Chart Of New Health Care Law

[lektrode]

Re: Chart Of New Health Care Law

....The proper use of insurance is to participate in a pool with a small premium to cover one if a catastrophic health event occurs. It's not to pay for a checkup or flu visit to the doctor. These expenses should be paid out of the health care part of the family budget.

You buy homeowner's insurance to protect against a fire or tornado that could leave you homeless. But you pay for maintenance like painting, plumbing, roof repairs, and lawn care out of pocket.

The use of insurance for health has been taken completely out of sound risk principles......

another EXCELLENT point, VT.

methinks that all began (coverage for the sniffles) with the HMO concept (which i used to think was a pretty good deal)

but then was ruined by all the state mandates (esp out where i pay for kaiser-permenente's soup to nuts plan)

personally, i DONT think stuff like routine maternity, substance abuse treatment and 'therapy', sexchange/counciling/therapy, never mind birth control NOR viagra and 'other' sorts of sexual-related treatments should be 'insurable' events.

those are LIFESTYLE ***CHOICES***

and i dont want to be subsidizing peoples 'lifestyles' any more than we already are being FORCED to

and i'll stop there.

[dcarrigg]

Re: Chart Of New Health Care Law

but how will the government save money. The only answer I see is rationing. Yes, insurance companies ration too, but the government may be even more restrictive.

Let me give you a few more answers to how the government could save considerable money under a single-payer system:

1) Transparency
2) Price negotiaing
3) Buying in bulk
4) No profit taking
5) Reduction in the complexity of the system

[radon]

Re: Chart Of New Health Care Law

not to interrupt (this excellent exchange)
methinks thats NOT part of the calculous/equation in all this (since single payer is likely to be the only way out of obama'scare)

Single payer might be a step in the right direction. My worry is that medical suppliers, pharmaceutical companies, and insurers all have too large a stake in this pig to risk real meaningful change.

[lektrode]

Re: Chart Of New Health Care Law

Single payer might be a step in the right direction. My worry is that medical suppliers, pharmaceutical companies, and insurers all have too a large a stake in this pig to risk real meaningful change.

agreed - but what eye see happnin - in the longer 'shorter' term - is that all the big 'stakeholders' are going to have a feeding frenzy, hogtrough gorge-session while all the political players make as much hay as they can before all this 'sunshine' sets/goes dark (and/or the treasury runs out of bernanke bux = US defaults)

[dcarrigg]

Re: Chart Of New Health Care Law

Single payer might be a step in the right direction. My worry is that medical suppliers, pharmaceutical companies, and insurers all have too large a stake in this pig to risk real meaningful change.

I think that within the next decade, we'll see a couple of states start to do it. Most doctors are for it. Particularly doctors in the Northeast. VT is supposed to do it in 2017. We'll see if they get there. My guess is it will take longer than they think. But this won't start as a federal program.

[vt]

Re: Chart Of New Health Care Law

"5) Reduction in the complexity of the system"

In all due respect, how does this jive with the organization chart this thread was based on? Yes that's Obamacare vs. single payer but the bureaucrats will still find a way to screw it up.

I agree that insurance companies are poorly managed, but I only see a government system as a worse alternative.

Hey, if you can design a system that works, I'll support you for the Noble prize

[dcarrigg]

Re: Chart Of New Health Care Law

Hey, if you can design a system that works, I'll support you for the Noble prize

I don't have to. Give the prize to Otto von Bismarck. He figured it out in 1883.

Edit: I just re-read that, and it sounds flippant. Sorry about that. It wasn't meant to be. I really think he came up with one of the best systems going way back then. It survived through all kinds of nasty governments and still is in place today.

So far as the complexity goes, I think Obamacare does nothing to solve it. I think single-payer would.

Just imagine instead of a for-profit hospital with for-profit doctors, for-profit nursing companies, for-profit pharmaceutical sales companies, for-profit catering companies, for-profit building management companies, for-profit parking lot management companies, for-profit real estate holding companies, for-profit staffing agencies, for-profit cleaning companies, for-profit security guard companies, etc. etc. there was just the hospital as a single not-for-profit entity. Things were often like this even in America until the eighties. I think it's a feasible model again if you squeeze the fat out of the system that all of these entities are living on.

Or imagine instead of 15 insurance companies with 100 plans charging different rates at different doctors offices for the same procedure, there was just a price for the procedure. Things get much simpler this way.

Like I said, either way George will still be guarding the door, Sally will still be making ham sandwiches, Sarah will still be plugging in IVs, and Rhonda will still be typing in policy data into a database in a cubicle. But Joe in billing may lose his job.

Healthcare is 18% of American GDP. It's 10% in Germany, where the population has a much worse age-demographic trend.

What I do worry about is job loss on that front. Healthcare has almost single-handedly replaced the jobs lost in Manufacturing over the last decades. Chopping 8% of GDP out of the pie has to be done slowly and incrementally or we're in bad trouble.

[shiny!]

