Rationing Medicare

[Trajan]

oh for god sakes...

 

[Quantum Windbag]

Several things wrong with your statement.

1. No one seriously involved in the debate is suggesting the government make health care decisions.
2. Even if that were the case, if we use Medicare as stand-in for likely coverage, CAM would not be covered.

Correction.

You are not talking about it, but there are plenty of people who are quite serious about it, and lobbying congress to force insurers to cover those things. As usual, you think the world revolves around you. It doesn't, and never will.

You're mixing arguments again. Item 1 was referring to your claim about the government controlling health care decisions.

They told me that I have to buy insurance that covers office visits and routine testing, how is that not controlling health care decisions?

 

[Greenbeard]

They told me that I have to buy insurance that covers office visits and routine testing, how is that not controlling health care decisions?

Haven't you claimed in the past to get coverage through a self-insured plan?

 

[Polk]

Correction.

You are not talking about it, but there are plenty of people who are quite serious about it, and lobbying congress to force insurers to cover those things. As usual, you think the world revolves around you. It doesn't, and never will.

You're mixing arguments again. Item 1 was referring to your claim about the government controlling health care decisions.

They told me that I have to buy insurance that covers office visits and routine testing, how is that not controlling health care decisions?

If that's your standard for control, you're also living under a totalitarian regime that controls painting, because you can't buy lead paint.

 

[Quantum Windbag]

They told me that I have to buy insurance that covers office visits and routine testing, how is that not controlling health care decisions?

Haven't you claimed in the past to get coverage through a self-insured plan?

Yes. And I also pointed out that, because of the PPACA, I can no longer buy the policy I have used for years. That is because the policy I had came no where near the minimum coverage requirements, and I am not politically connected enough to get a waiver.

What's your point?

 

[Quantum Windbag]

You're mixing arguments again. Item 1 was referring to your claim about the government controlling health care decisions.

They told me that I have to buy insurance that covers office visits and routine testing, how is that not controlling health care decisions?

If that's your standard for control, you're also living under a totalitarian regime that controls painting, because you can't buy lead paint.

I mix my own lead paint and use it to paint offices in Congress.



Nice to see that you actually understand the problem, even if you think I am crazy. The nanny state wants to make decisions for everyone, and you agree with them. Unlike you, I can make my own decisions.

Do you plan to grow up anytime soon?

 

[dblack]

If that's your standard for control, you're also living under a totalitarian regime that controls painting, because you can't buy lead paint.

That's not a valid analogy. If they forced you to buy lead paint, you might have a point. You see the difference, right?

 

[Polk]

If that's your standard for control, you're also living under a totalitarian regime that controls painting, because you can't buy lead paint.

That's not a valid analogy. If they forced you to buy lead paint, you might have a point. You see the difference, right?

That's not a valid analogy, unless you think having health insurance is harmful.

 

[Greenbeard]

Yes. And I also pointed out that, because of the PPACA, I can no longer buy the policy I have used for years. That is because the policy I had came no where near the minimum coverage requirements, and I am not politically connected enough to get a waiver.

What's your point?

Self-insured plans aren't subject to the qualified health plan requirements in the ACA, meaning they don't have to offer the essential benefits package you seemed to be referencing earlier. Perhaps you're not using the word the way the rest of the universe does?

As for political connections for annual limit waivers, you're the one who posted the GAO report that showed there was no political favoritism in the waiver process. Who could've guessed you didn't bother reading it?

 

[dblack]

That's not a valid analogy, unless you think having health insurance is harmful.

I do! The kind of insurance they intend to force on us is very harmful. I've made that point here repeatedly. In my view getting away from the low-deductible group insurance model is the single most important thing we can do to counter health care inflation and bring balance back to the market.

 

[Polk]

That's not a valid analogy, unless you think having health insurance is harmful.

I do! I've made that point here repeatedly. In my view getting away from the low-deductible group insurance model is the single most important thing we can do to counter health care inflation and bring balance back to the market.

You're right that your proposal would control health care inflation... by making services so expensive for the average person that they would die.

 

[dblack]

You're right that your proposal would control health care inflation... by making services so expensive for the average person that they would die.

Think about that. Are you really saying that people paying more of their health care bills out of pocket would make health care prices go up? Have you ever really thought about the way insurance affects the health care market?

