waiting

[onecut39]

Take a look folks, there you have it. The modern liberal retort to...well, anything that isn't an emotionally based argument void of logic and reason. If it feels good, it must right...and if you don't feel like they do, why you're just dumb.

Thank you young one for exposing to the light a little insight into your thought process and your ability to construct a compelling argument. After all, rule #1 is to know thy enemy. You've been great.

All the best.

If you take unfounded premises and put them forth as fact you are either dumb, or a liar or both. There are no other choices. Either way you are hoping I will be really stupid.

Sorry I'm not.

Ah, you're back. Isn't that wonderful...responding now with logic, reason and specificity. Okay, not really, but it sure is nice to hear from you again young man (woman?).

When you grow up and learn to debate like an adult, you may be capable of actually pointing out "unfounded premises", explaining how they're unfounded, while offering an alternative. If you're really mature, you'll be able to do that without childish name calling and ad hominem attacks. That's a big "if" of coursE.

You were saying about wait times and ualioty of care? The french are rated best in the world.

Health care in France: facing hard choices

 

[eflatminor]

The french are rated best in the world.

Oh well, if the United Nations says so

By the way, how is the French debt situation these days? All those entitlements working out well for the people? From your own link: "It will be the generation now entering the workforce who will pay for the years of deficit spending through some mix of higher taxes and reduced access."

Lovely, even more taxes and less care. Yea, we should shoot for that.

While I may agree France's healthcare system is better than other socialist systems, that does not mean our quasi-socialist approach should take that final step towards central control. Instead, we could stop tying healthcare insurance to jobs, stop forcing everything under the sun to be covered in policies issued, stop telling insurance carriers how much than can charge, make "loser pays" the standard for all lawsuits, and for heaven's sake, stop regulating the death out of the industry.

 

[oldernwiser]

dear fucking idiot are you claiming everything is just peachy that way?

Foul mouthed "lady", aren't you? How very mature.

I'm claiming all the government intervention (state and federal) in healthcare and healthcare insurance has caused costs to skyrocket, kept competition out of the market and quelled innovation, efficiency and choice. More central planning is not the answer, it never is.

If intervention of government raises the policy price then why is it that every one of the "government run" systems elsewhere are cheaper? In fact the next most expensive being about half of the cost of the US system. Why is it that The US is rated about 35 in outcomes?

Why is that?

This is economically derived. We have an unregulated monopoly - not the right term, I know - which controls the prices WE have to pay for services and medicine. We have a government which strongly protects intellectual property patent rights, which allows prices to rise arbitrarily, and there is no one to set a limit on how high the prices may be set. There is almost no such thing as competition in the medical care industry to hold costs at lower levels.

In essence, we're forced into the very real situation of having to decide how much we're willing to pay for our own lives, and woe unto them who can't keep up.

In most of the foreign health care markets, the prices are set at fixed levels and are negotiated by the government, who acts as a proxy for the end users, so that competition comes in the form of bids by providers.

Would it be cheaper? Maybe... figure that your taxes would rise by about the same amount as you're paying for insurance right now, but you wouldn't have a bill if you used medical services. Also, this method only works provided that the economy is stable - any downturns resulting in fewer taxpayers means fewer available services. There ARE trade offs.

 

[oldernwiser]

The french are rated best in the world.

Oh well, if the United Nations says so

By the way, how is the French debt situation these days? All those entitlements working out well for the people? From your own link: "It will be the generation now entering the workforce who will pay for the years of deficit spending through some mix of higher taxes and reduced access."

Lovely, even more taxes and less care. Yea, we should shoot for that.

While I may agree France's healthcare system is better than other socialist systems, that does not mean our quasi-socialist approach should take that final step towards central control. Instead, we could stop tying healthcare insurance to jobs, stop forcing everything under the sun to be covered in policies issued, stop telling insurance carriers how much than can charge, make "loser pays" the standard for all lawsuits, and for heaven's sake, stop regulating the death out of the industry.

