Here we go...Health Care 'Reform' passes

[aaron]

Re: Here we go...Health Care 'Reform' passes

Raja's Health Care Plan


Under Raja's Plan, excessive medical costs and profits will be flushed out of the system, therefore greater numbers of people will be able to afford to pay for their own medical care. But not everyone in society will receive state-of-the-art medical treatment . . . just as they don't now get the highest quality housing, cars or other aspects of life. Inexpensive, subsidized hospice or in-home treatment with palliative care (pain pills) will be provided for those who cannot afford medical care and are suffering . . . or on the way out.

Aaron's Amendment to the Raja Health Plan:

To pay for poor peoples' palliative care, I propose we put a tax on junk food. As tax receipts go down, health will go up.

[bpr]

Re: Here we go...Health Care 'Reform' passes

Sorry it's taken so long to respond. I had to reconcile some real-world friendship differences on this subject before returning to itulip.

Yes, I'm the guy that uses insane left-wing ideology and calls out his friend of five years and asks him to defend his insane far-right ideology.

Fair enough.

I will point out, however, that you are now switching arguments.

If I've switched arguments I have to apologize. Seriously. I majored in rhetoric and should know better. I though I was just expanding on my previous generalizations.

If the public option is so unpopular as is health care reform in general, then why do anything at all?

I don't believe the public option or reform in general are unpopular. I believe (again, perhaps erroneously) that the public is far more to the left than it believes.

Consider the quote I posted above about people's definition of the public option being statistically equal to random guesses.

Americans don't even realize how dreadfully liberal they are, with the media informing them.

As for healthcare reform in general, in my experience it's almost universal agreement: we need it. The amazing thing is, folks on the right are angry that such a corporate bill was passed, and I agree (to an extent).

I did say that the public option inspired the tea party movement, but to clarify, it was misinformation about the public option that actually inspired the movement.

Healthcare reform is wildly popular. Witness the number of anti-bill arguments that begin, "Healthcare reform is needed, but this bill.."

If the Tea Party folks were so scary, how did a strong arming of a health care reform bill - including a new obligatory tax - defuse this sentiment

It did not. But it got a bill passed. That's the bottom line. The federal government is now involved. No longer do we resort to calling our weak-ass state insurance regulator when you can't get a claim paid.

Yes, now we can call the weak-ass Department of Health and Human Services, but it's federal, and has the firepower that your state agency didn't have.

If the Democrats are so terrified of the November elections, then why rock the boat with a completely partisan bill which was ramrodded through the vociferous objections of the Republicans?

They tried "reaching across the aisle."

Didn't work out so well (see the previous two bills noted).

That's what the last year of debate was all about, getting a "bi-partisan" bill.

Obama learned the hard way: not gonna happen.

If you recall the election, it was Hillary** that wanted the mandate plan, and Obama was very against it: he wanted the public option. Hillary had gone this route before, maybe because she knew what was politically possible, having gone through this in 1993*.

What passed wasn't the plan they wanted; it was the plan they could get away with.

Does not compute.

Operator error. Okay, maybe not enough input.

* I should note that my definition of "politically possible" has nothing to do with public opinion, but refers to whether an idea will gain traction with the corporations that control not only the MSM, but also the actual lawmakers that we put into place. This makes the most important political issue of our time publicly funded elections, in my mind.

** I should note that my family, all Democrats, were strongly pro-Hillary because there is a direct familial connection, via the Rodhams (Hillary's family is from my area -- someone in her family knows someone in my family). I strongly opposed her solely on her healthcare proposal (the mandate) vs. Obamam's plan (the public option). In truth, I wore a Kucinich sweatshirt throughout the whole election - even after he dropped out. Ultimately, the plan Obama "rammed through our throats" was a lot closer to Hillary's proposed plan in 2008 than it was to his own, and I think my own family is a bit racist in their rejection of him. Bottom line is, they wanted Hillary because they knew her, not because she would change anything.

[c1ue]

Re: Here we go...Health Care 'Reform' passes

I did say that the public option inspired the tea party movement, but to clarify, it was misinformation about the public option that actually inspired the movement.

