Chart Of New Health Care Law

[lektrode]

Re: Chart Of New Health Care Law

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.

+100
(altho i'm pretty sure the .mil grunts will have a few obs about the quality of care...)

i've mentioned this concept on sev sep occasions mesself - my plan goes along the lines of this:

in an effort to be the med services provider of LAST RESORT, and offer some COMPETITION to the 'for profit' sector,

i propose that the .mil create what would essentially be a '6th branch of the .mil services'
and it could/would be called The US Medical Corps.

and would be primarily staffed by those endeavoring to get educated in the med sciences (vs 'arts' like polysci and .edu 'doctors')

who would ENLIST and go thru basic training - just like every other .mil grunt goes thru (no 'free' or easy rides)

they would then be trained, put thru internship and residency, just like the private sector does...
and once thru the program, WOULD OWE UNCLE SAM (that would be The Rest of US)
some number - maybe say an EQUAL number of years in service to their Fellow Americans, in exchange for the years of training and experience - on 'the front lines' in the ongoing battle against the FIre-financed med-ins-legal-drug mob

this would accomplish a number of goals:

would provide an option to the large number of req'd med students (to rplc the large number of docs/nurses et al, who will in all likelyhood be retiring/quitting the biz, shortly after obama'scare takes hold) - to get their educations paid for - without going into indentured-servant/slavery to pay off the 10's to 100's of THOUSANDS IN DEBT incurred to the .gov-financed .edu industrial-complex

and - ta DA!!

create a whole bunch of NEW JOBS in the process - all of which would then provide both a solution to the trillion dollar giveaway to the same bunch (noted above) that is basically in a position to BANKRUPT THE MIDDLE/WORKING CLASS, while they hold US hostage and demand RANSOM from the rest of the private sector...

ok - i'm open for suggestions on WHY WOULDNT THIS WORK???

O&BTW: happy labor day weekend, y'all!!!

we're off into the canyons for some camping...

[radon]

Re: Chart Of New Health Care Law

There are many facets to this problem.

I'll give you an example. A large manufacturer sells the hospital a mammography machine. Now the hospital has to recoup that expenditure by running 1000s of people through the machine. But does it work, and is it worth the exposure, the psychological stress of false positives, the following expensive procedure to biopsy a benign mass etc. Half of the knock-on effect from the follow up is simply to avoid a potential lawsuit. But it doesn't really matter to GE, they made money, the hospital made money, the insurers made money, even the lawyers made money. Everyone made money, but does it help patients, or does it set them up with a false expectation that if they go to screenings they will catch potential cancer early enough for treatment?

Part of the solution has to be removing conflicts of interest brought on by the finalization of the industry.

[radon]

Re: Chart Of New Health Care Law

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

Show me these losses the health insurance companies are taking.

You're the one who asserted that insurance companies always make a profit. That might have been true when they could deny applications. What do you think would happen to your auto premiums if your state's assigned risk plan disappeared and your insurance company was forced to accept all applicants?

So again, care to explain how an insurer with a rising medical loss ratio can remain profitable without raising premiums or seeking government subsidies? I'll give you a hint. You're going to overpay for your policy along with nearly everybody else.

[DSpencer]

Re: Chart Of New Health Care Law

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?

Apologies for being a bit hyperbolic but the tone of your argument struck a nerve with me because it sounded very much like a profit is bad type of speech. I won't argue that healthcare in the US is cost effective, but those numbers you throw out are misleading. For one thing, anyone who understands healthcare economics knows there is a huge difference between what is charged and what is paid. For another, hospitals can't simply bill $12 (or $24) for anti-venom because they have no way of billing for the nurses, electricity to keep the lights on, liability insurance etc etc.

If it's so easy to create a new healthcare facility, dramatically undercut existing prices (you could charge $500 for anti-venom), reduce healthcare costs for Americans, and still make a profit: do it. Or explain to me why you or others don't.

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

So what does happen to all the for-profit businesses then?

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.

