If Obamacare is so great why are there no insurers backing it and

[Vandalshandle]

Tell ya what. Find a single republican Senator, or even Rep., who supports single payer. Then you have a little credibility that the republican party will not fight against single payer until their last breath. The only way we will ever get rid of ACA and replace it with single payer, which is the only thing that will work in the long haul, is to once again have a democratic controlled house, senate and presidency. Having said that, you must exclude Trump, who specifically said before he was elected that he supports universal coverage. Now, of course, he does not.

What? You are confused on a couple of issues. I'm not claiming the Republicans won't fight single payer. I'll fight it too. I think it's a bad idea. Single Payer is better than ACA - at least it's honest socialism - but it's still antithetical to freedom. I'll also point out, again, that Democrats don't have consensus on single payer, even in their own party - so that's going nowhere. Marxist pipe dreams aside, ACA is the insurance industry's "last stand" against single payer. It's designed to forestall it as long as possible by co-opting the regulatory state to force everyone to play along. It's the ugliest sort of corporatist government.

OK. Sounds like you would prefer that I resurrect my career, and start declining health insurance applications again. I can live with that, if that is what America wants. I made a fairly decent living off of condemning people to die for lack of insurance to pay for critical operations.

Sounds like you're nursing delusions of grandeur. You weren't Death incarnate. You were an insurance bureaucrat. Get over it.

I seem to have a hard time figuring out just what the hell you are in favor of. You hate ACA. You hate single payer. You don't seem to have any position whatever on health insurance the way it was before ACA, when millions were denied insurance altogether. So tell me. Just what solution, if any, do you support that would stop the cost shifting from the poor and uninsurables to the insured, that would not violate your anti-Marxist principles. My take is that you are just a whiner who does not favor any solution at all.

 

[debbiedowner]

I'll put you down as being in favor of what I used to do for a living, which was denying applications for health insurance to about 30% of the applicants. After all, it is all about you, isn't it?

When 100 percent get all possible health insurance, including 12 million Mexicans the unfortunate consequence is that the bills can not be paid by Obamacare, thus the insurers drop out as they are, then NO ONE HAS INSURANCE................

What part of this eludes your low IQ brain

Would those be legal Mexicans?

If you don't know how many illegal Mejicanos there are here, you can Google it

Well, then I guess you answered my question, illegals, you didn't say that in your post. So you contend there are 12 million illegals on obamacare? You make a claim you fucking prove it moron.

Actually you have to prove that Obummacare insurers are not running away because the plan is an insolvent failure

What plan? I don't have to prove shit to you.

 

[Papageorgio]

So why are insurers backing out of Obamacare? There is potential that counties in states will have no Obama care option. Sounds like a problem.

 

[Moonglow]

how does Obamacare work without insurers

When you figure this out, let Obama know because he has no idea

There are insurance companies covering the ACHA..Duh!

 

[dblack]

I seem to have a hard time figuring out just what the hell you are in favor of. You hate ACA. You hate single payer. You don't seem to have any position whatever on health insurance the way it was before ACA, when millions were denied insurance altogether.

We have irrational expectations when it comes to health insurance. And for decades we've been trying to realize those irrational expectations via state policy. We have several generations of people weened on the idea that health insurance is the key to 'affording' health care, largely because of the practice of employer-provided group health plans.

The problem isn't that millions are denied health insurance. The problem is that millions can't afford basic health care - because health care costs too much - because most people are over-insured.

So tell me. Just what solution, if any, do you support that would stop the cost shifting from the poor and uninsurables to the insured, that would not violate your anti-Marxist principles.

If the cost shifting is all you're worried about, just repeal EMTALA. Then you can try to find a doctor and a hospital as stingy as you are who will refuse to treat poor people.

For me, the cost-shifting isn't a primary concern. Unfunded mandates like EMTALA are bad policy in general, but I'm much more concerned with the ugly fact that ordinary Americans can't afford ordinary health care, and this is directly attributable to bad public policy promoting unsustainable insurance practices. So the first step is to correct the bad public policy: repeal tax incentives promoting health insurance, especially those propping up employer-provided, group health insurance.

Before I go on, I'm going to guess that I've already lost you. My solutions are centered on getting us back to sane health insurance practices:

We need to dispel the belief that insurance is a way to make health care 'affordable'. It's not. Insurance makes health care more expensive.

We need get over the delusion that health insurance is a good idea for people who can't afford health care. It's not. There are much better things for them to spend their money on.

We need to stop propping up group health insurance plans. They are the primary driver of health care inflation and turn sick people into virtual slaves of their employer.

All of the above is premised on a preference for free markets and free consumers. If you have no such preference, and you can get consensus that we really do want government to take over health care, there are (relatively) sane ways to go about it. We could establish basic health care as a service of government in much the same way we have public education - locally controlled and financed. I'd still have concerns with ubiquitous government, but a decentralized plan would at least avoid creating a tempting nexus of control for those with an agenda.

 

[Vandalshandle]

I seem to have a hard time figuring out just what the hell you are in favor of. You hate ACA. You hate single payer. You don't seem to have any position whatever on health insurance the way it was before ACA, when millions were denied insurance altogether.

We have irrational expectations when it comes to health insurance. And for decades we've been trying to realize those irrational expectations via state policy. We have several generations of people weened on the idea that health insurance is the key to 'affording' health care, largely because of the practice of employer-provided group health plans.