As I've noted before, there is clear evidence that the Tea Parties are just as artificial as the 'anti-war' rallies that were so common when Bush was in the White House.

But the point is still the same - if the Tea Parties truly were politically dangerous for the Democratic party, then no party line cram-down of health care reform would have occurred. By the same token, if it was clear a cram-down had to happen, why not stick with the plan originally proposed? It is ridiculous to think that the Republicans matter in this instance; what is more likely is the lobbying power employed by the various health care industry constituents.

It is exactly due to this that leadership is needed, and clearly did not come forth.

It did not. But it got a bill passed. That's the bottom line. The federal government is now involved. No longer do we resort to calling our weak-ass state insurance regulator when you can't get a claim paid.

Yes, now we can call the weak-ass Department of Health and Human Services, but it's federal, and has the firepower that your state agency didn't have.

I disagree with this statement. The federal government is already intimately involved in health care via Medicare, the VA, and various other programs.

It is disingenuous to say that the health care reform bill is different.

Furthermore I would point out that there are plenty of other ways by which some type of health care reform would have passed:

1) Draft a bill which specifically prohibits discrimination based on pre-existing conditions. Nothing else. Then watch and see everyone get out of the way; any Senator or Representative of either party that tries to obstruct that gets slammed down.

2) Draft a bill which opens the VA hospital system to the uninsured and poor. Put some money into it. Then watch again as Senators and Representatives get out of the way: veterans see their system get more money, an alternate health care supply/provision system is spread more widely.

There are a number of other scenarios which would have clearly highlighted specific abuses in the present system and which would have been political suicide to oppose if not buried in with a myriad other causes.

** I should note that my family, all Democrats, were strongly pro-Hillary because there is a direct familial connection, via the Rodhams (Hillary's family is from my area -- someone in her family knows someone in my family). I strongly opposed her solely on her healthcare proposal (the mandate) vs. Obamam's plan (the public option). In truth, I wore a Kucinich sweatshirt throughout the whole election - even after he dropped out. Ultimately, the plan Obama "rammed through our throats" was a lot closer to Hillary's proposed plan in 2008 than it was to his own, and I think my own family is a bit racist in their rejection of him. Bottom line is, they wanted Hillary because they knew her, not because she would change anything.

Fair enough - but again Hillary had a Congress against her.

To point to Obama's bill as really being Hillary's, but with a same-party Congress and with a Clintonian stealing of credit - is this an endorsement or a condemnation?

Your note even says that Obama's original proposal was different and better than Hillary's.

[Ghent12]

Re: Here we go...Health Care 'Reform' passes

2) Draft a bill which opens the VA hospital system to the uninsured and poor. Put some money into it. Then watch again as Senators and Representatives get out of the way: veterans see their system get more money, an alternate health care supply/provision system is spread more widely.

I don't think your rhetoric meets reality on this one especially. Do you receive VA benefits? Last I heard, the VA system is almost broken with under-funded, over-tasked resources, and your bone to throw at them is to just give them more money while simultaneously saddling them with double the burden or more?

[Starving Steve]

Re: Here we go...Health Care 'Reform' passes

What to me is noteworthy is how long (decades) it took for the Congress, including the Demos in the Congress, to pass any form of health reform in America. And we finally ended-up with 2,050 pages of gobbly-gook nonsense--- very friendly to for-profit private health insurance companies and very friendly to lawyers--- when two short paragraphs of simple English would have sufficed as a complete health reform bill.

Anyway, we shall take what we can get from the corrupt U.S. Congress and build upon that health-reform in the very near future. We will move quickly toward Medicare for EVERYONE, no exceptions. That will be the socialized-medicine that we deserve.

And every single blue-dog Democrat in the South and every single Republican that has blocked health-reform for decades should be booted-out of office in the next election, no exceptions. There are no "good" blue-dog Demos and no "good" Republicans. <-------period.

[ThePythonicCow]

Re: Here we go...Health Care 'Reform' passes

Then watch again as Senators and Representatives get out of the way: veterans see their system get more money, an alternate health care supply/provision system is spread more widely.