So if all the owners of these for-profit places are such shrewd and calculating Scrooge McDucks then why would they waste money on excessive management instead of putting the profits in their pocket? The vast majority of the hospitals in my area are non-profits run by the Nuns and other religious groups. When you look at their publicly available financial statements they still have a big "excess of revenue over expenses". They just use the money to build more hospitals instead of giving it to the Nuns. And they get special tax breaks.

This is an interesting read. And maybe you will find the source credible. (Kidding about the last part- just trying to add some humor).
http://socialistworker.org/2009/07/2...on-profit-scam

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?

This is an overly dramatic strawman.
For the millionth time: We do not have a free market in healthcare in the US. And I never recall saying we should do nothing, I don't support the status quo. I've said on itulip many times that we have the worst of both worlds in many ways.

How about this compromise for our pretend itulip congress: The Feds create a public option BUT it has to compete on a level playing field. I.E. no taxpayer subsidies or tax exemptions etc.

[dcarrigg]

Re: Chart Of New Health Care Law

Apologies for being a bit hyperbolic but the tone of your argument struck a nerve with me because it sounded very much like a profit is bad type of speech. I won't argue that healthcare in the US is cost effective, but those numbers you throw out are misleading. For one thing, anyone who understands healthcare economics knows there is a huge difference between what is charged and what is paid. For another, hospitals can't simply bill $12 (or $24) for anti-venom because they have no way of billing for the nurses, electricity to keep the lights on, liability insurance etc etc.

They can calculate an hourly or nightly bill for nurses and overhead just like a hotel can calculate a nightly rate that includes electricity, insurance, cleaning staff, etc. They just don't because it's more profitable not to.

If it's so easy to create a new healthcare facility, dramatically undercut existing prices (you could charge $500 for anti-venom), reduce healthcare costs for Americans, and still make a profit: do it. Or explain to me why you or others don't.

There are large barriers to entry in the market. And there are people skimming every step of the way. But you think it's not easy to cut the anti-venom price? Look what happened in Chandler AZ last year. A woman is charged $83,046 for anti-venom. The press got wind of it. The hospital dropped the price by 80% over night. Who else can afford to cut 80% of the price out of a physical product simply due to bad press?

So what does happen to all the for-profit businesses then?

I'm under the assumption that if every other first world country can provide healthcare with better outcomes at half the cost, so can America. But if we had price transparency, and strong negotiating positions for healthcare consumers as a whole, then there would not be so much waste and fat for these entities to live on.

So if all the owners of these for-profit places are such shrewd and calculating Scrooge McDucks then why would they waste money on excessive management instead of putting the profits in their pocket? The vast majority of the hospitals in my area are non-profits run by the Nuns and other religious groups. When you look at their publicly available financial statements they still have a big "excess of revenue over expenses". They just use the money to build more hospitals instead of giving it to the Nuns. And they get special tax breaks.

You're not following how I understand most modern health facilities to work. The last major nation-wide integrated for-profit model died with Richard Scrushy and Healthsouth years ago. Now everything's segmented. You split off every segment of the hospital. The building itself becomes a 501(c)3 subsidiary of a for-profit management corporation. No property taxes are paid. Another for-profit subsidiary of the building management corporation will run the parking lot. Another will run the food. Then a for-profit healthcare delivery company provides the nurses. So one company owns a non-profit company that owns the land and building, and another company owns the healthcare product, which is basically the nurses and some equipment. Then multiple other companies provide all the services. It's "not for profit" when the tax man comes, but it's for profit otherwise. Sometimes there's a third equipment company, and the pharmacy is usually operated by a separate company on the floor as well. This was not how things used to be. But it is often how things are now.

This is an overly dramatic strawman.

That was the point. An hysterical response to an hysterical accusation.

For the millionth time: We do not have a free market in healthcare in the US. And I never recall saying we should do nothing, I don't support the status quo. I've said on itulip many times that we have the worst of both worlds in many ways.

