Gov Christie Tax Reformer Hoax- Property Tax Hike Banking

[Polish_Silver]

Health care: It's the insurance!

I highly recommend the atlantic monthly article on healthcare.


http://www.theatlantic.com/magazine/...y-father/7617/


Goldhill shows how the inefficiency is a result of the insurance paradigm.
It's certainly not a "free market" in the Adam Smith sense.

His corrective includes some subsidy for low income people. The key issue is that
providers need to compete, and patients need an incentive to economize.

The price structure is completely opaque in this country. That is not the case in other countries.
In Japan, the bureaucracy publishes a book that tells you the cost of every procedure. Medical procedures can definitely be priced on a marginal cost basis. We let the establishment treat costs like a sacred mystery.

In europe, private clinics post the costs of common procedures on a big sign behind the receptionist.


One idea is that preventive care should be free, possibly tax paid.


The system also has to recognize the difference between treating chronic conditions and "one time" events. One time events can be done on a fee for service basis.
Chronic conditions need some different kind payment paradigm.

[BK]

Re: Health care: It's the insurance!

I often point out to people discussing the healthcare crisis that Dental care costs demonstrate what happens when "everyone" has Dental insurance. Extraction of wisdom teeth for children today can run to $2,000 -$3,000. Years ago my dentist removed one of my wisdom teeth for $75, Dental care costs have been out running CPI for a couple of decades. Why?

Dental services are now based on procedure pricing similar to the Procedure pricing of medical procedures? Insurance companies don't pay for Professional Dental procedures based on time and resources consumed - they based on the Value of the procedure. This has led to a world where Dentist can't afford to spend time diagnosing dental problems they need to be focused on selling Dental procedures and Dental tests to their patients. With most of the Dentist patients costs being paid by an Insurance company that only pays for procedures - no time can be wasted thinking or analysis - (Insurance Companies don't pay claims for time spent analyzing patients problem - the diagnostician has been killed by wide spread Dental and Medical insurance).

[wayiwalk]

Re: Gov Christie Tax Reformer Hoax- Property Tax Hike Banking

There is nothing mean about honest talk about death panels, although the name is clearly meant to cause a reaction.

It is an honest starting point for discussion that has to happen.

It is disgusting that republicans can knowingly raise the issue as though they are there to protect gov't paid for health benefits (!), and disgusting that democrats don't have the balls to honestly admit that yes, we need to have this discussion in order to provide benefits for healthy people.

I imagine the members of the hospice industry must be aghast at the way this is a political football tossed around, when eveything they do is about maintaining dignity for the person undergoing such a stage at the end of life.

[charliebrown]

Re: Gov Christie Tax Reformer Hoax- Property Tax Hike Banking

I have probably groused about this before, but my experiences are the same on multiple occasions.

About 8 years ago I needed a CAT scan, I was on a 80/20 plan, and the procedure was going to cost about $4000.00. Being frugal, I figured if I can get the cost down,
I'm saving 20% of that. I called 3 hospitals, two said 4K, one said 3K. So I figure hey the 20% of the savings is 200.00. Plus the cheap hospital was closest to my
house. Then I get a bill for 6K. Now I had the diagnositic codes when I got the quote, so I call in and say WTH. The billing department apologies and says sorry, the person you spoke to gave you a bad quote. too bad for you, you still owe us the $1200.

Have you ever called your insurance company and asked if a procedure would be covered? That little voice on a tape recorder says, "quotes are no guarantee of coverage". WTH again. If the insurance company doesn't know who the heck does???? And we are talking about astronomical numbers. Screw up a quote on
an MRS or some other procedure and you know have a 10K bill. Talk about owing your life to the Pullman Co. Now we owe our lives to the hospital.
I just finished paying off a bunch of hospital bills on payment plan.

Regarding "Death Panels", yes we do need to discuss this. Maybe we can have Grandma watch a movie about how she will be saving many lives, and give her a suicide pill, and she chooses to take it or not. Sorry to be course. I am deeply religious and believe in the sanctity of life, but I have been surrounded by people who have perished and their last years of life have been spent in an out of hospitals, weak and vomitting with Chemo. Hundreds of K spent for 1 year of sucky life. The other alternative is to have a beaurocrat decide who gets paid for and who doesn't. Seems to be too much power in the state's hands. Maybe and asset grab. If you have cash, and get sick the state gets it all for saving your life. You will be provided with some level of subsistence living. Don't know what to do about the poor who become very ill.