Having my "system" get more money (1) does nothing for my physcial health, other than increasing my blood pressure a couple of points, and (2) harms my political and financial health, with yet more graft, corruption, bribes, fraud, waste, misallocations and inefficiencies.

[radon]

Re: Here we go...Health Care 'Reform' passes

I don't think your rhetoric meets reality on this one especially. Do you receive VA benefits? Last I heard, the VA system is almost broken with under-funded, over-tasked resources, and your bone to throw at them is to just give them more money while simultaneously saddling them with double the burden or more?

My father receives VA benefits and his treatment has been excellent, it even includes things like expensive hearing aids.

[Starving Steve]

Re: Here we go...Health Care 'Reform' passes

Having my "system" get more money (1) does nothing for my physcial health, other than increasing my blood pressure a couple of points, and (2) harms my political and financial health, with yet more graft, corruption, bribes, fraud, waste, misallocations and inefficiencies.

The best thing to help Americans live as long and live as well as Canadians now live, thanks to Canada's Medicare for EVERYONE, would be to copy the Medicare that Canada has. This would mean that we proceed now in the U.S. to further reform the corrupt (for-profit) private U.S. health insurance racquet, maybe even abolish it entirely.

And this corrupt U.S. Congress, especially the U.S. Senate run by the South are a disgrace to anyone with anything between their ears. Every senator who blocked healthcare reform (for five decades) should be thrown-out on their arse. There are no good Republicans and no good blue-dog Demos.

[Ghent12]

Re: Here we go...Health Care 'Reform' passes

My father receives VA benefits and his treatment has been excellent, it even includes things like expensive hearing aids.

Yes, the VA system gets good reviews, but the only time I hear about it from people who have gone through it is when they screw up. Perhaps that's because it's more frequent for someone to complain about a hospital visit than to talk about how good it was. Accurate data is harder to come by for this system, it seems.

That said, I still don't think increasing the burden and just shoving money at it will improve much of anything.

[c1ue]

Re: Here we go...Health Care 'Reform' passes

This is where I get my impression of the VA system - that and having directly worked with many seniors who are enrolled.

Is it perfect? Hell no. But is it better than anything outside Medicare or a high paid private system - for example the San Francisco public clinics?

Absolutely.

http://www.cbo.gov/ftpdocs/88xx/doc8...Text.3.1.shtml

(Millions of veterans)

Source: Congressional Budget Office based on data from and budget submissions by the Department of Veterans Affairs (VA)
Note: "Enrollees not seeking care" are veterans who were enrolled in VA’s system but who did not seek care in a particular year; "enrollees seeking care" were patients within VA’s system.
a. Projected.
VA’s enrollment system, begun in 1999 in accordance with provisions of the Veterans’ Health Care Eligibility Reform Act of 1996 (Public Law 104-262; 110 Stat. 3177), calls for veterans who desire services to be assigned to a priority group based on service-connected disabilities, service-related exposures, income, assets, and other factors. Currently, there are eight priority groups (see Box 1). Those in the highest priority groups, 1 through 3, have service-connected disabilities of varying degrees, while those in priority group 4 have serious disabilities that are not service-connected. Priority group 5 consists of low-income veterans, and priority group 6 includes those with environmental exposures (to Agent Orange, for instance) as well as many recent combat veterans. The veterans in priority groups 7 and 8 have no compensable service-connected disabilities and have higher income than those in priority group 5.