 

[Polk]

You're right that your proposal would control health care inflation... by making services so expensive for the average person that they would die.

Think about that. Are you really saying that people paying more of their health care bills out of pocket would make health care prices go up? Have you ever really thought about the way insurance affects the health care market?

No. Your proposal would reduce total cost, but that's pretty irrelevant to the person having to bear that cost out-of-pocket.

 

[dblack]

No. Your proposal would reduce total cost, but that's pretty irrelevant to the person having to bear that cost out-of-pocket.

Slow down and think about this, please. Let's look at the average low-deductible, high-premium insurance plan. Let's say a family is paying $800/month for a plan with $500 yearly deductible. Their out of pocket expenses for health care for the year will be between $9,600 and $10,100.

Alternatively, they could get a catastrophic plan for $300/month with a $7000 deductible. Under this plan, their yearly out of pocket health care expenses would run between $3,600 and $10,600. Not much different on the high end, but up to $6,000 less if they stay healthy.

The important thing is what this does to their incentives as health care consumers. With the normal policy, once the deductible is paid (which, with such a low deductible is almost always the case) there's exactly no reason to look for bargains on health care. In fact, there's arguably the opposite incentive. If it's not costing the patient any more money, they're likely to choose the more expensive option at every opportunity. The doctors will happily oblige.

On the other hand, patients with the catastrophic plans will be paying up to $7000 in cash (or writing checks from an HSA if the ACA doesn't ban them). Every penny they can save on those expenses is money they keep. You can bet they'll be asking doctors about prices, and looking for bargains when they can. And doctors who want their business will have incentive to keep prices low. Or better yet, the patients will be working hard to keep themselves and their families healthy so they can keep the $7000 in their pockets.

That's what missing from the current health care market and it's the principal reason health care inflation continues to spiral upward at many times the 'normal' inflation rate. People have been choosing this option (high-deductible, low-premium) more and more and it's scared the insurance companies. It's making their group plans even less profitable and exposing them as fundamentally flawed. The only way out for them is to change the way they do business, or turn to the government to bail them out and force us to keep playing their game.

 

[MikeK]

We're not going to have enough providers to go around, not if we add in 30 million new people plus a sizeable portion of our society growing older and needing more care. We just don't have the money, a lot of people are going to be denied access or have to wait for extended periods of time. I predict a lot of people showing up in ERs across the country.

I think you're right and the point you're making addresses a concern I've had for some time.

When I was in the military and had a medical problem, such as flu symptoms, a minor injury, etc., I walked over to Sick Bay and was interviewed by a junior Navy Medical Corpsman. If the problem wasn't something he could take care of, he referred it to a senior Corpsman, all of whom were very experienced and knowledgeable. Only if the problem was truly serious would the senior Corpsman refer it to the Duty MD, a Navy officer, or to the Naval Hospital on base.

Those Navy Corpsman were impressively competent. Once when on field maneuvers in the Philippines I developed a painful boil on an inner thigh. A field Corpsman, who was no older than I, gave me a shot of novcocaine, lanced the boil, put a drain in it, dressed it, gave me a little box of penicillin tablets and I was back on my bulldozer next day. I call that no-bullshit medical care.

That was back in 1957. More recently a tiny cut developed into a painful and rapidly expanding infection in a finger on a Friday afternoon. It was too late to visit my GP so I went to the local emergency room where I sat for two hours before being interviewed by a clerk who filled out a bunch of papers, led me into a small ward, had me lie in a bed, where I lay half-covered and bored stiff for another hour. Finally an exhausted-looking intern insisted on lancing the infection, which was elaborately dressed by an impatient nurse. I later learned my insurance company was billed for nearly $500 for that elaborately redundant waste of time. All I really needed was the antibiotic.

If I had brought the same problem to a Sick Bay a Navy Corpsman would have given me a box of penicillin tablets and sent me on my way. The whole thing would have taken ten minutes.

If there was a community walk-in clinic in my area, staffed by ex-military medics, I would happily have taken my infected finger there and by-passed all the overpriced, wasteful, bureaucratic rigamarole I went through -- mainly because the law requires that an MD attends every complaint regardless of how minor.

If there were such clinics available in all or most communities I believe they would effectively and inexpensively treat the vast majority of typical medical complaints, referring the more serious ones to MDs. If that level of treatment is adequate for military personnel I see no reason why it is not acceptable for civilians. Especially those who can't afford to be treated by an MD for every minor problem.