The problem isn't that millions are denied health insurance. The problem is that millions can't afford basic health care - because health care costs too much - because most people are over-insured.

So tell me. Just what solution, if any, do you support that would stop the cost shifting from the poor and uninsurables to the insured, that would not violate your anti-Marxist principles.

If the cost shifting is all you're worried about, just repeal EMTALA. Then you can try to find a doctor and a hospital as stingy as you are who will refuse to treat poor people.

For me, the cost-shifting isn't a primary concern. Unfunded mandates like EMTALA are bad policy in general, but I'm much more concerned with the ugly fact that ordinary Americans can't afford ordinary health care, and this is directly attributable to bad public policy promoting unsustainable insurance practices. So the first step is to correct the bad public policy: repeal tax incentives promoting health insurance, especially those propping up employer-provided, group health insurance.

Before I go on, I'm going to guess that I've already lost you. My solutions are centered on getting us back to sane health insurance practices:

We need to dispel the belief that insurance is a way to make health care 'affordable'. It's not. Insurance makes health care more expensive.

We need get over the delusion that health insurance is a good idea for people who can't afford health care. It's not. There are much better things for them to spend their money on.

We need to stop propping up group health insurance plans. They are the primary driver of health care inflation and turn sick people into virtual slaves of their employer.

All of the above is premised on a preference for free markets and free consumers. If you have no such preference, and you can get consensus that we really do want government to take over health care, there are (relatively) sane ways to go about it. We could establish basic health care as a service of government in much the same way we have public education - locally controlled and financed. I'd still have concerns with ubiquitous government, but a decentralized plan would at least avoid creating a tempting nexus of control for those with an agenda.

I am not sure how any of the changes you mention would change the fact that my Primary Care doctor had to spend $250,000 in education expenses to become a doctor, and another $1 million, more or less, to furnish and set up her practice, which leaves little or no room for pay cuts. Tort reform would help, because of the high cost of malpractice insurance. I had an anesthesiologist tell me that his malpractice premium was 30% of his net income. Marcus Welby is dead.

As for health insurance raising the cost of health care, that is nonsense. It was true back when health insurance was an indemnity business, but the HMO pricing model is what is used today, and it brought overutilization to a screeching halt. In my case, for example, my doctor had to get pre-authorization from my insurer just to prescribe Metformin for my diabetics, and it is not even very expensive. Advancing technology is a big part of the cost. An MRI machine is now getting close to $2 million dollars. At one time, I was in charge of provider contracts, and we squeezed every dime out of every provider, especially hospitals, who wanted to charge us $2,600 per inpatient day, and wound up having to settle for $675. Per idem pricing put an end to providers buying a new boat every year. It also put the insurance companies in the driver's seat. Every time we had to renew a hospital provider contract, we set off a reverse bidding war with every hospital in town, since we had 50,000 members in that town, and was in fact, the 800 pound gorilla. For a hospital to lose a potential market of 50,000 patents in a small city would be catastrophic to them

 

[dblack]

I seem to have a hard time figuring out just what the hell you are in favor of. You hate ACA. You hate single payer. You don't seem to have any position whatever on health insurance the way it was before ACA, when millions were denied insurance altogether.

We have irrational expectations when it comes to health insurance. And for decades we've been trying to realize those irrational expectations via state policy. We have several generations of people weened on the idea that health insurance is the key to 'affording' health care, largely because of the practice of employer-provided group health plans.

The problem isn't that millions are denied health insurance. The problem is that millions can't afford basic health care - because health care costs too much - because most people are over-insured.

So tell me. Just what solution, if any, do you support that would stop the cost shifting from the poor and uninsurables to the insured, that would not violate your anti-Marxist principles.

If the cost shifting is all you're worried about, just repeal EMTALA. Then you can try to find a doctor and a hospital as stingy as you are who will refuse to treat poor people.

For me, the cost-shifting isn't a primary concern. Unfunded mandates like EMTALA are bad policy in general, but I'm much more concerned with the ugly fact that ordinary Americans can't afford ordinary health care, and this is directly attributable to bad public policy promoting unsustainable insurance practices. So the first step is to correct the bad public policy: repeal tax incentives promoting health insurance, especially those propping up employer-provided, group health insurance.

Before I go on, I'm going to guess that I've already lost you. My solutions are centered on getting us back to sane health insurance practices:

We need to dispel the belief that insurance is a way to make health care 'affordable'. It's not. Insurance makes health care more expensive.

We need get over the delusion that health insurance is a good idea for people who can't afford health care. It's not. There are much better things for them to spend their money on.

We need to stop propping up group health insurance plans. They are the primary driver of health care inflation and turn sick people into virtual slaves of their employer.

All of the above is premised on a preference for free markets and free consumers. If you have no such preference, and you can get consensus that we really do want government to take over health care, there are (relatively) sane ways to go about it. We could establish basic health care as a service of government in much the same way we have public education - locally controlled and financed. I'd still have concerns with ubiquitous government, but a decentralized plan would at least avoid creating a tempting nexus of control for those with an agenda.

I am not sure how any of the changes you mention would change the fact that my Primary Care doctor had to spend $250,000 in education expenses to become a doctor, and another $1 million, more or less, to furnish and set up her practice, which leaves little or no room for pay cuts. Tort reform would help, because of the high cost of malpractice insurance. I had an anesthesiologist tell me that his malpractice premium was 30% of his net income. Marcus Welby is dead.