Factors Affecting Medical Spending by the Department of Veterans Affairs

A few news articles and publications have noted that the cost per patient or enrollee has remained relatively stable for the Department of Veterans Affairs (VA), while the costs faced by Medicare and other health plans have risen faster than general inflation.1 By one measure—the budget authority per enrollee for the Veterans Health Administration (VHA)—the cost fell by 29.0 percent in real (inflation-adjusted) terms between 1999 and 2005, reflecting an annual decrease of 5.6 percent. However, those figures do not take into account the changing mix of patients within the VA system, which has seen rapid growth in the overall number of patients and particularly in the enrollment by veterans whose care, on average, is less expensive than that for previous patients. Those less costly enrollees include patients who are younger, who are less disabled, or who seek only a small portion of their care from VA, as well as some enrollees who do not seek any care from the department in a given year. Adjusting for the changing mix of patients (using data on reliance and relative costs by priority group), the Congressional Budget Office (CBO) estimates that VHA’s budget authority per enrollee grew by 1.7 percent in real terms from 1999 to 2005 (0.3 percent annually).2 Though not the decline in cost per capita that is suggested by the unadjusted figures, that estimate still indicates some degree of cost control when compared with Medicare’s real rate of growth of 29.4 percent in cost per capita over that same period (4.4 percent per year). One factor that has enabled VA to hold down its costs is the fact that federal law enables the department to purchase pharmaceutical products at prices that are less than those available to nearly any other purchaser.3 In addition, VA uses a restrictive formulary to reduce its pharmaceutical costs even further. However, in 2006, pharmaceuticals made up 13.5 percent of VA’s medical expenditures, compared with 10.1 percent of total national health expenditures. The higher percentage for the department despite its lower acquisition costs may reflect its older population of patients and the fact that some veterans rely on VA disproportionately for pharmaceuticals because of its relatively low copayment rate of $8 per prescription. Until allowed by the Veterans’ Health Care Eligibility Reform Act of 1996, VA was prohibited by statute from providing outpatient care to many patients. So the department lagged behind other providers in moving health care from an inpatient to an outpatient setting. Providing care in an outpatient setting reduces the costs of many medical services, although not necessarily the total cost of care, as convenient access to VA outpatient care may increase the overall demand for medical services from VA (and perhaps from all sources). If the shift toward outpatient care has resulted in a reduction in per capita spending, it could have benefited VA more than Medicare during the period being analyzed here, 1999 to 2005, particularly if many of those seeking care from VA’s outpatient clinics were receiving medical services from other sources as well. While VHA’s real per capita spending has increased little in recent years, the agency’s overall spending has grown rapidly. The agency’s medical budget has doubled in the past decade, rising from $17 billion in 1996 to $36 billion in 2007, reflecting an annual compound growth rate of 7.4 percent in nominal terms (or 5.2 percent after accounting for inflation). That growth in the agency’s budget can be traced in large part to a rapidly expanding population of patients since the passage of the Veterans’ Health Care Eligibility Reform Act of 1996, from 4.2 million enrollees in 1999 (the first year in which the enrollment system established by that law was fully operational) to 7.9 million in 2006. However, in any given year, some enrollees do not seek any medical care from VA, either because they do not become ill or because they rely on other sources of care. In 2006, about 5.0 million veterans received services from a VA hospital or clinic, up from 3.2 million in 1999 (see Figure 1). Many new patients who have entered the VA system fall into priority groups 7 and 8—veterans with no service-connected disabilities and with income and/or net worth above established thresholds, who previously had very limited access to the department’s medical services. Those groups differ in some ways from VA’s traditional target population. Many enrolled veterans in those groups are older but have access to other sources of care, such as Medicare. On average, veterans in priority groups 7 and 8 receive only about 20 percent of their care from VA and the rest from other sources; as a result, the cost to VA of those enrollees is relatively small compared with the costs for veterans in priority groups 1 through 5 (see Box 1). In addition to the influx of older veterans in priority groups 7 and 8, recent combat veterans are enrolling in much higher numbers than recently