Re: Chart Of New Health Care Law

dcarrigg, once again I must commend you on your masterful number crunching and deeply thoughtful posts. I don't tell you often enough, but it's really appreciated.

[lektrode]

Re: Chart Of New Health Care Law

dcarrigg, once again I must commend you on your masterful number crunching and deeply thoughtful posts. I don't tell you often enough, but it's really appreciated.

sigh... i'll hafta suffice with a +1 here - since i just blew a 1/2 hours worth of 2fingahd typin by pressing the wrong GD key somehow
and LOST IT ALL!!!

so y'all have been spared... ;)

but was going to address dc's comment about 'thats the way things were up til the 80's' (i think things started getting wierd after the 90's, no matter what the bankster apologists have to say...)

its also why i'm at a distinct disadvantage round here - because i cant type any faster than i can compose and dammit!
i had a good one goin...

[c1ue]

Re: Chart Of New Health Care Law

You don't pay as much because your policy doesn't include high risk drivers. Policies that cover them are considerably more expensive.

The problem is - you don't actually know what a high risk driver is.

For example: the ways by which an insurance company traditionally measured a driver's risk factor is (I believe) a function of age, traffic ticket, accident, and location.

The ways be which monitoring can occur now start with braking, extend to exceeding speed limits, include the number of times you drive at certain hours, and who knows where this will go.

The reality is that many people who think they are safe drivers - are not going to be under this new system, because the past system is based on avoiding accidents while the new systems are based on actual behavior. Thus if you speed regularly - you aren't a safe driver irrespective of how many accidents you do not have. If you have 4 or 5 people cut you off in traffic, or turn in front of you, you aren't going to be a safe driver. If you work a job that means you drive home after midnight, you aren't going to be a safe driver. If you work a 9 to 5 job, you aren't a safe driver (commute times are the worst for accidents, right after the midnight to 4 am shift).

Care to explain how an insurer with a rising medical loss ratio can remain profitable without raising premiums or seeking government subsidies?

Actually, you'd have to be the one explaining.

Show me these losses the health insurance companies are taking.

[dcarrigg]

Re: Chart Of New Health Care Law

"5) Reduction in the complexity of the system"

In all due respect, how does this jive with the organization chart this thread was based on? Yes that's Obamacare vs. single payer but the bureaucrats will still find a way to screw it up.

I agree that insurance companies are poorly managed, but I only see a government system as a worse alternative.

Hey, if you can design a system that works, I'll support you for the Noble prize

By the way, sometimes when we're talking about these things, I think it's tough to see the forest through the trees. I was thinking about our conversation last night, and this morning it hit me: we're talking about this all wrong.

Americans like to talk about healthcare (or at least you and I were) as a choice between the private market options we have today and government run healthcare.

But that's really a false choice.

45.1% of total health costs in America are paid by the federal government through Medicaid and Medicare (they're not that much of the population, but they're half of the sick population). 48.6 million people are on Medicaid. 44.3 million people are on Medicare. Another 57.5 million had no insurance at some point last year and they rack up bills to states when they get care and the hospitals can't collect. That's a whole lot of people for the government to take care of. Now, some of these people overlap. But not all. There are at least 100,000,000 people here. And that's not counting SCHIP, which is more state healthcare.

I think the current system seems like it's all private insurance because all of us are relatively wealthy and had it. But there's clearly a third of the population that is poorer and goes most, if not all, of their lives without it. And it's clear that the government is already a big player in the healthcare industry. It's covering half of all the costs, for chrissakes.

So really, the choice isn't between a private sector system and a government system. It's between a half-government system and a more-than-half government system. At least I think it is. And if that's the case, maybe there's not as much to argue about here as we think.

[DSpencer]

Re: Chart Of New Health Care Law

Just imagine instead of a for-profit hospital with for-profit doctors, for-profit nursing companies, for-profit pharmaceutical sales companies, for-profit catering companies, for-profit building management companies, for-profit parking lot management companies, for-profit real estate holding companies, for-profit staffing agencies, for-profit cleaning companies, for-profit security guard companies, etc. etc. there was just the hospital as a single not-for-profit entity. Things were often like this even in America until the eighties. I think it's a feasible model again if you squeeze the fat out of the system that all of these entities are living on.

So why stop there? Why allow for-profit anything?

Imagine non-profit fast food. (Hey then the workers could get their $15/hr, right?). Non-profit law firms. Non-profit groceries. Non-profit auto manufacturers. Non-profit everything. Oh, by the way you said you own a business, what type of business? Can that one be non-profit also?

Imagine how much better everything would be? I can't believe nobody has tried this already!

[dcarrigg]

Re: Chart Of New Health Care Law

So why stop there? Why allow for-profit anything?

Imagine non-profit fast food. (Hey then the workers could get their $15/hr, right?). Non-profit law firms. Non-profit groceries. Non-profit auto manufacturers. Non-profit everything. Oh, by the way you said you own a business, what type of business? Can that one be non-profit also?

