Why not attack the $600 billion health care cost driver?

[geauxtohell]

Many of you are so ignorant of the real villains in the health care costs or you are either afraid!

You naively attack the health insurance companies that are simply the payers of the health care bills presented to them!

If any of you took the time to honestly look at health insurance companies "PUBLIC" financial documents you'd see the average health insurance company pays out 80% of premiums in claims.

AND $600 billion according to the people [health care providers!!!]
that MAKE those payment claims to the insurance company is done purely out of fear of lawsuits!

Who pays that?
Insurance companies/Medicare and the general public.

All because 90% of the doctors admit they practice "defensive medicine" so they won't be sued!

Nine out of 10 physicians reported practicing defensive medicine.
Doctors Estimate Defensive Medicine Costs Americans $650-850 Billion Annually
Doctors Practice Medicine in Fear, New Study Finds

Why is is so hard to face this Number ONE cost driver..FEAR of Lawsuits create "Defensive Medical practices"!

There is a solution if any of you have any interest in learning rather then constantly blaming the wrong parties!

A.) Because the actual studies indicate that the costs from malpractice litigation are a small fraction of the pie.

B.) Because, as long as medicine is a business, the basic right to be made economically whole for a tort inherent to our legal system.

You can't have a capitalist medicine system while depriving the customers of their right to recourse for breach of duty.

In other words, you can't have it both ways.

 

[Greenbeard]

Like any state will be able to afford it.

I doubt any analysis has been done on the proposal but I suspect Sanders' proposal wouldn't end up costing states much more than their current arrangements.

Right now, the federal government pays a portion of each state's Medicaid expenses--it's called the Federal Medical Assistance Percentage (FMAP) and it varies from state-to-state based on the state's per capita income. A state's FMAP will be somewhere between 50 percent (for the wealthiest states) and 83 percent (for the poorest state--no state actually has a low enough per capita income to get that high of a percentage), meaning that for the richest states the feds cover half the cost of their program and for poorer states it covers more than half the cost. Averaged out over all the states, the federal government pays about 57% of Medicaid costs in the nation.

Under Sanders' proposal, since it seems to be modeled after Medicaid, each state would receive an FMAP-like contribution to their state single-payer system but it would be much more generous than what they get for their Medicaid programs now: "The weighted-average Federal contribution percentage for all States shall equal 86 percent and in no event shall such percentage be less than 81 percent nor more than 91 percent."

Of course, the state single-payer programs in Sanders' bill would be more extensive than current Medicaid programs, as they'd cover all of the state's population, so even though they get a greater federal contribution their programs would also cost more.

But Sanders also relies heavily on capitation (a fixed dollar amount associated with each person, varying based on a few different factors). That isn't how the current federal contribution to state Medicaid programs works, though states often rely on capitation when they're contracting Medicaid out to private insurance companies. Right now the feds provide matching funds for every dollar the state spends so the commitment for both the state and the feds is open-ended. For Sanders' single-payer programs, the federal and state contribution would be percentages of some set state-level capitation amount.

So there's a bit more predictability of federal and state expenditures for his program.

 

[Listening]

We're not going to be able to create a single-payer system except piecemeal on the state level until we get the corporate influence out of the federal government, so that's not really a problem. First things first.

I realize you're talking about individual state-level efforts (like Vermont's successful legislation and California's twice-vetoed bill), but interestingly enough, this session Bernie Sanders has introduced federal legislation for a state-level single-payer program.

Unlike some of the other proposals (e.g. H.R. 676) which are built more on a Medicare model, Sanders' bill is built on the Medicaid model, in which each state has its own individualized program, operated by the state government, in a joint federal-state partnership. I thought that was fascinating because national single-payer advocates rarely seem to look to Medicaid for inspiration for a potential program structure.

And once again, we are faced with Sanders telling Colorado they have to have a health care program ? Or can a state op out.

I am all for state run programs for the states that want them.

 

[jillian]

AND $600 billion according to the people [health care providers!!!]
that MAKE those payment claims to the insurance company is done purely out of fear of lawsuits!

First, your figures appear to be wildly inflated:

Malpractice liability costs U.S. $55.6 billion: study | Reuters

Try $55 billion.

Total health care costs in the U.S. in 2008 was roughly $2.3 trillion, or $2,300 billion. That means the cost of malpractice liability in increased health care costs constitute no more than 2.3% of the total health care cost in this country.

Moreover, not all of that can be saved through health-care reform. A patient injured or killed by medical malpractice must have some form of redress; it is simply not acceptable to tell a patient who has been crippled or brain-damaged for life to lump it. So in terms of realistic tort reform, the savable cost is bound to be much less than 2.3%.

he has to do these threads... that's what he gets paid for.

he got humiliated on one this a.m., so decided to spam the board with this new one.