I do believe that we need to uncouple insurance from employers. This would be an economical stimulant of it's own if employers didn't have healthcare wrapped into their price schedules. Of course, it might also mean a quicker turnaround in their workforce due to injuries and illness (which is how employers got saddled with providing insurance benefits in the first place).

As to selling policies with only specified coverage goes, I'm not with you on that. We already have something similar to that now with insurance companies offering certain coverages and deductibles that change from company to company. Most people don't understand the coverage they get from a "standard" plan - allowing them to mix and match individual coverage would make a bad situation even worse.

Unregulated, the insurance companies would be free to gouge their customers and kill other smaller companies and refuse to pay for coverage for arbitrary reasons - this has already been seen in the case of GA vs South-Eastern Underwriters. Repealing the McCarron-Ferguson Act and allowing insurance to be considered as commerce, which would force regulation under the Sherman Antitrust Act, would be one way to go - but there are other reasons why you'd want your coverage based in the state you live in.

We don't need better insurance. We don't need MORE insurance. What we need is a better way to manage health care costs.

 

[dblack]

As to selling policies with only specified coverage goes, I'm not with you on that. We already have something similar to that now with insurance companies offering certain coverages and deductibles that change from company to company. Most people don't understand the coverage they get from a "standard" plan - allowing them to mix and match individual coverage would make a bad situation even worse.

<sarcasm>Right. The last thing we want to do is "allow" people to buy the products and services that meet their needs.</sarcasm>

We don't need better insurance. We don't need MORE insurance. What we need is a better way to manage health care costs.

Agreed. Over-insured health care consumers have little to no incentive to demand lower costs in their health care - the opposite actually.

 

[signelect]

Here is the real delima for my family. I would like to have the same insurance plan that my congressman and President get. I don't care what it is I just want equality with the people I elect to represent me. That is not too much to ask for is it. I dare you to argue with that from either side.

 

[oldernwiser]

As to selling policies with only specified coverage goes, I'm not with you on that. We already have something similar to that now with insurance companies offering certain coverages and deductibles that change from company to company. Most people don't understand the coverage they get from a "standard" plan - allowing them to mix and match individual coverage would make a bad situation even worse.

<sarcasm>Right. The last thing we want to do is "allow" people to buy the products and services that meet their needs.</sarcasm>

We don't need better insurance. We don't need MORE insurance. What we need is a better way to manage health care costs.

Agreed. Over-insured health care consumers have little to no incentive to demand lower costs in their health care - the opposite actually.

All sarcasm aside, how do you make a determination as to whether you need to carry long-term sickness coverage such as cancer, or high blood pressure, or even HIV? What about convalescent coverage? Or mental health coverage? Allowing people to mix and match individual things they may or may not need would be no better than killing insurance altogether - at some point in their lives there will be a circumstance which they didn't bank on and which - because they lacked either hindsight or funding - they are now completely financially responsible for. How does that help?

I think you closed your sarcasm tag prematurely. It doesn't really matter whether you rate as over-insured, under-insured, or uninsured. If you need a certain drug or operation to save your life, does cost drive your decision? Do you put off open heart surgery or chemo and shop around? How much we value our lives and livelihoods is what drives up the cost of health care, not how much we're willing to pay for it.

 

[dblack]

All sarcasm aside, how do you make a determination as to whether you need to carry long-term sickness coverage such as cancer, or high blood pressure, or even HIV? What about convalescent coverage? Or mental health coverage? Allowing people to mix and match individual things they may or may not need would be no better than killing insurance altogether - at some point in their lives there will be a circumstance which they didn't bank on and which - because they lacked either hindsight or funding - they are now completely financially responsible for. How does that help?

It helps by allowing people to decide for themselves how much risk is acceptable, and how much they'd rather be responsible for their own circumstances. I understand that 'freedom' simply isn't a valuable concept to some, and that those people are willing to trade away most of it in exchange for promises of security. I'm not.

I think you closed your sarcasm tag prematurely. It doesn't really matter whether you rate as over-insured, under-insured, or uninsured. If you need a certain drug or operation to save your life, does cost drive your decision? Do you put off open heart surgery or chemo and shop around? How much we value our lives and livelihoods is what drives up the cost of health care, not how much we're willing to pay for it.