It starts and ends with the consumer. No amount of nannying, whether from HMOs or the government, will keep prices down as long as people aren't paying their own bills. Everyone who thinks about economics at all knows this. They may try to explain (wish) it away, but it's utterly unavoidable. When it comes to something as important as health care, people will always choose the most expensive option available if someone else is buying. Especially when that someone else is an impersonal corporation.

Health insurance is still an indemnity business. You can dress it up like a social safety net, but it's not. No private business model can support what you're after (socialized health care). The delusion that it can - that we can have our socialism and pretend it's something else - is literally killing us.

 

[Vandalshandle]

I seem to have a hard time figuring out just what the hell you are in favor of. You hate ACA. You hate single payer. You don't seem to have any position whatever on health insurance the way it was before ACA, when millions were denied insurance altogether.

We have irrational expectations when it comes to health insurance. And for decades we've been trying to realize those irrational expectations via state policy. We have several generations of people weened on the idea that health insurance is the key to 'affording' health care, largely because of the practice of employer-provided group health plans.

The problem isn't that millions are denied health insurance. The problem is that millions can't afford basic health care - because health care costs too much - because most people are over-insured.

So tell me. Just what solution, if any, do you support that would stop the cost shifting from the poor and uninsurables to the insured, that would not violate your anti-Marxist principles.

If the cost shifting is all you're worried about, just repeal EMTALA. Then you can try to find a doctor and a hospital as stingy as you are who will refuse to treat poor people.

For me, the cost-shifting isn't a primary concern. Unfunded mandates like EMTALA are bad policy in general, but I'm much more concerned with the ugly fact that ordinary Americans can't afford ordinary health care, and this is directly attributable to bad public policy promoting unsustainable insurance practices. So the first step is to correct the bad public policy: repeal tax incentives promoting health insurance, especially those propping up employer-provided, group health insurance.

Before I go on, I'm going to guess that I've already lost you. My solutions are centered on getting us back to sane health insurance practices:

We need to dispel the belief that insurance is a way to make health care 'affordable'. It's not. Insurance makes health care more expensive.

We need get over the delusion that health insurance is a good idea for people who can't afford health care. It's not. There are much better things for them to spend their money on.

We need to stop propping up group health insurance plans. They are the primary driver of health care inflation and turn sick people into virtual slaves of their employer.

All of the above is premised on a preference for free markets and free consumers. If you have no such preference, and you can get consensus that we really do want government to take over health care, there are (relatively) sane ways to go about it. We could establish basic health care as a service of government in much the same way we have public education - locally controlled and financed. I'd still have concerns with ubiquitous government, but a decentralized plan would at least avoid creating a tempting nexus of control for those with an agenda.

I am not sure how any of the changes you mention would change the fact that my Primary Care doctor had to spend $250,000 in education expenses to become a doctor, and another $1 million, more or less, to furnish and set up her practice, which leaves little or no room for pay cuts. Tort reform would help, because of the high cost of malpractice insurance. I had an anesthesiologist tell me that his malpractice premium was 30% of his net income. Marcus Welby is dead.

It starts and ends with the consumer. No amount of nannying, whether from HMOs or the government, will keep prices down as long as people aren't paying their own bills. Everyone who thinks about economics at all knows this. They may try to explain (wish) it away, but it's utterly unavoidable. When it comes to something as important as health care, people will always choose the most expensive option available if someone else is buying. Especially when that someone else is an impersonal corporation.

Health insurance is still an indemnity business. You can dress it up like a social safety net, but it's not. No private business model can support what you're after (socialized health care). The delusion that it can - that we can have our socialism and pretend it's something else - is literally killing us.

Black, having spent 50 years pricing health insurance, I respectfully have to tell you that you don't know what you are talking about. The HMO pricing model rewards thrift on the part of the insured and punishes extravagance. My plan has a $0 copay for a primary care visit, but a $50 copay for a specialist. Any lab work and imaging has to be preauthorized by the HMO, and they only allow it when AMA protocall recommends it. Almost all surgeries are now done on an outpatient basis. In fact, I have had 4 surgeries in the last 3 years, all of which were outpatient. Medications are priced by tier. Tier 1, generic, is $0 copay. there are 3 more tiers with copay up to 50% for tier 4. If the medication does the same thing as a cheaper med., it is not even on the insurer's formulary, meaning that they don't cover it at all. Every year, the insurer calls me and suggest medications that are cheaper to me and them. The HMO model has what they call a "gatekeeper", meaning that you can not self refer yourself to a second physical exam every year, or to expensive specialists that you do not need. Medicare has adopted exactly the same procedures and protocall. If I go to the emergency room, and it is deemed to not be an emergency, they don't pay at all. When my wife had her baby back in 1983, she stayed in the hospital 5 days, and Humana Hospital gave us a lobster dinner. Today, you are released in 2 days. Even hospice care is mostly done art home now. If I go to a non contracted provider, my doctor bill is subject to a $500 deductible, and 20% coinsurance, rather than $0 copay, and 0% coinsurance. You can bet your bottom dollar that today's insurers know how to save money, and just to make sure that some doc doesn't try to bend the rules by recodeing procedures and diagnoses, we have an MD as the Medical Director, and nurse practitioners scanning every pre-auth with a magnifying glass. Any HMO or insurance company that does not exercise this same level of diligence would soon be out of business. In addition, we have about 6 fine print pages of exclusions for treatments for illnesses or injuries ranging from cosmetic treatment to unnecessary, experimental, treatment covered by worker's comp,costs that we deem unreasonable and uncustomary, etc., etc.. We have a fee schedule that we present to every provider with every possible charge that can be coded and the price we will pay that provider for performing it. The contract the provider signs disallows him from balance billing the patent if he wants more than that. If he does not think our fee schedule is high enough, he won't sign the contract, and THAT is why many doctors opted out of treating ACA patients.