 

[Greenbeard]

And once again, we are faced with Sanders telling Colorado they have to have a health care program ? Or can a state op out.

I am all for state run programs for the states that want them.

Under the Sanders proposal, "Every individual who is a resident of the United States and is a citizen or national of the United States or lawful resident alien (as defined in subsection (d)) is entitled to benefits for health care services under this Act under the appropriate State health security program." The way I read it, if a state doesn't want to run one of the single-payer programs ("Health Security Programs"), the feds will do it for them because their residents are entitled to one of those programs, though don't quote me on that one. That would be a key difference from Medicaid, since no state is actually required to operate a Medicaid program.

An interesting question is the extent to which these state-based Health Security Programs would be able to do some of the things state Medicaid programs can do. For example, Medicaid programs can get waivers from federal requirements to try new things--the most expansive option is called an 1115 waiver. I'm curious as to the extent Sanders would allow states flexibility to customize certain aspects of the state system. Given that his bill outlines a very particular arrangement for the way the system operates, I imagine there would be less flexibility than there is for something like the current Medicaid program but I could be wrong on that.

 

[Ropey]

We're not going to be able to create a single-payer system except piecemeal on the state level until we get the corporate influence out of the federal government, so that's not really a problem. First things first.

I realize you're talking about individual state-level efforts (like Vermont's successful legislation and California's twice-vetoed bill), but interestingly enough, this session Bernie Sanders has introduced federal legislation for a state-level single-payer program.

Unlike some of the other proposals (e.g. H.R. 676) which are built more on a Medicare model, Sanders' bill is built on the Medicaid model, in which each state has its own individualized program, operated by the state government, in a joint federal-state partnership. I thought that was fascinating because national single-payer advocates rarely seem to look to Medicaid for inspiration for a potential program structure.

And once again, we are faced with Sanders telling Colorado they have to have a health care program ? Or can a state op out.

I am all for state run programs for the states that want them.

Mandate by referendum is the Republican way. Or so I was taught. Ohio shows the trending. Now when it comes to public unions being able to negotiate and bargain with other public officials then the voters have spoken?

And then when it comes to ObamaCare, Gay Marriage, etc., the prevailing Liberal view is that those arenas should be decided by the courts? Roe should never have made it to the Federal level imo.

 

[Listening]

And then when it comes to ObamaCare, Gay Marriage, etc., the prevailing Liberal view is that those arenas should be decided by the courts? Roe should never have made it to the Federal level imo.

We agree.

First, liberals have always depended on the courts to help them in their efforts to further constrain society the way they would like it constrained. After all, why go through the normal channels when you have Harry Blackmun to aid your cause (if it were up to me, they'd dig him up, shoot him and not bother to bury him again). The will of the people means nothing if you can get the will of the SCOTUS.

Next...Roe....absolutely right. It had been a states issue since the start of time and it should have stayed one. If Roe were overturned today, probably half the states would have abortion rights for women. At the time of Roe, it was four (from memory).

 

[Ropey]

And then when it comes to ObamaCare, Gay Marriage, etc., the prevailing Liberal view is that those arenas should be decided by the courts? Roe should never have made it to the Federal level imo.

We agree.

First, liberals have always depended on the courts to help them in their efforts to further constrain society the way they would like it constrained. After all, why go through the normal channels when you have Harry Blackmun to aid your cause (if it were up to me, they'd dig him up, shoot him and not bother to bury him again). The will of the people means nothing if you can get the will of the SCOTUS.

Next...Roe....absolutely right. It had been a states issue since the start of time and it should have stayed one. If Roe were overturned today, probably half the states would have abortion rights for women. At the time of Roe, it was four (from memory).

"We"?

I mentioned Roe to show the clear move towards removing mandated referendum and instilling legislating judges to do the work of the people. This is another facet of larger government ...

Which is the agenda of the left.

 

[mskafka]

Many of you are so ignorant of the real villains in the health care costs or you are either afraid!

You naively attack the health insurance companies that are simply the payers of the health care bills presented to them!

If any of you took the time to honestly look at health insurance companies "PUBLIC" financial documents you'd see the average health insurance company pays out 80% of premiums in claims.

AND $600 billion according to the people [health care providers!!!]
that MAKE those payment claims to the insurance company is done purely out of fear of lawsuits!

Who pays that?
Insurance companies/Medicare and the general public.

All because 90% of the doctors admit they practice "defensive medicine" so they won't be sued!

Nine out of 10 physicians reported practicing defensive medicine.
Doctors Estimate Defensive Medicine Costs Americans $650-850 Billion Annually
Doctors Practice Medicine in Fear, New Study Finds

Why is is so hard to face this Number ONE cost driver..FEAR of Lawsuits create "Defensive Medical practices"!