discharged veterans have traditionally, perhaps partly because of the special eligibility period currently in place that allows enrollment regardless of income or service-connected disability status (see Box 2). Those enrollees are younger than the average for VA patients. While some have serious injuries, most are relatively healthy; the average cost of patients with special eligibility status was only $2,600 in 2006, compared with about $5,800 for all VA patients. VA has received supplemental appropriations in recent years that have contributed to the growth in its total medical budget. The Government Accountability Office has reported that 28 percent of VA’s 2005 supplemental budget request ($273 million out of $975 million) was intended to meet the demand for medical treatment of recent combat veterans. The remainder went (in descending order of funding) to long-term care, unexpected numbers of patients in priority groups 1 through 6 (even omitting those who served in the Iraq or Afghanistan theater), unexpected increases in enrollees’ use of medical services, efforts to reduce waiting lists, and rapid growth in spending by the Civilian Health and Medical Program of the Department of Veterans Affairs.4 The Quality of VA’s Medical Care VHA’s Office of Quality and Performance has adopted the definition of health care quality proposed by the Institute of Medicine (IOM): Quality is "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."5 The IOM also noted that health care should have the following attributes: ■ "Safe—avoiding injuries to patients from the care that is intended to help them. ■ Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively). ■ Patient-centered—providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. ■ Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care. ■ Efficient—avoiding waste, including waste of equipment, supplies, ideas, and energy. ■ Equitable—providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status."6 VA tracks many aspects of its health care along the dimensions highlighted by the IOM. Evidence of the Quality of VA’s Health Care VA officials have often cited studies that have given the department high ratings for the quality of its medical care. For example, then-Secretary of Veterans Affairs James Nicholson stated in a speech in July 2007, "We lead private and Government health care providers in almost every measure and our state-of-the-art quality care arcs from the research lab to a patient’s bedside."7 Michael Kussman, then-Acting (now confirmed) Under Secretary for Health, gave testimony before the Congress in March 2007 in which he called VA "the Nation’s leader in providing high-quality health care" and cited a number of external research studies to support that claim.8 VA tracks the quality of its medical care using a variety of indicators for such areas as adherence to clinical guidelines, waiting times for access to services, and customer satisfaction. One key index is the Clinical Practice Guidelines Index, which measures the degree to which a provider follows nationally recognized standards of care that have been shown to improve health outcomes.9 Another is the Prevention Index II, which VA uses to track compliance with clinical guidelines for preventive care that research has tied to improved health and well-being.10 In 2006, VA reported average scores of 87 percent on the Clinical Practice Guidelines Index and 90 percent on the Prevention Index II, exceeding the department’s targets of 77 percent and 88 percent, respectively. 11 For both measures, the scores have improved in recent years. From 2004, when the Clinical Practice Guidelines Index was put in place (replacing an older composite measure), to 2006, VA’s score on the index rose 10 percentage points. VA’s score on the Prevention Index II rose 8 percentage points from 2002 to 2006. CBO was unable to identify any directly comparable scores for other government providers or for private providers because, even though VA’s indicators are composed of many individual measures that are commonly used throughout the health care industry, the indexes are composites developed specifically for VA. In 2008, VA is planning to adopt more quality measures that are industrywide, such as those in the Healthcare Effectiveness Data and Information Set (HEDIS), in order to improve comparability with other providers.12 Those key indexes used by VA focus on process measures of quality rather than outcome measures for several reasons. First, process measures are easier to track—for example, VA’s electronic health information system can easily identify what percentage of heart patients had their blood pressure checked during their last primary care visit. Second, process measures are easier to compare among facilities; they do not need to be adjusted for differences in the risk of the population of patients. Third, the process measures that are tracked are drawn from published clinical guidelines, which in turn are based on published research regarding health outcomes for patients. Nevertheless, it