health care the same?

 

This is so complex, but ANYONE (yea, AHB) that thinks a single payor system is the right thing to do has some serious educating of themselves that they need to do. It's pretty common sensible. You want ONE SINGLE option when it comes to health care?

 

And here's a thought: you pro-choice people ought to be ashamed. You want women to have the right to choose what they do with their bodies - yet you want the government to tell you what to do with it? That's a pretty slippery slope you're going down. I'm not trying to belittle a pro-choice person - I'm just trying to point out the obvious problems with government takeover of a health care system.

 

 

[Balta1701]

You're misunderstanding what I'm saying, I think.

 

INSURANCE should be something that's turned over to individuals. The tax breaks that employers get, individuals could get. Re: employers and that "bump in pay" - yea right. But really, your care is determined by your employer. Is that right? So is all health care the same?

There's one thing you're missing, and it's the one we keep coming back to; scale. You put me out there on the market on my own buying insurance and frankly I'm outgunned, especially if insurers have the right to turn down your family because of any reason they want. You're purchasing insurance against something that might happen to you in the future; you have no ability to guarantee at the time of purchase what type of quality you'll get if you need the insurer to work. That's one of the reasons I keep ranting against insurers; they spend so much money trying to deny you care once you get in to their system. And when you throw in the fact that, as I presented a week or so ago, much of the country is considered "Highly concentrated" in being served by only 1 or 2 insurers at max, you really don't have a lot of choices.

 

When you go through a company, you have the small advantage in that the company has numbers. The insurer can't bully them around as much because they have more negotiating power than you do personally. They have the ability to work at cost-control on different levels. They can't deny an employee as easily based on preexisting conditions or find ways around paying their end when a full company is involved. Even in a highly concentrated market, you gain just a little bit of leverage.