 

[dblack]

I seem to have a hard time figuring out just what the hell you are in favor of. You hate ACA. You hate single payer. You don't seem to have any position whatever on health insurance the way it was before ACA, when millions were denied insurance altogether.

We have irrational expectations when it comes to health insurance. And for decades we've been trying to realize those irrational expectations via state policy. We have several generations of people weened on the idea that health insurance is the key to 'affording' health care, largely because of the practice of employer-provided group health plans.

The problem isn't that millions are denied health insurance. The problem is that millions can't afford basic health care - because health care costs too much - because most people are over-insured.

So tell me. Just what solution, if any, do you support that would stop the cost shifting from the poor and uninsurables to the insured, that would not violate your anti-Marxist principles.

If the cost shifting is all you're worried about, just repeal EMTALA. Then you can try to find a doctor and a hospital as stingy as you are who will refuse to treat poor people.

For me, the cost-shifting isn't a primary concern. Unfunded mandates like EMTALA are bad policy in general, but I'm much more concerned with the ugly fact that ordinary Americans can't afford ordinary health care, and this is directly attributable to bad public policy promoting unsustainable insurance practices. So the first step is to correct the bad public policy: repeal tax incentives promoting health insurance, especially those propping up employer-provided, group health insurance.

Before I go on, I'm going to guess that I've already lost you. My solutions are centered on getting us back to sane health insurance practices:

We need to dispel the belief that insurance is a way to make health care 'affordable'. It's not. Insurance makes health care more expensive.

We need get over the delusion that health insurance is a good idea for people who can't afford health care. It's not. There are much better things for them to spend their money on.

We need to stop propping up group health insurance plans. They are the primary driver of health care inflation and turn sick people into virtual slaves of their employer.

All of the above is premised on a preference for free markets and free consumers. If you have no such preference, and you can get consensus that we really do want government to take over health care, there are (relatively) sane ways to go about it. We could establish basic health care as a service of government in much the same way we have public education - locally controlled and financed. I'd still have concerns with ubiquitous government, but a decentralized plan would at least avoid creating a tempting nexus of control for those with an agenda.

I am not sure how any of the changes you mention would change the fact that my Primary Care doctor had to spend $250,000 in education expenses to become a doctor, and another $1 million, more or less, to furnish and set up her practice, which leaves little or no room for pay cuts. Tort reform would help, because of the high cost of malpractice insurance. I had an anesthesiologist tell me that his malpractice premium was 30% of his net income. Marcus Welby is dead.

It starts and ends with the consumer. No amount of nannying, whether from HMOs or the government, will keep prices down as long as people aren't paying their own bills. Everyone who thinks about economics at all knows this. They may try to explain (wish) it away, but it's utterly unavoidable. When it comes to something as important as health care, people will always choose the most expensive option available if someone else is buying. Especially when that someone else is an impersonal corporation.

Health insurance is still an indemnity business. You can dress it up like a social safety net, but it's not. No private business model can support what you're after (socialized health care). The delusion that it can - that we can have our socialism and pretend it's something else - is literally killing us.

Black, having spent 50 years pricing health insurance, I respectfully have to tell you that you don't know what you are talking about. The HMO pricing model rewards thrift on the part of the insured and punishes extravagance. My plan has a $0 copay for a primary care visit, but a $50 copay for a specialist. Any lab work and imaging has to be preauthorized by the HMO, and they only allow it when AMA protocall recommends it. Almost all surgeries are now done on an outpatient basis. In fact, I have had 4 surgeries in the last 3 years, all of which were outpatient. Medications are priced by tier. Tier 1, generic, is $0 copay. there are 3 more tiers with copay up to 50% for tier 4. If the medication does the same thing as a cheaper med., it is not even on the insurer's formulary, meaning that they don't cover it at all. Every year, the insurer calls me and suggest medications that are cheaper to me and them. The HMO model has what they call a "gatekeeper", meaning that you can not self refer yourself to a second physical exam every year, or to expensive specialists that you do not need. Medicare has adopted exactly the same procedures and protocall. If I go to the emergency room, and it is deemed to not be an emergency, they don't pay at all. When my wife had her baby back in 1983, she stayed in the hospital 5 days, and Humana Hospital gave us a lobster dinner. Today, you are released in 2 days. Even hospice care is mostly done art home now. If I go to a non contracted provider, my doctor bill is subject to a $500 deductible, and 20% coinsurance, rather than $0 copay, and 0% coinsurance. You can bet your bottom dollar that today's insurers know how to save money, and just to make sure that some doc doesn't try to bend the rules by recodeing procedures and diagnoses, we have an MD as the Medical Director, and nurse practitioners scanning every pre-auth with a magnifying glass. Any HMO or insurance company that does not exercise this same level of diligence would soon be out of business. In addition, we have about 6 fine print pages of exclusions for treatments for illnesses or injuries ranging from cosmetic treatment to unnecessary, experimental, treatment covered by worker's comp,costs that we deem unreasonable and uncustomary, etc., etc.. We have a fee schedule that we present to every provider with every possible charge that can be coded and the price we will pay that provider for performing it. The contract the provider signs disallows him from balance billing the patent if he wants more than that. If he does not think our fee schedule is high enough, he won't sign the contract, and THAT is why many doctors opted out of treating ACA patients.