is important to examine health outcomes in addition to process measures, as some process measures have been shown to have a relatively tenuous connection to health outcomes.13 Although some studies have compared outcomes for VA patients with those for patients treated by other providers, they have not allowed for drawing broad conclusions.14 In such studies, adjusting for differences in the risks of the patients can be problematic. Also, VA patients may have other sources of health coverage (such as Medicare, Medicaid, or private insurance) and often seek some care outside of VA’s system, complicating the distinction between a "VA patient" and a "non-VA patient." Thus, although it remains important to study the health outcomes of VA patients and to compare them to those for patients in other systems, VA is likely to continue to rely heavily on process measures in gauging and improving the quality of care in its facilities. VA also tracks measures of access to care, particularly, waiting times for appointments or procedures. VA reported that, in 2006, 96 percent of all veterans seeking primary medical care and 95 percent of all veterans seeking specialty care were seen within 30 days of their desired dates.15 However, according to a 2005 report by the VA Inspector General (IG), the department’s data on waiting times were not accurate, and, in fact, many fewer patients were receiving appointments within the 30-day window than the figures cited by the department in its official reports.16 In September 2007, in a follow-up audit, the VA IG found that established procedures were still not being followed and that, as a result, data on waiting times could not be relied upon.17 In addition to measuring quality and access, VA also tracks its performance in terms of patients’ satisfaction, including using the American Customer Satisfaction Index (ACSI), which ranks customer satisfaction with a variety of federal programs and private-sector industries.18 In 2005, VA achieved a satisfaction score of 83 (out of 100) on the ACSI for inpatient care and 80 (out of 100) for outpatient care, compared with averages for private-sector providers of 73 for inpatient care and 75 for outpatient care. In 2004, the ratings were higher for both VA and the private sector. For VA, the scores for inpatient and outpatient care were 84 and 83, respectively, while the average scores for the private sector were 79 and 81.19 Starting in 2008, VA hopes to track its patients’ satisfaction using the Consumer Assessment of Healthcare Providers and Systems (CAHPS), a set of standardized surveys developed by the Agency for Healthcare Research and Quality (AHRQ) that ask patients to evaluate their health care experiences. Using the CAHPS surveys could improve VA’s ability to compare its performance to that of the Department of Defense and the private sector. One potential concern about assessing the satisfaction of VA’s patients is the impact that the department’s low cost-sharing requirements may have on the ratings. Patients with service-connected disabilities receive care for those conditions free of charge. For the treatment of conditions not connected to service, VA may charge low copayments and can also bill veterans’ private insurance plans. The copayments for prescription drugs, outpatient visits, and inpatient care are relatively modest when compared with those faced by most users of private-sector health insurance. It is possible that individuals who face low or no costs for their care may be more satisfied than those who pay higher costs. However, it is also possible that veterans have high expectations of the level of service they should receive from VA’s health system as individuals who served their country in uniform, sometimes incurring disabilities in the process. Another potential concern about how to interpret VA’s satisfaction ratings is the fact that the ratings do not incorporate the satisfaction of veterans who cannot access the system (either because they are priority group 8 veterans who were not enrolled before the January 2003 freeze in enrollment for that group or because VA facilities are geographically inaccessible to them) or who choose not to use the system. However, for any health care system, satisfaction ratings reflect the views only of people who are patients within that system. VA is not alone among government health care providers in tracking patients’ satisfaction. In recent years, the Department of Defense’s TRICARE system has increasingly emphasized improving its beneficiaries’ satisfaction (see Box 4). Although TRICARE’s overall satisfaction ratings compare favorably to civilian benchmarks, active-duty service members, who generally must use the in-house military health system, report lower satisfaction than do family members and retirees, who have better access to the civilian TRICARE network. Retirees report slightly higher levels of satisfaction with the system than active-duty personnel and their families do, despite the fact that retirees generally pay higher cost-sharing amounts.

