Gov. Role in Health Care Question

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by JamesInFlorida, May 7, 2011.

  1. JamesInFlorida
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    JamesInFlorida Senior Member

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    Just curious as to what people here will say about this. Do you think the government should pass legislation to prevent the following example below from happening, and if so what, and if not why not?

    I know someone, who's in his mid/late 30s, immigrated here (legally), has held the same job steadily, recently became a US citizen, married a US citizen here, and just had a baby. He's a prime example of somebody coming here for a better life-and an example of the American dream. Did everything the right way. He's a hard worker, and has health insurance for his family through his employer.

    His newborn baby however has many medical problems-and needs very expensive medical attention, or will die. The health insurance company has already alerted the company he works for that he's no longer able to stay on the policy.

    I think there's something very wrong with this scenario-and it can happen to ANYBODY. I think America can do better for our citizens than this.

    edit: to be fair they're not dropping him, but just charging a ridiculous amount, knowing full well he, and the other employees cannot afford it. Adding edit here, rather than my post.
     
    Last edited: May 7, 2011
  2. auditor0007
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    auditor0007 Gold Member

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    This is what the insurance companies do. You should see what happens when you have a private policy and become sick. They'll do whatever they can to stop covering you. This is why we had to have some type of healthcare reform. Unfortunately, we're still leaving everything in the hands of the insurance companies. Until a person actually becomes very sick, it is hard to make them understand how bad the insurance companies can be. But that is the nature of insurance companies. Unlike almost anything else covered by insurance, an individual doesn't always have a choice in becoming ill. And eventually, everyone becomes ill unless they die in an accident or die when they suddenly become sick such as with a heart attack or aneurysm.
     
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  3. code1211
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    code1211 Senior Member

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    The national origin of the person in the story is not important.

    The cost of the medical care is all that matters.

    The Obamacare approach has nothing at all to do with medical care. The only thing it addresses, and that it hopes to confiscate, is the insuarance dollars to pay for the medical care.

    Liberals proclaim that our "Healthcare System" is the worst in the industrialized world and yet make no moves to change it. All they want to talk about is the dollars paid to the insurance companies.

    This is what you are doing.

    If the costs are generated by the healthcare providers and the insurance companies are paying those costs, why do you attack those who are paying and not those who are charging?

    The price of the care is already established. The insurance company only acknowledges that cost and passes it along.

    Until something is done to reduce the costs, the costs will remain high.
     
  4. Bfgrn
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    Bfgrn Gold Member

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    If you want an insight into how insurance companies operate, I suggest you take a half hour and listen to this interview. Wendell Potter has 20 years of experience as an insurance executive. You will come away with a different view of 'for profit' health insurance and how real death panels already exist. Unfortunately, your friends baby is on that list.

    [​IMG]

    Wendell Potter on Profits Before Patients

    Here is a recent article Potter authored: Insurers Getting Rich By Not Paying for Care
     
  5. Gadawg73
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    Gadawg73 Gold Member

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    Government pays 75% of all prescription costs now and Medicare is all paid for by government and that is blank check health care.
    And it would be GOP that passed Gramps Dope Plan.
     
  6. Greenbeard
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    Greenbeard Gold Member

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    Where does this perception come from? Is it from the media's focus on the health insurance provisions of the ACA during the public debate? Or the implicit suggestion that it's some kind of carbon copy of the much more limited Massachusetts law (it isn't). It certainly wasn't 2,000 pages just of insurance law.

    The reality is that the ACA (particularly when combined with CHIPRA from 2009 and certain pieces of the stimulus) does take a system view: building capacity to measure and evaluate care quality, building the research base for evidence-based treatment, focusing on fostering care coordination and more patient-centered delivery of care, encouraging prevention and health maintenance at the individual level, and so on.

    If you're interested in the health or health care components of the law (as opposed to the much more famous health insurance provisions), then you'll want to look in particular at some of the ways the ACA has the government using its leverage as a payer to encourage delivery system (i.e. health care) reforms. I've posted some of the highlights before:


    How does this kind of thing work? Take one of the earliest examples, from late last year:

    Why reorganize the way it does business to reign in costs now? They're getting ready to respond to payment reforms, including bundled payments, that are coming down the pike:

    That's how something like payment reform at the state or federal level translates directly into health care reform on the provider end.

    That was the point of the proposed public health insurance option: to give private insurance companies greater leverage in the negotiations that set reimbursement rates (i.e. prices) for provider services. Even that indirect attack on provider markups was considered too heavy-handed by The Powers That Be, though the public option polled very well with the public.

    Much of the ACA is dedicated to laying the groundwork for a system that can identify and implement improvements in care quality and delivery that can reduce costs. But what you're talking about here isn't the actual cost of delivering care, it's the price that providers charge for that care. And there's precious little in the ACA to nudge provider prices toward their costs, even as those costs are, one hopes, reduced in the decade or two ahead. As I mentioned, the public option was the primary mechanism for achieving that but that was removed.

    The difficulty is that tackling prices, as opposed to the underlying inefficiencies and quality deficiencies that raise costs (which is where the ACA's focus lies), will invariably look like very heavy-handed government intervention; the public option was actually a rather roundabout, indirect way of tackling the problem and even that was demonized. Perhaps we'll see more states bite the bullet and institute all-payer rate-setting.

    But the reality is that health care reform isn't what you're talking about--we have that now, or at least the contours of it, and if we implement it well (a big if, given the animosity in the political layer of government right now) we stand to see major improvements in care and greater cost-effectiveness in its delivery. But provider prices are a different issue than that.
     
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    Last edited: May 8, 2011
  7. sparky
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    sparky VIP Member

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    pretty good Greenbeard, so to synopsize it all down to one governmental fucntion might be to use the term de-monopolize.....
     
  8. MaggieMae
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    MaggieMae Reality bits

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    Surely you jest. "Liberals" and other thinking people have been trying to create a system for better health care for ALL Americans for decades. But the Republicans simply won't agree to it, which includes of course reining in high costs of medical services because that would mean tampering with free enterprise and the right to make a profit regardless how much it hurts consumers. The insurance-for-all was the best deal possible.
     
  9. code1211
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    code1211 Senior Member

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  10. Greenbeard
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    Greenbeard Gold Member

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    Well:

     

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