[wayiwalk]

Re: Gov Christie Tax Reformer Hoax- Property Tax Hike Banking

Not a panel to decide "thumbs up or down", but a discussion on dollar limits, or what procedures can be covered via the gov't paid care.

Old school style, my mom took care for my dad for his last 6 months, at home, with the help of caregivers, rather than subject him to the cold care in institutions and hospitals.

If you build it, they will come....If we make the care available, there will always be people willing to accept thousands of dollars of care paid for by others, without considering the cost/benefit in the same context they would if it was coming out of their own pocket.

[Milton Kuo]

Re: Gov Christie Tax Reformer Hoax- Property Tax Hike Banking

Regarding "Death Panels", yes we do need to discuss this. Maybe we can have Grandma watch a movie about how she will be saving many lives, and give her a suicide pill, and she chooses to take it or not. Sorry to be course. I am deeply religious and believe in the sanctity of life, but I have been surrounded by people who have perished and their last years of life have been spent in an out of hospitals, weak and vomitting with Chemo. Hundreds of K spent for 1 year of sucky life.

This talk of spending a tremendous amount of money to extend life for a short period of time brings to mind the following article from The New York Times, "Costly Cancer Drugs Offers Hope, but Also a Dilemma," about the costs of Genentech's (now Roche Pharmaceutical) Avastin, which is used to treat cancer. One notable excerpt:

... Despite its price, which can reach $100,000 a year, Avastin has become one of the most popular cancer drugs in the world, with sales last year of about $3.5 billion, $2.3 billion of that in the United States.

But there is another side to Avastin. Studies show the drug prolongs life by only a few months, if that.

The sales figures are also quite interesting considering that two-thirds of revenue comes from the U.S. Either there are far more instances of cancer in the U.S. than the rest of the world or we're paying substantially more than the rest of the world, which includes many wealthy, developed countries.

[Polish_Silver]

Re: Gov Christie Tax Reformer Hoax- Property Tax Hike Banking

BK,

How do we solve the problem? I've got a few ideas.

1) "insurance" should only apply to large and unusual costs.

2) incentives must include preventive care---pay the doc a fixed fee based on the number (and age) of patients and the measurable health outcomes--then he has incentive to care for them in the most cost effective fashion.

3) Some kind of "kicker" needed for low income people. But they too must have an incentive to use resources effectively.

[aaron]

Re: Gov Christie Tax Reformer Hoax- Property Tax Hike Banking

Government should help pay for health coverage until age 65, and after that you are on your own. Prices WILL drop when the ever-lasting, deep-pockets of other people's money come to an end. We have it ass backwards in this country. Medicare when you hit 65? How about care for those who will still be productive in society? Paying for the "big things" is also backwards. If the gov. pays for a minimum standard of care (old school procedures and generic medicine), society will be a lot better off and more productive than if we try to keep grandma going with a 3rd heart transplant.

Government should be paying for the procedures and medicines that help the largest number of people for the minimum of cost. Private insurance can fill the gap, much like life insurance.

Costs are insane in the U.S. for "health" care. Absolutely crazy. It is because there is no competition and no real market. And, old people feel they are entitled to ever-lasting life when they have not even saved money for it and naturally vote for more and more.

The only good thing about this 'health'care system at this point is that it is unsustainable. It will crash and burn soon enough.

[c1ue]

Re: Gov Christie Tax Reformer Hoax- Property Tax Hike Banking

Costs are insane in the U.S. for "health" care. Absolutely crazy. It is because there is no competition and no real market. And, old people feel they are entitled to ever-lasting life when they have not even saved money for it and naturally vote for more and more.

While I agree with the first part, the second part is more than a bit stereotypical.

Those on Medicare as well as those approaching Medicare aren't seeking to live forever.

The position I most commonly see is that they paid their share when they were working, and should receive the second part of the social contract they all participated in.

Ultimately demonizing Medicare distracts from the real problem: the cost of health care in the US followed by a clearly flawed architecture for health care in same.

[jpatter666]

Re: Gov Christie Tax Reformer Hoax- Property Tax Hike Banking

Ultimately demonizing Medicare distracts from the real problem: the cost of health care in the US followed by a clearly flawed architecture for health care in same.

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