You're missing the point. Or rather choosing to focus on a different point. This is actually the same sort of misdirection that PPACA indulges in.

I'm talking about the core problem with health care in the US - which is that it costs way more than it should. I'm specifically addressing the part that over-insured patients play in distorting the health care market.

You, like the authors of PPACA, are instead preoccupied with a different problem, namely what to do about people who can't afford the health care they need. Which is really just a special case of the problem of what to do about people who are too poor to take care of themselves in general.

The thing is, these two problems are very different and require different solutions. And if we're not careful, the solutions to one can worsen the other: The various welfare and safety net programs implied by the second problem tend to apply even more inflationary pressure on the health care market. But if we don't effectively address the first problem, if we don't get health care price inflation under control, we won't be able to afford a safety net large enough or strong enough to pay for the health care we need. Likewise, getting prices under control, even bringing them down, significantly reduces our safety net requirements.

 

[oldernwiser]

You're missing the point. Or rather choosing to focus on a different point. This is actually the same sort of misdirection that PPACA indulges in.

I'm talking about the core problem with health care in the US - which is that it costs way more than it should. I'm specifically addressing the part that over-insured patients play in distorting the health care market.

You, like the authors of PPACA, are instead preoccupied with a different problem, namely what to do about people who can't afford the health care they need. Which is really just a special case of the problem of what to do about people who are too poor to take care of themselves in general.

The thing is, these two problems are very different and require different solutions. And if we're not careful, the solutions to one can worsen the other: The various welfare and safety net programs implied by the second problem tend to apply even more inflationary pressure on the health care market. But if we don't effectively address the first problem, if we don't get health care price inflation under control, we won't be able to afford a safety net large enough or strong enough to pay for the health care we need. Likewise, getting prices under control, even bringing them down, significantly reduces our safety net requirements.

I'm not missing the point at all - in fact we're talking about the same issue from 2 different points of view. I happen to disagree that the amount of insurance coverage you have has much bearing on what prices we pay for medical services - except that as costs rise, insurance companies have most of the cash available to accommodate the providers. Nor do I agree with the implementation of ACA, which will, at best, forestall the inevitable collapse of insurance as we know it.

I believe that the economic model of supply and demand as it pertains to the medical industry is flawed. Health care isn't a commodity like, say, a TV. We can choose our TVs to suit our tastes and budgets. Many manufacturers build those TVs to our tastes, and compete with each other to keep prices attractive enough for us to spend cash on them. On the other hand, you're either healthy or not healthy. There's no "healthy enough for my budget" - especially if you're looking at a long term debilitating illness. In order to satisfy supply and demand, more and more people need to refuse care - which they won't. And so, there's no real economical pressure on health care providers to keep costs down. As a result, prices rise and continue to rise. This is where ACA fails to address Obama's original mandate - to provide affordable health care.

Further, the laws on intellectual property rights on medicines play a huge part in making sure there is very little competition for prescription drugs. This allows a pharmaceutical company to charge exorbitant rates for the drugs it manufactures. ACA fell short here as well.

I do agree with you that the poor/unemployed/underemployed exacerbates the problem even further by causing providers to charge even higher prices for services to people who can afford them (which is why you'll see 2 prices for services at hospitals and doctor's offices - a low one for someone paying out of pocket, and the "industry standard" price they charge to insurance carriers). Since the EMTALA Act makes sure that no one is turned away from emergency treatment based on their ability to pay, emergency rooms have to charge more to cover what the tax breaks miss. As their prices rise, so do the prices of private practice.

On the issue of the policies themselves, the "standard" policies were put in place to help providers with their billing practices. They know that a BCBS group policy will have certain coverages and co-pays, they also know that BCBS will only pay $X while AETNA will pay $Y, and who knows if Medicare will pay at all for a given procedure. If you pick the type of coverage yourself, providers will spend MORE time looking at your policy to see whether they charge you or charge your carrier, which would also kick up costs a bit.