There is a solution if any of you have any interest in learning rather then constantly blaming the wrong parties!

Because of your username, I'm going to assume that you work in healthcare?

 

[mskafka]

How about some anecdotal illustrations to see if you understand what $600 billion IS!!

"In a recent letter to the Wall Street Journal, a Texas doctor described how, since being
unsuccessfully sued in 1995, he has "doubled and tripled the number of tests and consultations that I order."
But the orthopedic hospital would not accept month-old test results,
nor even an explicit waiver by me of any liability. The result was pure waste:
more than $1,000 spent on wholly unnecessary tests.
Philip K. Howard - Medical Tort Reform Could Save Billions



Overall, 91 percent of doctors surveyed agreed with both statements.

http://www.google.com/hostednews/ap/article/ALeqM5js4_BkHmmxcniut6D1lhI_3GzHyAD9GKG3A82

"Defensive medicine is when doctors order multiple tests, MRIs and other procedures, not because the patient needs them, but to protect against litigation based on allegations that something should have been done but wasn’t.
Experts estimate as much as $300 billion in unnecessary costs is attributable to defensive medicine.
Besides more time-consuming appointments, patients are left with fewer services and less access to quality care as doctors either narrow their practices or leave the profession entirely."
http://www.sfexaminer.com/opinion/E...take-on-trial-lawyers-in-speech-57953202.html

So he was UNSUCCESSFULLY sued, which means what he was already doing was adequate to avoid a successful lawsuit, but the CON$ervative quack doctor saw an opportunity to pad his income by charging his patients for useless tests. The more tests he orders the more money HE makes. We need to get the greedy CON$ out of the medical profession to save $600 billion!

Now Ed, I often agree with you on many issues, but defensive medicine is a very real problem in healthcare. I see it every day. Now is it the ONLY problem? Hell no it isn't.

 

[dblack]

I'd like to ask any of the health care professionals on the board, especially those who run a private practice: To what extent does price competition influence the amount you charge for a given service?

Most discussion of health care inflation is preoccupied with cost drivers. And I realize that's the topic of this thread, but it also seems to be the one-sided focus of pretty much every examination of the health care market. Almost no one talks about market pressures. From what I can tell, market pressures exist in the health care market, but they are mostly artificial, and often doing the opposite of what we'd hope (driving prices up rather than keeping them down).

Nearly every small business owner is constantly struggling with cost-drivers, and one of the main challenges of working for yourself is figuring out how to price your services low enough to attract consumers in the face of those cost-drivers. It just doesn't seem to me like doctors face that kind of pressure.

I've have more questions - if you're still with me:

How often to you feel you're being price shopped?

Do your customers usually ask how much a service or procedure will cost when considering whether to go through with it or not? Ever?

After you propose a procedure or treatment, do you think most patients are shopping around for a better deal from another doctor? Any?

Does it price even matter to most patients?

It's my understanding that the only significant downward price pressure on doctor's fees is the practice of insurance companies setting maximum payouts for certain services. In regard to that practice:

Do all insurance companies do this? Or just some?

Do you pass on the remainder (the difference between what you want to charge and what the insurance company pays) to the patient?

Do you charge your non-insured patients (assuming you have any) the same rates that the insurance companies pay?

Do you know how much this practice (setting maximum payouts) is regulated by insurance regulation?

Thanks in advance to any of you who take the time to answer!

 

[geauxtohell]

It would also be a fallacy to think that healthcare providers benefit the most from "tort reform". That is not the case. Healthcare insurance companies benefit the most. As it stands most states have now capped non-economic damages which is a boon doggle for insurance companies. It ensures their payouts are minimal.

Do you think the insurance companies want to eliminate litigation? Hell no. Then their services would no longer be needed.

I have no problem discussing the issue, and "defensive" medicine is a problem, the problem is that it's hard to find an honest discussion on the matter.

 

[PeteEU]

Many of you are so ignorant of the real villains in the health care costs or you are either afraid!

You naively attack the health insurance companies that are simply the payers of the health care bills presented to them!

If any of you took the time to honestly look at health insurance companies "PUBLIC" financial documents you'd see the average health insurance company pays out 80% of premiums in claims.

AND $600 billion according to the people [health care providers!!!]
that MAKE those payment claims to the insurance company is done purely out of fear of lawsuits!

Who pays that?
Insurance companies/Medicare and the general public.

All because 90% of the doctors admit they practice "defensive medicine" so they won't be sued!