The most cogent numbers? $36B for a population of over 7 million served including hospitals, clinics, full time staff, etc etc.

Compare with the Obama 'health care reform' bill: $1.2T over 10 years with zero actual medical staff.

[Ghent12]

Re: Here we go...Health Care 'Reform' passes

The most cogent numbers? $36B for a population of over 7 million served including hospitals, clinics, full time staff, etc etc.

Compare with the Obama 'health care reform' bill: $1.2T over 10 years with zero actual medical staff.

True, and those newly added people put under the purview of the VA system will very greatly benefit from it. However, you can't scale the system to infinity, or to the national level without drastic controls on access other than cost. Scaling it by any appreciable amount will probably result in 'normalizing' it with the rest of the healthcare system.

How much water do you wish to add to your milk? It will only look and taste like milk for so long...

[flintlock]

Re: Here we go...Health Care 'Reform' passes

You forgot

6) Reduce level of care to 19th century standards.

7) Invest in leeches.

No insurance? Come on.:rolleyes: I'm going to assume you were half joking.

Modern medicine is expensive. It also is very effective. If you think almost every ailment known to man is going to go away because people eat better and excercise then you are naive. I assure you people in the 19th century ate plenty of veggies and got lots of exercise, with little sugar or transfats. Yet they died like flies when some little bug that would be considered minor today came along. Or do you think it won't happen to you? Or you think you won't care and are willing to just take a pain pill and die. Or you think you'd be fine just letting your grandchild die of a easily treatable disease, because no care is available, because nobody wanted to pay into an insurance plan IN ADVANCE, so no hospital was built?

Or are just rich people going to pay for it all and we poor minions get to zip in and just pay a small fee when we really, really need it?

It won't happen like that. Nobody wants to think they'll get seriously sick. But it happens, despite all attempts to avoid it. Sure, a lot of fat ass lazy idiots screw things up for the rest of us. But that is not where all the money is going. A lot is going towards trying to be all things to all people. A lot is going to towards trying to be perfect at everything so some maggot lawyer won't try and sue the shit of of the hospital because they didn't anticipate every possible complication. A lot is going to people who never paid a dime into the system. A lot is going toward advanced treatments that save few, because some researcher wants to prove he can climb the next Mt. Everest of medical research. Meanwhile millions can't get basic care. A lot of the money goes towards this silly little game where the insurance companies and the doctors try and see how badly they can screw each other over. A lot goes to a system where curing the patient is no longer even a top priority, but rather way down the list behind meeting profit forecasts for their corporate bosses. A lot goes toward paying for doctors who order dubious tests because they also own the labs that do the test, or just get a kickback. Or because some doctor prescribes the latest, most expensive drug because he thinks that drug rep with the low cut blouse likes him. I could go on all day.

I agree costs can be brought way down, people should take more responsibility for their own health, and that some sort of tiered level of care should be available depending on your ability to pay for it. But no insurance would mean no virtually no medical care. Everyone says they'd be willing to pay for it out of pocket, but how many actually do when they get the $120,000 tab for that 2 weeks in ICU? Better yet, how many relatives care about paying old granddad's bill when he's dead they are looking at buying that new boat with the inheritance.

No one is willing to invest a billion dollars in a fancy hospital complex if they do not feel assured there is a system in place to ensure they get paid for services rendered. Those "going naked" on health insurance benefit because there are enough willing to pay in to the system to ensure the facilities get built. If everyone quit paying in the system it would collapse like a house of cards. Medical care would still be available, but not at the level we have become used to. I think a lowering of the standard level of care is inevitable. I just don't think we have to throw out the baby with the bath water.

The system used to work pretty well. We just need to fix it. Not destroy it.

[Starving Steve]

Re: Here we go...Health Care 'Reform' passes

You forgot

6) Reduce level of care to 19th century standards.

7) Invest in leeches.

No insurance? Come on.:rolleyes: I'm going to assume you were half joking.

Modern medicine is expensive. It also is very effective. If you think almost every ailment known to man is going to go away because people eat better and excercise then you are naive. I assure you people in the 19th century ate plenty of veggies and got lots of exercise, with little sugar or transfats. Yet they died like flies when some little bug that would be considered minor today came along. Or do you think it won't happen to you? Or you think you won't care and are willing to just take a pain pill and die. Or you think you'd be fine just letting your grandchild die of a easily treatable disease, because no care is available, because nobody wanted to pay into an insurance plan IN ADVANCE, so no hospital was built?

Or are just rich people going to pay for it all and we poor minions get to zip in and just pay a small fee when we really, really need it?

It won't happen like that. Nobody wants to think they'll get seriously sick. But it happens, despite all attempts to avoid it. Sure, a lot of fat ass lazy idiots screw things up for the rest of us. But that is not where all the money is going. A lot is going towards trying to be all things to all people. A lot is going to towards trying to be perfect at everything so some maggot lawyer won't try and sue the shit of of the hospital because they didn't anticipate every possible complication. A lot is going to people who never paid a dime into the system. A lot is going toward advanced treatments that save few, because some researcher wants to prove he can climb the next Mt. Everest of medical research. Meanwhile millions can't get basic care. A lot of the money goes towards this silly little game where the insurance companies and the doctors try and see how badly they can screw each other over. A lot goes to a system where curing the patient is no longer even a top priority, but rather way down the list behind meeting profit forecasts for their corporate bosses. A lot goes toward paying for doctors who order dubious tests because they also own the labs that do the test, or just get a kickback. Or because some doctor prescribes the latest, most expensive drug because he thinks that drug rep with the low cut blouse likes him. I could go on all day.