How about this compromise for our pretend itulip congress: The Feds create a public option BUT it has to compete on a level playing field. I.E. no taxpayer subsidies or tax exemptions etc.

No true market. No true scotsman.

[lektrode]

Re: Chart Of New Health Care Law

I'm under the assumption that if every other first world country can provide healthcare with better outcomes at half the cost, so can America. But if we had price transparency, and strong negotiating positions for healthcare consumers as a whole, then there would not be so much waste and fat for these entities to live on....

+1 point for dc.

wait a sec - wrong color highlight (sorry dc)

i'm also under the assumption that if any other country can do something - anything - for 'less than half' ???

WE CAN BLOW THE DOORS OFF ANY OF EM!

[DSpencer]

Re: Chart Of New Health Care Law

They can calculate an hourly or nightly bill for nurses and overhead just like a hotel can calculate a nightly rate that includes electricity, insurance, cleaning staff, etc. They just don't because it's more profitable not to.

They can calculate whatever they feel like, that doesn't mean they will get paid one dime. The payers decide what gets paid and most have specific rules on what charges are allowable and what are not. I'm not aware of any major payer that will pay for electricity or cleaning staff.

If you have a superior understanding of how this works, please share it.

There are large barriers to entry in the market.

Who creates these barriers and why?

I'm under the assumption that if every other first world country can provide healthcare with better outcomes at half the cost, so can America. But if we had price transparency, and strong negotiating positions for healthcare consumers as a whole, then there would not be so much waste and fat for these entities to live on.

This is non-responsive: Transparency and strong negotiating positions are not the same as removing the for-profit parts of healthcare which is what I thought you were saying should be done.

You're not following how I understand most modern health facilities to work. The last major nation-wide integrated for-profit model died with Richard Scrushy and Healthsouth years ago. Now everything's segmented. You split off every segment of the hospital. The building itself becomes a 501(c)3 subsidiary of a for-profit management corporation. No property taxes are paid. Another for-profit subsidiary of the building management corporation will run the parking lot. Another will run the food. Then a for-profit healthcare delivery company provides the nurses. So one company owns a non-profit company that owns the land and building, and another company owns the healthcare product, which is basically the nurses and some equipment. Then multiple other companies provide all the services. It's "not for profit" when the tax man comes, but it's for profit otherwise. Sometimes there's a third equipment company, and the pharmacy is usually operated by a separate company on the floor as well. This was not how things used to be. But it is often how things are now.

I won't claim to know how most health facilities work with regard to this type of structure. In any case, we probably agree that "not for profit" is a scam in many cases.

No true market. No true scotsman.

Wasn't it you in this very thread making the point that the government controls much of the market? The rest is so highly regulated that it's hard to call it free. I guess it's a matter of degree and opinion though. If you think that saying we don't have a true free market is a logical fallacy then so be it.

[c1ue]

Re: Chart Of New Health Care Law

I'll give you an example. A large manufacturer sells the hospital a mammography machine. Now the hospital has to recoup that expenditure by running 1000s of people through the machine. But does it work, and is it worth the exposure, the psychological stress of false positives, the following expensive procedure to biopsy a benign mass etc. Half of the knock-on effect from the follow up is simply to avoid a potential lawsuit. But it doesn't really matter to GE, they made money, the hospital made money, the insurers made money, even the lawyers made money. Everyone made money, but does it help patients, or does it set them up with a false expectation that if they go to screenings they will catch potential cancer early enough for treatment?

Your example is purely theoretical, and more importantly, totally wrong.

Try getting health care in these other 1st world and 2nd world nations. They have better and newer machines that in the US - because their medical services aren't so concerned with squeezing the last dime of profit out.

Some concrete examples: An MRI scan in the US costs 10x to 100x more than anywhere else. The machine is exactly identical. Yes, there is some labor cost difference, but it isn't a doctor performing the scan.

US: http://comparemricost.com/

MRI cost can range between $400 to $3,500 depending upon which MRI procuedure is performed (example: brain mri vs. shoulder mri) and where you have the MRI test performed.