Imagine how much better everything would be? I can't believe nobody has tried this already!

You're getting hyperbolic on me. There is a difference between a "product" that is nearly perfectly price inelastic and a product that is rather elastic where goods and serivices may be bought and sold with price comparisons.

You wouldn't pay $300 for a Big Mac if Whoppers were $1, right? Then why does this happen every day in healthcare? $300 for an aspirin. $2,400 for a 10 minute ambulance ride. $30,000 for an anti-venom that cost $12 to make. $30,000 for a 45 minute surgery. Face it. Microeconomics breaks down at life and death. A perfectly inelastic market combined with the physical inability to move when one is injured and an intermediary payment proxy is the perfect storm for price gouging. Why do you think the US spends 18% of GDP on healthcare, but nowhere else comes close?

It used to be people didn't make so much money off the sick. You can see it in the GDP numbers over time. It wasn't a spot to make your fortune. It was a menial job reserved for nurses and nuns. Now there's 17 CEOs in the damn building. There has been a culture change in healthcare in this country. That's for sure.

Let me put it this way:

Why have government at all? Why not just have private thugs defend private property? Why not end school lunch? Why not just let people starve in the streets? Why not end public school entirely and leave legions of poor and uneducated to roam the landscape like thunderdome? Why not privatize the legislature and give laws to whoever bids the most? Why not close all the libraries? Why not put a toll both on every road? Why not privatize the ocean and charge people to look at it? Why not privatize the air we breathe and put a meter on everybody's lungs? Why not privatize the national parks and strip mine them for resources? Why not privatize the sun and the clouds and patent the sunny day? Why should the government prevent a free market in people? Why not end Republic and just have a strongman government run by the richest and strongest among us? Why not crown Bill Gates king?

Because doing that would be ridiculous.

Just as you claiming I'm some sort of communist for thinking about a different model of healthcare is ridiculous.

I'm not talking about going Chairman Mao here and re-appropriating business property.

I'm just talking about setting clear and transparent pricing methods publicly through a single-payer system. But I am assuming that as soon as that happens, the price gouging will stop, and hospitals will not be able to support 17 in-building CEOs. They're living off the fat of the system.

How can there not be fat here? How does the US Government spend more on healthcare as a percentage of its budget than every other nation, have fewer doctors and nurses per capita, still only cover half the costs and a third of the people, and still have worse health results if the status quo is so great? The following is a table from a 2008 report. Pre-recession data. Healthcare costs have grown since then as a percentage of GDP. How high will they go?



If you think it's feasible to have 30% of the economy be FIRE and another 20% be healthcare, and have both be growing while everything else shrinks, then fine. We'll keep doing nothing. Let more people go bankrupt for medical problems. Let more people die because they're scared of going bankrupt if they walk into the hospital. Let Goldman buy their house and extort them. So long as all your money goes to mandatory private insurance instead of taxes, then the ideology is fulfilled. Who cares if it bankrupts the nation? That's the red-blooded American free-market solution you love. All that matters is that we kneel to the golden calf. Right?

[Woodsman]

Re: Chart Of New Health Care Law

Just as you claiming I'm some sort of communist for thinking about a different model of healthcare is ridiculous.

Of course, this type of argumentation is commonplace now and otherwise sensible folks are quick to employ it. Any proposal, no matter how sensible, that does not tow the "free market" line is ridiculed with the most absurd reductionist arguments. Even here in this last redoubt of reason and common sense!

Why have government at all? Why not just have private thugs defend private property? Why not end school lunch? Why not just let people starve in the streets? Why not end public school entirely and leave legions of poor and uneducated to roam the landscape like thunderdome? Why not privatize the legislature and give laws to whoever bids the most? Why not close all the libraries? Why not put a toll both on every road? Why not privatize the ocean and charge people to look at it? Why not privatize the air we breathe and put a meter on everybody's lungs? Why not privatize the national parks and strip mine them for resources? Why not privatize the sun and the clouds and patent the sunny day? Why should the government prevent a free market in people? Why not end Republic and just have a strongman government run by the richest and strongest among us? Why not crown Bill Gates king?

I thought that was the plan. Surely that's the neocon/neoliberal (neo feudalist) dream...

[c1ue]

Re: Chart Of New Health Care Law

So really, the choice isn't between a private sector system and a government system. It's between a half-government system and a more-than-half government system. At least I think it is. And if that's the case, maybe there's not as much to argue about here as we think.

You're still failing to distinguish between payment for health care and delivery of same.

Government or not government is really irrelevant; delivery is 100% private unless you're a Veteran (or a national level politician).

What I've noted before several times is that there is much reason why the US government should consider getting into the health care delivery area - not as a profit center but as a cost reduction measure. If 100 million people are consuming health care via the government, why not have the government also get into the loop in delivering said health care - as opposed to just fork up the taxpayer payments?

It isn't like the US government doesn't have any expertise in health care delivery.