IMO, insurance needs to be phased out completely. It was never intended to cover cradle to grave medical expenses. While I know that people gripe about the taxes they pay, if you were to consider insurance premiums as another tax it would begin to make sense that we start considering a way to nationalize our health care industry in order to contain the costs and stabilize the market. If we fail to do this, prices will continue to rise, which in turn will force insurance companies to put more of the financial responsibilities on us until the cost of care rises to a point where insurance can't sustain the financial burden and simply collapses. At which point, the 1% will most likely become the 80%.

 

[dblack]

I believe that the economic model of supply and demand as it pertains to the medical industry is flawed. Health care isn't a commodity like, say, a TV. We can choose our TVs to suit our tastes and budgets. Many manufacturers build those TVs to our tastes, and compete with each other to keep prices attractive enough for us to spend cash on them. On the other hand, you're either healthy or not healthy. There's no "healthy enough for my budget" - especially if you're looking at a long term debilitating illness. In order to satisfy supply and demand, more and more people need to refuse care - which they won't. And so, there's no real economical pressure on health care providers to keep costs down. As a result, prices rise and continue to rise. This is where ACA fails to address Obama's original mandate - to provide affordable health care.

Here I can tell you, from experience, that you're simply wrong. The vast majority of decisions we make about health care expenditures don't occur in emergency situations, or in the face of long-term debilitating illness. They occur when deciding which doctor to see to treat your child's ear infection, or what drug to take of those the doctor recommends. They occur when deciding whether to get regular check-ups that might prevent expensive problems later - or whether to not worry about it because your 'covered'. The fact that millions of those decisions are made every year by people with upside-down economic incentives can't possibly be insignificant. I've yet to see a well-documented study on this dynamic, but it is sorely needed.

My previous employer offered high-deductible ($3000), low-premium insurance plans combined with a savings account, funded by regular installments from the company, to cover the deductible. The net cost for this plan was actually less for the employer than traditional group plans, but it was desirable in another way - which is far more important in terms of the overall health care problem. The money in the savings account was my money to keep.

Over the years I was there, I was struck by how this arrangement changed my attitude toward health care, even my relationship with doctors. When you're paying out of pocket for health care, you actually ask how much it's going to cost. You ask if there are cheaper alternatives. You ask if there are discounts available (and you'd be surprised how often there are - for cash payment, for flexible appt timing, etc...). You ask if a given test is necessary, or just a cya for the doctor. The point is, when it's your money you give a shit. When it's not, you don't. When it's not your money, the incentives are the opposite. When you're "covered" you want the best that someone else's money can buy in all cases - necessary or not.

Further, the laws on intellectual property rights on medicines play a huge part in making sure there is very little competition for prescription drugs. This allows a pharmaceutical company to charge exorbitant rates for the drugs it manufactures. ACA fell short here as well.

On this, I suspect we could find some agreement. There is a wide body of regulation that needs to be re-examined. And when people are spending their own money, they'll be much more interested in demanding - from their representatives in government - that these issues be addressed. As it is - if we're "covered" - we don't really care.

IMO, insurance needs to be phased out completely. It was never intended to cover cradle to grave medical expenses. While I know that people gripe about the taxes they pay, if you were to consider insurance premiums as another tax it would begin to make sense that we start considering a way to nationalize our health care industry in order to contain the costs and stabilize the market. If we fail to do this, prices will continue to rise, which in turn will force insurance companies to put more of the financial responsibilities on us until the cost of care rises to a point where insurance can't sustain the financial burden and simply collapses. At which point, the 1% will most likely become the 80%.

Right, and I suppose this is the most frustrating aspect of health care reform. Instead of addressing the market distorting affects of our current policies, ambitious lawmakers are using them as an excuse to radically expand the scope and power of government by taking over health care entirely. It's particularly disgusting to see many of them willfully, and relatively openly, condoning policies that distort the market still further - in the hopes that the suffering so inflicted will drive more and more of us to accept state dependency as the solution.