Nine out of 10 physicians reported practicing defensive medicine.
Doctors Estimate Defensive Medicine Costs Americans $650-850 Billion Annually
Doctors Practice Medicine in Fear, New Study Finds

Why is is so hard to face this Number ONE cost driver..FEAR of Lawsuits create "Defensive Medical practices"!

There is a solution if any of you have any interest in learning rather then constantly blaming the wrong parties!

Sorry but you are a tad dishonest.

Does malpractice insurance and so on have an impact? of course it does. But the largest impact? Hell no.

There is zero competition in the US in the healthcare industry. Thanks to friendly politicians, the healthcare industry has over the last many decades written the legislation that governs them. This means geographical monopolies/duopolies, ban on negotiations by the US federal government on drugs and care when buying from the private sector, and of course the big one.. not allowed to parallel import any drugs even from Canada, and making it a criminal offence... and so on and so on.

On top of that there is next to no price regulation/control so drug companies can rip your citizens for all they are worth. And dont use the lame excuse they need money to develop drugs... they use more on advertising than on R&D. Of course I do not advocate communist type price controls, but an agency that keeps tabs on drug companies for the consumer so that the drug companies dont put too high a profit margin on its drugs.

Also paying doctors per procedure... the most idiotic thing ever. Of course they going to do as many tests as possible.. they and the HMOs earn money by doing so! Sure there is the fear of being sued, but the main driver is the fact they get paid per procedure... the fear of being sued when someone comes in with a classic flu... you dont need 236516 tests to deal with that.. and yet if you get paid per test... then why not!. Yes it is changing, but far too slowly....

The above two (especially the first one) drive prices on healthcare up far far faster than any failed malpractice system.

For an European, our insurance companies actually would rather have us shipped back to Europe as fast as possible if we get injured in the US, even for a broken leg or arm, rather than pay for the overpriced American system... it is cheaper to ship us back! Thats how bad it is....

 

[geauxtohell]

Many of you are so ignorant of the real villains in the health care costs or you are either afraid!

You naively attack the health insurance companies that are simply the payers of the health care bills presented to them!

If any of you took the time to honestly look at health insurance companies "PUBLIC" financial documents you'd see the average health insurance company pays out 80% of premiums in claims.

AND $600 billion according to the people [health care providers!!!]
that MAKE those payment claims to the insurance company is done purely out of fear of lawsuits!

Who pays that?
Insurance companies/Medicare and the general public.

All because 90% of the doctors admit they practice "defensive medicine" so they won't be sued!

Nine out of 10 physicians reported practicing defensive medicine.
Doctors Estimate Defensive Medicine Costs Americans $650-850 Billion Annually
Doctors Practice Medicine in Fear, New Study Finds

Why is is so hard to face this Number ONE cost driver..FEAR of Lawsuits create "Defensive Medical practices"!

There is a solution if any of you have any interest in learning rather then constantly blaming the wrong parties!

Sorry but you are a tad dishonest.

Does malpractice insurance and so on have an impact? of course it does. But the largest impact? Hell no.

There is zero competition in the US in the healthcare industry. Thanks to friendly politicians, the healthcare industry has over the last many decades written the legislation that governs them. This means geographical monopolies/duopolies, ban on negotiations by the US federal government on drugs and care when buying from the private sector, and of course the big one.. not allowed to parallel import any drugs even from Canada, and making it a criminal offence... and so on and so on.

On top of that there is next to no price regulation/control so drug companies can rip your citizens for all they are worth. And dont use the lame excuse they need money to develop drugs... they use more on advertising than on R&D. Of course I do not advocate communist type price controls, but an agency that keeps tabs on drug companies for the consumer so that the drug companies dont put too high a profit margin on its drugs.

Also paying doctors per procedure... the most idiotic thing ever. Of course they going to do as many tests as possible.. they and the HMOs earn money by doing so! Sure there is the fear of being sued, but the main driver is the fact they get paid per procedure... the fear of being sued when someone comes in with a classic flu... you dont need 236516 tests to deal with that.. and yet if you get paid per test... then why not!. Yes it is changing, but far too slowly....

The above two (especially the first one) drive prices on healthcare up far far faster than any failed malpractice system.

For an European, our insurance companies actually would rather have us shipped back to Europe as fast as possible if we get injured in the US, even for a broken leg or arm, rather than pay for the overpriced American system... it is cheaper to ship us back! Thats how bad it is....

A lab test isn't a procedure, and I've yet to encounter any system that reimburses for diagnostic tests. At this point, ultrasound at the bedside isn't even reimbursed, even though it requires skill to do.

Procedures, where the physician actually employs a skill to do something to the patient's body (i.e. laceration repair, arthrocentesis, lumbar puncture, intubation, placing a central line) are re-imbursed as they should be. Those are part of the skill set that makes physicians different.