All of what you're discussing here is simply cost containment - ie reduction in costs to the insurance company, ie reduction in benefits to policy holders. We're paying more and getting less. And you have to do that because prices are inflated beyond reason. The reduced "demand" (it's not real demand, but we'll get to that in another lesson) might inject some downward price pressure, but it's trivial compared to the value decisions that health consumers will still be in charge of..

 

[Vandalshandle]

I seem to have a hard time figuring out just what the hell you are in favor of. You hate ACA. You hate single payer. You don't seem to have any position whatever on health insurance the way it was before ACA, when millions were denied insurance altogether.

We have irrational expectations when it comes to health insurance. And for decades we've been trying to realize those irrational expectations via state policy. We have several generations of people weened on the idea that health insurance is the key to 'affording' health care, largely because of the practice of employer-provided group health plans.

The problem isn't that millions are denied health insurance. The problem is that millions can't afford basic health care - because health care costs too much - because most people are over-insured.

So tell me. Just what solution, if any, do you support that would stop the cost shifting from the poor and uninsurables to the insured, that would not violate your anti-Marxist principles.

If the cost shifting is all you're worried about, just repeal EMTALA. Then you can try to find a doctor and a hospital as stingy as you are who will refuse to treat poor people.

For me, the cost-shifting isn't a primary concern. Unfunded mandates like EMTALA are bad policy in general, but I'm much more concerned with the ugly fact that ordinary Americans can't afford ordinary health care, and this is directly attributable to bad public policy promoting unsustainable insurance practices. So the first step is to correct the bad public policy: repeal tax incentives promoting health insurance, especially those propping up employer-provided, group health insurance.

Before I go on, I'm going to guess that I've already lost you. My solutions are centered on getting us back to sane health insurance practices:

We need to dispel the belief that insurance is a way to make health care 'affordable'. It's not. Insurance makes health care more expensive.

We need get over the delusion that health insurance is a good idea for people who can't afford health care. It's not. There are much better things for them to spend their money on.

We need to stop propping up group health insurance plans. They are the primary driver of health care inflation and turn sick people into virtual slaves of their employer.

All of the above is premised on a preference for free markets and free consumers. If you have no such preference, and you can get consensus that we really do want government to take over health care, there are (relatively) sane ways to go about it. We could establish basic health care as a service of government in much the same way we have public education - locally controlled and financed. I'd still have concerns with ubiquitous government, but a decentralized plan would at least avoid creating a tempting nexus of control for those with an agenda.

I am not sure how any of the changes you mention would change the fact that my Primary Care doctor had to spend $250,000 in education expenses to become a doctor, and another $1 million, more or less, to furnish and set up her practice, which leaves little or no room for pay cuts. Tort reform would help, because of the high cost of malpractice insurance. I had an anesthesiologist tell me that his malpractice premium was 30% of his net income. Marcus Welby is dead.

It starts and ends with the consumer. No amount of nannying, whether from HMOs or the government, will keep prices down as long as people aren't paying their own bills. Everyone who thinks about economics at all knows this. They may try to explain (wish) it away, but it's utterly unavoidable. When it comes to something as important as health care, people will always choose the most expensive option available if someone else is buying. Especially when that someone else is an impersonal corporation.

Health insurance is still an indemnity business. You can dress it up like a social safety net, but it's not. No private business model can support what you're after (socialized health care). The delusion that it can - that we can have our socialism and pretend it's something else - is literally killing us.

Black, having spent 50 years pricing health insurance, I respectfully have to tell you that you don't know what you are talking about. The HMO pricing model rewards thrift on the part of the insured and punishes extravagance. My plan has a $0 copay for a primary care visit, but a $50 copay for a specialist. Any lab work and imaging has to be preauthorized by the HMO, and they only allow it when AMA protocall recommends it. Almost all surgeries are now done on an outpatient basis. In fact, I have had 4 surgeries in the last 3 years, all of which were outpatient. Medications are priced by tier. Tier 1, generic, is $0 copay. there are 3 more tiers with copay up to 50% for tier 4. If the medication does the same thing as a cheaper med., it is not even on the insurer's formulary, meaning that they don't cover it at all. Every year, the insurer calls me and suggest medications that are cheaper to me and them. The HMO model has what they call a "gatekeeper", meaning that you can not self refer yourself to a second physical exam every year, or to expensive specialists that you do not need. Medicare has adopted exactly the same procedures and protocall. If I go to the emergency room, and it is deemed to not be an emergency, they don't pay at all. When my wife had her baby back in 1983, she stayed in the hospital 5 days, and Humana Hospital gave us a lobster dinner. Today, you are released in 2 days. Even hospice care is mostly done art home now. If I go to a non contracted provider, my doctor bill is subject to a $500 deductible, and 20% coinsurance, rather than $0 copay, and 0% coinsurance. You can bet your bottom dollar that today's insurers know how to save money, and just to make sure that some doc doesn't try to bend the rules by recodeing procedures and diagnoses, we have an MD as the Medical Director, and nurse practitioners scanning every pre-auth with a magnifying glass. Any HMO or insurance company that does not exercise this same level of diligence would soon be out of business. In addition, we have about 6 fine print pages of exclusions for treatments for illnesses or injuries ranging from cosmetic treatment to unnecessary, experimental, treatment covered by worker's comp,costs that we deem unreasonable and uncustomary, etc., etc.. We have a fee schedule that we present to every provider with every possible charge that can be coded and the price we will pay that provider for performing it. The contract the provider signs disallows him from balance billing the patent if he wants more than that. If he does not think our fee schedule is high enough, he won't sign the contract, and THAT is why many doctors opted out of treating ACA patients.