It looks like the Court might give us some breathing room on this campaign, but in the long run I'm not hopeful. Corporatism is a powerful trend in our government and I don't see us reversing it any time soon.

 

[Old Rocks]

...there is no escape short of national health care.

Of course, because free markets are out of the question.

A free market health care system in this nation has given us the highest per capita costs of any nation for a system that has vastly inferior results compared to the other rich industrial nations. In fact, the only people really gaining from the present system are the very rich that make profit off of other peoples misery.

 

[Old Rocks]

[ame=http://www.youtube.com/watch?v=yVgOl3cETb4]"We&#39;re Number 37" - Paul Hipp - YouTube[/ame]

 

[oldernwiser]

The vast majority of decisions we make about health care expenditures don't occur in emergency situations, or in the face of long-term debilitating illness. They occur when deciding which doctor to see to treat your child's ear infection, or what drug to take of those the doctor recommends. They occur when deciding whether to get regular check-ups that might prevent expensive problems later - or whether to not worry about it because your 'covered'. The fact that millions of those decisions are made every year by people with upside-down economic incentives can't possibly be insignificant. I've yet to see a well-documented study on this dynamic, but it is sorely needed.

I'll grant you part of this. Like using a debit card, if you don't see the dollars you tend to forget how many you're using. On the other hand, consider the folks who don't have a health care plan and are living hand to mouth as it is. These people MUST postpone regular check ups and preventative care or they face the very real decision of whether to eat or pay the light bill. They are extremely frugal with their health care dollars, and there are a lot of them - and as our economy slumps, there are a lot more. I would venture a guess that these folks offset some of the unintentional over-spending that occurs when you're just not paying attention. And yet, you're right - this is a dynamic that was never even considered in ACA.

My previous employer offered high-deductible ($3000), low-premium insurance plans combined with a savings account, funded by regular installments from the company, to cover the deductible. The net cost for this plan was actually less for the employer than traditional group plans, but it was desirable in another way - which is far more important in terms of the overall health care problem. The money in the savings account was my money to keep.

Nice plan, but that was forward thinking by your employer. Most employers don't take that amount of time to consider creative ways to save their employees a few bucks. They opt for a few of the off the shelf packages to satisfy government regulations, and that's the end of it.

Over the years I was there, I was struck by how this arrangement changed my attitude toward health care, even my relationship with doctors. When you're paying out of pocket for health care, you actually ask how much it's going to cost. You ask if there are cheaper alternatives. You ask if there are discounts available (and you'd be surprised how often there are - for cash payment, for flexible appt timing, etc...). You ask if a given test is necessary, or just a cya for the doctor. The point is, when it's your money you give a shit. When it's not, you don't. When it's not your money, the incentives are the opposite. When you're "covered" you want the best that someone else's money can buy in all cases - necessary or not.

I have to give you this point too, but with some qualifications. You were in a fairly unique situation where YOU managed your own care funding. You budgeted your $3k - which, in normal situations would cover a small family's medical expenses for a year fairly adequately. And because the remainder of that $3k was yours to keep, it paid to keep costs down. Like I said, awesome plan.

If we're on top of our own care - something I've always been - we can take advantage of the discounts, use only generics, find alternatives to procedures that seem unnecessary, yada yada... But, we aren't medically intelligent enough to ask some of the questions we need to ask, and when we are, we don't have enough training to understand all the answers. But, it goes beyond that. If you do a little investigating you can see that your kid's ear infection will cost you $50 out of pocket, or $60 on insurance. If you happen to have $50 in your pocket (especially if your employer put that $50 in your pocket), fine. But, what if you don't? $60 of insurance money is the only way to go, and many subscribers are stuck with just that option.

Adding to that is the way that carriers are billed. I have done some software consulting in quite a few Dr offices, each of them billed carriers 10-30% more than they knew they would be paid with the expectation that as "reasonable and customary" prices were reviewed, there was built-in pressure to raise the amounts carriers paid for services. While you may be able to save 5% of a provider's fees paying cash, providers themselves make that up in spades milking a cash cow and taking advantage of people with a fair job, with benefits, which pays them with little more than subsistence. And at that, only if they're lucky.