Australia: http://www.medscans.com.au/info/mri-info.html

This depends on the area of the body being imaged. In some situations, an MRI may be covered by Medicare such as for pensioners or war veterans (DVA) or for particular scans ordered by specialists. For most scans, expect to be out of pocket between $100 and $500.

So your argument is false on its face. The above internet data only confirms what I have seen first hand.

You're the one who asserted that insurance companies always make a profit. That might have been true when they could deny applications. What do you think would happen to your auto premiums if your state's assigned risk plan disappeared and your insurance company was forced to accept all applicants?

So again, care to explain how an insurer with a rising medical loss ratio can remain profitable without raising premiums or seeking government subsidies? I'll give you a hint. You're going to overpay for your policy along with nearly everybody else.

Nope - you were the one that said that the health insurance companies were employing these practices otherwise they would lose money.

I've challenged you to demonstrate this. Chickening out?

[dcarrigg]

Re: Chart Of New Health Care Law

*duplicate post for some reason*

[dcarrigg]

Re: Chart Of New Health Care Law

They can calculate whatever they feel like, that doesn't mean they will get paid one dime. The payers decide what gets paid and most have specific rules on what charges are allowable and what are not. I'm not aware of any major payer that will pay for electricity or cleaning staff.

If you have a superior understanding of how this works, please share it.

Who creates these barriers and why?

I'm not aware for paying for electricity or a cleaning staff at a hotel either. It's built into the bill. They can still tell me what a bed costs per night.

This is non-responsive: Transparency and strong negotiating positions are not the same as removing the for-profit parts of healthcare which is what I thought you were saying should be done.

That maybe could have been clearer then. I was saying that it's impossible to support so many petite bourgeois (to keep the joke going), once you take price gouging out of the equation. And I know price gouging's in the equation because there are neighbors with whom one may compare costs for the same thing.

I won't claim to know how most health facilities work with regard to this type of structure. In any case, we probably agree that "not for profit" is a scam in many cases.

I think it's just a result of the gouging. It's a lot easier to charge top dollar when you can just argue that some third party invoices you for what it invoices. And the non-profit deal is a scam on top of it all. It's the same method used by tax cheats with shell corporations. Make a confusing mess too complicated to untangle, charge top dollar, pay nothing in taxes.

Wasn't it you in this very thread making the point that the government controls much of the market? The rest is so highly regulated that it's hard to call it free. I guess it's a matter of degree and opinion though. If you think that saying we don't have a true free market is a logical fallacy then so be it.

Yes. But the United States has the most free market system in the first world. You just called me a communist when I suggested single-payer healthcare might be the way to go. So we clearly don't have government healthcare either, if that's communist and scary.

But that wasn't the way I thought you were using the term. I'll say it's half government, half free market. But you say it's not free market because the government interferes. Since all markets are created by law, all corporations are registered by the state, all transactions are done in state currency or over state infrastructure, and the government interferes in all of them, that means that you can use the phrase "not a true free market" for anything but drug dealers over bit coin, and even then, I think there's some regulation in the fiber optics they're using to get the job done.

Let me give you an analogy that might clear up what it seems like you're arguing from my point of view:

It's like a philosopher, a farmer, and a grumpy old yankee are looking at a tired horse not pulling its weight surrounded by happy donkeys. The farmer suggests mildly that maybe the horse is not fit for the job and another donkey might get the job done better. But a philosopher comes out and insists that only a unicorn can do it. And even though unicorns are just horses without horns, they'd do a better job for some reason. And that horse isn't a true unicorn because it doesn't have a horn. Even though there are no unicorns, the philosopher insists that using any animal but a unicorn for the job is treason, and that a horse is better than a damn donkey. Meanwhile, the donkeys continue to get the work done as the horse wheezes, putters out, eats twice as much, and costs more to stable. But the philosopher insists the horse is better than the donkey, and just isn't working as good because it is missing his horn.