All of what you're discussing here is simply cost containment - ie reduction in costs to the insurance company, ie reduction in benefits to policy holders. We're paying more and getting less. And you have to do that because prices are inflated beyond reason. The reduced "demand" (it's not real demand, but we'll get to that in another lesson) might inject some downward price pressure, but it's trivial compared to the value decisions that health consumers will still be in charge of..

Sigh. Whatever, Black.....

 

[dblack]

We have irrational expectations when it comes to health insurance. And for decades we've been trying to realize those irrational expectations via state policy. We have several generations of people weened on the idea that health insurance is the key to 'affording' health care, largely because of the practice of employer-provided group health plans.

The problem isn't that millions are denied health insurance. The problem is that millions can't afford basic health care - because health care costs too much - because most people are over-insured.

If the cost shifting is all you're worried about, just repeal EMTALA. Then you can try to find a doctor and a hospital as stingy as you are who will refuse to treat poor people.

For me, the cost-shifting isn't a primary concern. Unfunded mandates like EMTALA are bad policy in general, but I'm much more concerned with the ugly fact that ordinary Americans can't afford ordinary health care, and this is directly attributable to bad public policy promoting unsustainable insurance practices. So the first step is to correct the bad public policy: repeal tax incentives promoting health insurance, especially those propping up employer-provided, group health insurance.

Before I go on, I'm going to guess that I've already lost you. My solutions are centered on getting us back to sane health insurance practices:

We need to dispel the belief that insurance is a way to make health care 'affordable'. It's not. Insurance makes health care more expensive.

We need get over the delusion that health insurance is a good idea for people who can't afford health care. It's not. There are much better things for them to spend their money on.

We need to stop propping up group health insurance plans. They are the primary driver of health care inflation and turn sick people into virtual slaves of their employer.

All of the above is premised on a preference for free markets and free consumers. If you have no such preference, and you can get consensus that we really do want government to take over health care, there are (relatively) sane ways to go about it. We could establish basic health care as a service of government in much the same way we have public education - locally controlled and financed. I'd still have concerns with ubiquitous government, but a decentralized plan would at least avoid creating a tempting nexus of control for those with an agenda.

I am not sure how any of the changes you mention would change the fact that my Primary Care doctor had to spend $250,000 in education expenses to become a doctor, and another $1 million, more or less, to furnish and set up her practice, which leaves little or no room for pay cuts. Tort reform would help, because of the high cost of malpractice insurance. I had an anesthesiologist tell me that his malpractice premium was 30% of his net income. Marcus Welby is dead.

It starts and ends with the consumer. No amount of nannying, whether from HMOs or the government, will keep prices down as long as people aren't paying their own bills. Everyone who thinks about economics at all knows this. They may try to explain (wish) it away, but it's utterly unavoidable. When it comes to something as important as health care, people will always choose the most expensive option available if someone else is buying. Especially when that someone else is an impersonal corporation.

Health insurance is still an indemnity business. You can dress it up like a social safety net, but it's not. No private business model can support what you're after (socialized health care). The delusion that it can - that we can have our socialism and pretend it's something else - is literally killing us.

Black, having spent 50 years pricing health insurance, I respectfully have to tell you that you don't know what you are talking about. The HMO pricing model rewards thrift on the part of the insured and punishes extravagance. My plan has a $0 copay for a primary care visit, but a $50 copay for a specialist. Any lab work and imaging has to be preauthorized by the HMO, and they only allow it when AMA protocall recommends it. Almost all surgeries are now done on an outpatient basis. In fact, I have had 4 surgeries in the last 3 years, all of which were outpatient. Medications are priced by tier. Tier 1, generic, is $0 copay. there are 3 more tiers with copay up to 50% for tier 4. If the medication does the same thing as a cheaper med., it is not even on the insurer's formulary, meaning that they don't cover it at all. Every year, the insurer calls me and suggest medications that are cheaper to me and them. The HMO model has what they call a "gatekeeper", meaning that you can not self refer yourself to a second physical exam every year, or to expensive specialists that you do not need. Medicare has adopted exactly the same procedures and protocall. If I go to the emergency room, and it is deemed to not be an emergency, they don't pay at all. When my wife had her baby back in 1983, she stayed in the hospital 5 days, and Humana Hospital gave us a lobster dinner. Today, you are released in 2 days. Even hospice care is mostly done art home now. If I go to a non contracted provider, my doctor bill is subject to a $500 deductible, and 20% coinsurance, rather than $0 copay, and 0% coinsurance. You can bet your bottom dollar that today's insurers know how to save money, and just to make sure that some doc doesn't try to bend the rules by recodeing procedures and diagnoses, we have an MD as the Medical Director, and nurse practitioners scanning every pre-auth with a magnifying glass. Any HMO or insurance company that does not exercise this same level of diligence would soon be out of business. In addition, we have about 6 fine print pages of exclusions for treatments for illnesses or injuries ranging from cosmetic treatment to unnecessary, experimental, treatment covered by worker's comp,costs that we deem unreasonable and uncustomary, etc., etc.. We have a fee schedule that we present to every provider with every possible charge that can be coded and the price we will pay that provider for performing it. The contract the provider signs disallows him from balance billing the patent if he wants more than that. If he does not think our fee schedule is high enough, he won't sign the contract, and THAT is why many doctors opted out of treating ACA patients.