 

[Greenbeard]

The vast majority of decisions we make about health care expenditures don't occur in emergency situations, or in the face of long-term debilitating illness. They occur when deciding which doctor to see to treat your child's ear infection, or what drug to take of those the doctor recommends. They occur when deciding whether to get regular check-ups that might prevent expensive problems later - or whether to not worry about it because your 'covered'.

Is this where you think the vast majority of health dollars are being spent?

 

[eflatminor]

...there is no escape short of national health care.

Of course, because free markets are out of the question.

A free market health care system in this nation has given us the highest per capita costs of any nation for a system that has vastly inferior results compared to the other rich industrial nations. In fact, the only people really gaining from the present system are the very rich that make profit off of other peoples misery.

Yea, that's what we have today in America's health care system...a free market.

 

[dblack]

The vast majority of decisions we make about health care expenditures don't occur in emergency situations, or in the face of long-term debilitating illness. They occur when deciding which doctor to see to treat your child's ear infection, or what drug to take of those the doctor recommends. They occur when deciding whether to get regular check-ups that might prevent expensive problems later - or whether to not worry about it because your 'covered'.

Is this where you think the vast majority of health dollars are being spent?

I suppose not. But we're discussing inflated prices for routine health care, not gross national health care expenditures.

 

[onecut39]

The french are rated best in the world.

Oh well, if the United Nations says so

By the way, how is the French debt situation these days? All those entitlements working out well for the people? From your own link: "It will be the generation now entering the workforce who will pay for the years of deficit spending through some mix of higher taxes and reduced access."

Lovely, even more taxes and less care. Yea, we should shoot for that.

While I may agree France's healthcare system is better than other socialist systems, that does not mean our quasi-socialist approach should take that final step towards central control. Instead, we could stop tying healthcare insurance to jobs, stop forcing everything under the sun to be covered in policies issued, stop telling insurance carriers how much than can charge, make "loser pays" the standard for all lawsuits, and for heaven's sake, stop regulating the death out of the industry.

"Socialist" is defined as the ownership and control of the production facilities.

France is not a socialist system

You do realize that the US is the only system in the world that is driven by profit? Where are all those benefits this is supposed to bring?

 

[onecut39]

...there is no escape short of national health care.

Of course, because free markets are out of the question.

A free market health care system in this nation has given us the highest per capita costs of any nation for a system that has vastly inferior results compared to the other rich industrial nations. In fact, the only people really gaining from the present system are the very rich that make profit off of other peoples misery.

Hey Old I just gave you a thanks. Not because your post was was so useful, it is after all old information that is readily available and is regularly ignored by those on the right.

You get my my thanks simply for being truthful, a rare quality on any message board. You seem to do that a lot. Thanks again.

 

[dblack]

Hey Old I just gave you a thanks. Not because your post was was so useful, it is after all old information that is readily available and is regularly ignored by those on the right.

It's not "information", it's an opinion. And the reason it's ignored (and not just by those on the "right", btw) is because there is a lot of equivocation on the meaning of the term free market. From my perspective, what we have now - and have had for some time - is a far cry from a free market. Further, the biggest problems we have with health care are directly attributable to regulation and tax policies that have moved us away from a free market. They distort our use of insurance and accelerate health care inflation.

 

[oldernwiser]

Hey Old I just gave you a thanks. Not because your post was was so useful, it is after all old information that is readily available and is regularly ignored by those on the right.

It's not "information", it's an opinion. And the reason it's ignored (and not just by those on the "right", btw) is because there is a lot of equivocation on the meaning of the term free market. From my perspective, what we have now - and have had for some time - is a far cry from a free market. Further, the biggest problems we have with health care are directly attributable to regulation and tax policies that have moved us away from a free market. They distort our use of insurance and accelerate health care inflation.

I'd agree with that mostly.

I guess that sooner or later we have to answer the current question: Should health care be governed by "free market" principles?