 

[Polk]

That sounds great, but that's not how the numbers break down in the real world.

The biggest problem with this entire argument is it assumes people want to "health care consumers". People don't shop for bargains because they lack incentives to do so. They don't shop for bargains because they don't want second-rate care.

 

[dblack]

That sounds great, but that's not how the numbers break down in the real world.

How do they break down? If anything, my numbers are modest. I'm reading articles that site average yearly premiums at much higher - $13,000+/year, and the catastrophic polices somewhat cheaper with slightly lower deductibles than what I quoted. In any case, the numbers would have to be radically off - which I don't think you can prove - to discount the argument. Paying for health care out of pocket will increase incentive to hunt for bargains, and it will increase incentives for doctors to offer them. I know. I've been there. When you're writing checks for your own health care you DO ask how much? When you're not, you don't care.

People don't shop for bargains because they lack incentives to do so. They don't shop for bargains because they don't want second-rate care.

None of us want 'second-rate' anything. But we deal with reality. It's our delusional insistence on evading reality that's painted us into the corner we're in with health care. No bailout or mandate is going to fix that.

 

[Quantum Windbag]

Yes. And I also pointed out that, because of the PPACA, I can no longer buy the policy I have used for years. That is because the policy I had came no where near the minimum coverage requirements, and I am not politically connected enough to get a waiver.

What's your point?

Self-insured plans aren't subject to the qualified health plan requirements in the ACA, meaning they don't have to offer the essential benefits package you seemed to be referencing earlier. Perhaps you're not using the word the way the rest of the universe does?

As for political connections for annual limit waivers, you're the one who posted the GAO report that showed there was no political favoritism in the waiver process. Who could've guessed you didn't bother reading it?

Whatever.

The company no longer offers the policy, and tells me, and everyone else, that is because of the PPACA. The news is also full of stories about insurers that have been selling similar policies no longer offering them. That means that I have to choose between every insurer in America lying to me, or you lying to me.

Guess who I believe.

 

[Polk]

That sounds great, but that's not how the numbers break down in the real world.

How do they break down? If anything, my numbers are modest. I'm reading articles that site average yearly premiums at much higher - $12,000/year, and the catastrophic polices somewhat cheaper with slightly lower deductibles than what I quoted. In any case, the numbers would have to be radically off - which I don't think you can prove - to discount the argument. Paying for health care out of pocket will increase incentive to hunt for bargains, and it will increase incentives for doctors to offer them. I know. I've been there. When you're writing checks for your own health care you DO ask how much? When you're not, you don't care.

Really? I'm looking at policies in my state and while the cost of a high-deductible plan is cheaper than your previous post, the out-of-pocket costs are also significantly higher (deductible of 10k, plus 20% of everything beyond that).

People don't shop for bargains because they lack incentives to do so. They don't shop for bargains because they don't want second-rate care.

None of us want 'second-rate' anything. But we deal with reality. It's our delusional insistence on evading reality that's painted us into the corner we're in with health care. No bailout or mandate is going to fix that.

The bold is true, but you're missing a key point. People don't think of health care in the same way they think of shoes. A lot of people have no problem wearing a pair of shoes from a dollar store to cut costs. I doubt you'll find anyone willing to have major surgery in a back alley to cut costs.

 

[Polk]

Yes. And I also pointed out that, because of the PPACA, I can no longer buy the policy I have used for years. That is because the policy I had came no where near the minimum coverage requirements, and I am not politically connected enough to get a waiver.

What's your point?

Self-insured plans aren't subject to the qualified health plan requirements in the ACA, meaning they don't have to offer the essential benefits package you seemed to be referencing earlier. Perhaps you're not using the word the way the rest of the universe does?

As for political connections for annual limit waivers, you're the one who posted the GAO report that showed there was no political favoritism in the waiver process. Who could've guessed you didn't bother reading it?

Whatever.

The company no longer offers the policy, and tells me, and everyone else, that is because of the PPACA. The news is also full of stories about insurers that have been selling similar policies no longer offering them. That means that I have to choose between every insurer in America lying to me, or you lying to me.

Guess who I believe.

It's not like health insurers have any incentives to oppose the ACA. O wait...