All of what you're discussing here is simply cost containment - ie reduction in costs to the insurance company, ie reduction in benefits to policy holders. We're paying more and getting less. And you have to do that because prices are inflated beyond reason. The reduced "demand" (it's not real demand, but we'll get to that in another lesson) might inject some downward price pressure, but it's trivial compared to the value decisions that health consumers will still be in charge of..

Sigh. Whatever, Black.....

Sorry....

 

[ShaklesOfBigGov]

Time to do away with the insurance companies. They're just "death panels" that aren't subject to being voted out. Single payer, NOW!

Here is what happens when government Is left to completely run healthcare, from the concerns of those who look to them to approve treatment.

.
Click here to support Hayleys Cancer Treatment Fund organized by Hayley Kalinins


Click here to support Louise's cancer treatment organised by Kenny Washington

 

[dblack]

Time to do away with the insurance companies. They're just "death panels" that aren't subject to being voted out. Single payer, NOW!

I don't understand. You most certainly can "vote out" a private insurer. And it only takes one vote - yours. With government, if you're in the minority, tough luck.

 

[danielpalos]

We passed ACA so that people who are mensurable because of health issues can still get insurance that could save their lives. We aren't interested in whiners like you because you might have to change doctors. Go cry on Sarah Palin's shoulder.

So you are saying that the people who registered for Obamacare are all getting the care that they deserve from the doctor and insurance plan of their choice?

Fuck off asswipe, all you are is a delusional fool, now smoke the rest of your dope

Do you guys ever quit whining about having to change doctors?

Let me put that another way. We don't give a rat's ass that you have to change doctors. We care about the people who were uninsureable, but now they aren't.

So you admit that you do not care that some Americans do not have a doctor to choose from in their own town or county. Dude this means that these people are paying for insurance that they can not get as not everyone has a car to travel to the other side of the state just to see a doctor that may not even have time to see them.

However I am glad that you have admitted that you do not care.

Now fuck off shithead

I'll put you down as being in favor of what I used to do for a living, which was denying applications for health insurance to about 30% of the applicants. After all, it is all about you, isn't it?

When 100 percent get all possible health insurance, including 12 million Mexicans the unfortunate consequence is that the bills can not be paid by Obamacare, thus the insurers drop out as they are, then NO ONE HAS INSURANCE................

What part of this eludes your low IQ brain

End the drug war, right wingers.

 

[danielpalos]

I seem to have a hard time figuring out just what the hell you are in favor of. You hate ACA. You hate single payer. You don't seem to have any position whatever on health insurance the way it was before ACA, when millions were denied insurance altogether.

We have irrational expectations when it comes to health insurance. And for decades we've been trying to realize those irrational expectations via state policy. We have several generations of people weened on the idea that health insurance is the key to 'affording' health care, largely because of the practice of employer-provided group health plans.

The problem isn't that millions are denied health insurance. The problem is that millions can't afford basic health care - because health care costs too much - because most people are over-insured.

So tell me. Just what solution, if any, do you support that would stop the cost shifting from the poor and uninsurables to the insured, that would not violate your anti-Marxist principles.

If the cost shifting is all you're worried about, just repeal EMTALA. Then you can try to find a doctor and a hospital as stingy as you are who will refuse to treat poor people.

For me, the cost-shifting isn't a primary concern. Unfunded mandates like EMTALA are bad policy in general, but I'm much more concerned with the ugly fact that ordinary Americans can't afford ordinary health care, and this is directly attributable to bad public policy promoting unsustainable insurance practices. So the first step is to correct the bad public policy: repeal tax incentives promoting health insurance, especially those propping up employer-provided, group health insurance.

Before I go on, I'm going to guess that I've already lost you. My solutions are centered on getting us back to sane health insurance practices:

We need to dispel the belief that insurance is a way to make health care 'affordable'. It's not. Insurance makes health care more expensive.

We need get over the delusion that health insurance is a good idea for people who can't afford health care. It's not. There are much better things for them to spend their money on.

We need to stop propping up group health insurance plans. They are the primary driver of health care inflation and turn sick people into virtual slaves of their employer.

All of the above is premised on a preference for free markets and free consumers. If you have no such preference, and you can get consensus that we really do want government to take over health care, there are (relatively) sane ways to go about it. We could establish basic health care as a service of government in much the same way we have public education - locally controlled and financed. I'd still have concerns with ubiquitous government, but a decentralized plan would at least avoid creating a tempting nexus of control for those with an agenda.

I am not sure how any of the changes you mention would change the fact that my Primary Care doctor had to spend $250,000 in education expenses to become a doctor, and another $1 million, more or less, to furnish and set up her practice, which leaves little or no room for pay cuts. Tort reform would help, because of the high cost of malpractice insurance. I had an anesthesiologist tell me that his malpractice premium was 30% of his net income. Marcus Welby is dead.