I agree costs can be brought way down, people should take more responsibility for their own health, and that some sort of tiered level of care should be available depending on your ability to pay for it. But no insurance would mean no virtually no medical care. Everyone says they'd be willing to pay for it out of pocket, but how many actually do when they get the $120,000 tab for that 2 weeks in ICU? Better yet, how many relatives care about paying old granddad's bill when he's dead they are looking at buying that new boat with the inheritance.

No one is willing to invest a billion dollars in a fancy hospital complex if they do not feel assured there is a system in place to ensure they get paid for services rendered. Those "going naked" on health insurance benefit because there are enough willing to pay in to the system to ensure the facilities get built. If everyone quit paying in the system it would collapse like a house of cards. Medical care would still be available, but not at the level we have become used to. I think a lowering of the standard level of care is inevitable. I just don't think we have to throw out the baby with the bath water.

The system used to work pretty well. We just need to fix it. Not destroy it.

The for-profit private U.S. healthcare system is the most expensive in the world. It serves the fewest people. It has the highest mortality. It has the most law suits. WHAT ELSE IS THERE TO KNOW??????????????????

To make-believe that the U.S. for-profit private healthcare system "just needs a few changes" is like trying to make-believe that there are "some good blue-dog Demos and some good Republicans". What it shows me is that you have no understanding at all about what is wrong with for-profit U.S. healthcare and do not understand why it can not (and should not) be salvaged.

Maybe stick to making moonshine in the hills of Tennessee. Otherwise, you had better live for a while in other developed and free countries, maybe in Europe or Canada or in the South Pacific. With some global perspective in your life, you might see how terrible the American for-profit private healthcare system is, by nearly every measure.

I mean: get a clue! :rolleyes:

[c1ue]

Re: Here we go...Health Care 'Reform' passes

True, and those newly added people put under the purview of the VA system will very greatly benefit from it. However, you can't scale the system to infinity, or to the national level without drastic controls on access other than cost. Scaling it by any appreciable amount will probably result in 'normalizing' it with the rest of the healthcare system.

How much water do you wish to add to your milk? It will only look and taste like milk for so long...

Certainly your statement is true, but I'd note that a significant fraction of the 7 million+ veterans in the VA system have significant chronic care issue (disabled, etc).

So it is not clear to me that adding 30 million uninsured is equivalent to quadrupling the active population being served.

And either way - the scaling issue applies equally to both the private sector and VA.

My point was simply that the VA is already across the nation; already serves millions; and already has experience hiring and managing staff.

I would not expect it to be able to instantly scale up, but equally I do expect it has the capability to do so.

And again - offering an alternative albeit a minimum level scale of health care is one way to break up the incestuous existing mix.

[ThePythonicCow]

Re: Here we go...Health Care 'Reform' passes

7) Invest in leeches.

Oh dear. I can see the headlines now:

• Genetically modified leeches destroying honey bees.
• Monsanto gains monopoly on selling leech eggs to India farmers.
• India farmers committing suicide when they can't afford more leech eggs.
• Leeches injecting NSA tracked microchips into patients.
• Defective Chinese leeches leave broken teeth in patients.
• Pfizer accused of bribing FDA to get new leech breed licensed.
• Novartis patents on leeches corning world leech market.
• Leeches spreading "leech" flu.
• Vaccines for "leech" flu stuffed with squalene and mercury.
• Leeches cause cancer, heart disease and "erectile dysfunction"
• Texas farmer arrested for selling raw leeches.
• Leech meat found in White Castle burger.
• Congressman apologizes for calling opponent a "leech."
• Medicare Part L passed, guaranteeing leech treatment to everyone.
• Unfunded mandate for Medicare Part L in hundreds of billions of dollars.