It starts and ends with the consumer. No amount of nannying, whether from HMOs or the government, will keep prices down as long as people aren't paying their own bills. Everyone who thinks about economics at all knows this. They may try to explain (wish) it away, but it's utterly unavoidable. When it comes to something as important as health care, people will always choose the most expensive option available if someone else is buying. Especially when that someone else is an impersonal corporation.

Health insurance is still an indemnity business. You can dress it up like a social safety net, but it's not. No private business model can support what you're after (socialized health care). The delusion that it can - that we can have our socialism and pretend it's something else - is literally killing us.

Black, having spent 50 years pricing health insurance, I respectfully have to tell you that you don't know what you are talking about. The HMO pricing model rewards thrift on the part of the insured and punishes extravagance. My plan has a $0 copay for a primary care visit, but a $50 copay for a specialist. Any lab work and imaging has to be preauthorized by the HMO, and they only allow it when AMA protocall recommends it. Almost all surgeries are now done on an outpatient basis. In fact, I have had 4 surgeries in the last 3 years, all of which were outpatient. Medications are priced by tier. Tier 1, generic, is $0 copay. there are 3 more tiers with copay up to 50% for tier 4. If the medication does the same thing as a cheaper med., it is not even on the insurer's formulary, meaning that they don't cover it at all. Every year, the insurer calls me and suggest medications that are cheaper to me and them. The HMO model has what they call a "gatekeeper", meaning that you can not self refer yourself to a second physical exam every year, or to expensive specialists that you do not need. Medicare has adopted exactly the same procedures and protocall. If I go to the emergency room, and it is deemed to not be an emergency, they don't pay at all. When my wife had her baby back in 1983, she stayed in the hospital 5 days, and Humana Hospital gave us a lobster dinner. Today, you are released in 2 days. Even hospice care is mostly done art home now. If I go to a non contracted provider, my doctor bill is subject to a $500 deductible, and 20% coinsurance, rather than $0 copay, and 0% coinsurance. You can bet your bottom dollar that today's insurers know how to save money, and just to make sure that some doc doesn't try to bend the rules by recodeing procedures and diagnoses, we have an MD as the Medical Director, and nurse practitioners scanning every pre-auth with a magnifying glass. Any HMO or insurance company that does not exercise this same level of diligence would soon be out of business. In addition, we have about 6 fine print pages of exclusions for treatments for illnesses or injuries ranging from cosmetic treatment to unnecessary, experimental, treatment covered by worker's comp,costs that we deem unreasonable and uncustomary, etc., etc.. We have a fee schedule that we present to every provider with every possible charge that can be coded and the price we will pay that provider for performing it. The contract the provider signs disallows him from balance billing the patent if he wants more than that. If he does not think our fee schedule is high enough, he won't sign the contract, and THAT is why many doctors opted out of treating ACA patients.

All of what you're discussing here is simply cost containment - ie reduction in costs to the insurance company, ie reduction in benefits to policy holders. We're paying more and getting less. And you have to do that because prices are inflated beyond reason. The reduced "demand" (it's not real demand, but we'll get to that in another lesson) might inject some downward price pressure, but it's trivial compared to the value decisions that health consumers will still be in charge of..

It is about opportunity costs; sinking money in healthcare is better than sinking money in a drug war.

And, expensive labor means capital will be seeking gains from efficiency.

 

[dblack]

It is about opportunity costs; sinking money in healthcare is better than sinking money in a drug war.

Maybe - but it's still "sinking" money. Or rather, funneling it through the insurance industry and then sinking it into their bank accounts.

 

[danielpalos]

It is about opportunity costs; sinking money in healthcare is better than sinking money in a drug war.

Maybe - but it's still "sinking" money. Or rather, funneling it through the insurance industry and then sinking it into their bank accounts.

Why would You care, if we can redistribute income from the drug war to healthcare?

 

[dblack]

It is about opportunity costs; sinking money in healthcare is better than sinking money in a drug war.

Maybe - but it's still "sinking" money. Or rather, funneling it through the insurance industry and then sinking it into their bank accounts.

Why would You care, if we can redistribute income from the drug war to healthcare?

Because I don't want government in charge of health care.

 

[Vandalshandle]

It is about opportunity costs; sinking money in healthcare is better than sinking money in a drug war.

Maybe - but it's still "sinking" money. Or rather, funneling it through the insurance industry and then sinking it into their bank accounts.

Why would You care, if we can redistribute income from the drug war to healthcare?

Because I don't want government in charge of health care.

I guess you are going to be really unhappy when you become a Medicare insured. Of course, you would not have to worry about that if there was no government Medicare program, because private insurers used to decline almost everyone at age 65 and older.

 

[dblack]

It is about opportunity costs; sinking money in healthcare is better than sinking money in a drug war.

Maybe - but it's still "sinking" money. Or rather, funneling it through the insurance industry and then sinking it into their bank accounts.

Why would You care, if we can redistribute income from the drug war to healthcare?

Because I don't want government in charge of health care.

I guess you are going to be really unhappy when you become a Medicare insured. Of course, you would not have to worry about that if there was no government Medicare program, because private insurers used to decline almost everyone at age 65 and older.

It definitely bothers me. We'll see how it goes, but power gets used. If we give government power over our health care, government will use it to control us. Maybe you imagine government as an eternally beneficial force in the world, but I've seen different.