The grumpy old yankee pipes in to say, "There are no unicorns." And the philosopher's response is, "But there were unicorns in the past, and it doesn't mean we couldn't genetically engineer them in the future." Both the farmer and the grumpy old yankee remain skeptical that there were ever unicorns in the past. And they remain skeptical that it's possible to genetically engineer them in the future. Finally, after much debate, the grumpy old yankee in the group pipes up, "That donkey's getting the job done and all this talk about unicorns is for damn fools." And the farmer says, "Now I don't want you both fighting. We'll just keep that horse."


I think that's the fallacy. If private insurance companies and a private marketplace exist for 2/3 of the population and 1/2 the health costs, there's some sort of free market there. There has to be. It's definitely at least a horse, even if it's not a unicorn.

And meanwhile the donkeys all around us keep chugging along...

[Thailandnotes]

Re: Chart Of New Health Care Law

I’ve pretty much given up thinking about health insurance and the delivery of care, but I do think Thailand’s mishmash of public/private options offers some clues as to what is possible.

The government legislating that “here are these people on the bottom that can’t buy insurance or care, and we, the government will pay for their care, but we demand that it will be inexpensive so that you as a hospital will only make a very small amount on it” has a huge knock on effect for lowering the price for procedures for all the citizenry (knee replacements, MRI’s ).

My landlord’s mother is in her 80’s. They shop for healthcare just as they shop for the best deal on new tires. You can walk into a hospital here and ask how much a colonoscopy will cost, and they will tell you, and they will tell which nearby hospitals offer it cheaper and pretty much get the other hospitals’ prices right.

Many people would scratch their heads, and ask, “So doesn’t that mean hospitals are gouging the rich and middle class a lot more to subsidize the lower class?” Turns out, no.

[lektrode]

Re: Chart Of New Health Care Law

....do think Thailand’s mishmash of public/private options offers some clues as to what is possible.

The government legislating that “here are these people on the bottom that can’t buy insurance or care, and we, the government will pay for their care, but we demand that it will be inexpensive so that you as a hospital will only make a very small amount on it” has a huge knock on effect for lowering the price for procedures for all the citizenry (knee replacements, MRI’s ).

My landlord’s mother is in her 80’s. They shop for healthcare just as they shop for the best deal on new tires. You can walk into a hospital here and ask how much a colonoscopy will cost, and they will tell you, and they will tell which nearby hospitals offer it cheaper and pretty much get the other hospitals’ prices right.

Many people would scratch their heads, and ask, “So doesn’t that mean hospitals are gouging the rich and middle class a lot more to subsidize the lower class?” Turns out, no.

+1
this seems to me - a grumpy ole yankee - to be the crux of the problem in the US - that pricing is so... obfuscatory (never mind confiscatory) - its like my anecdote/experience the other day, attending an info seminar on GERD - the doc, who actually performs the surgical proceedure and was there primarily as an advocate (salesman) for the proceedure - had no idea what the charges would be - which to me is evidence enough to suggest that COSTS are absolutely irrelevant to THEIR policies (and marketing of said services) - and methinks thats a direct result of the 3rd-party nature of the whole US mishmash - it because SOMEBODY ELSE PAYS - that the provider/deliverer of the services cant (or more likely _wont_) tell us what the services will cost.

i also think its a function - a deliberate function - of how the whole settlement of med bills is worked out - an uninsured person wants/needs some service and he gets quoted an astronomical number - the same person, but insured - gets said service and the insurer is able to command a huge discount from the provider - in exchange for what, exactly?

and here's another example of the sheer madness - my 'insurer' - who is also the provider - quotes me a $1500 'co-pay' for some service (dont matter which) - on top of the 6grand/yr i'm already paying for the 'insurance' - with the co-pay shown next to the 'value' of said service at some multiple of that (double or more) - when this same service (more extensive actually) can be had elsewhere for the same or LESS THAN MY QUOTED CO-PAY(??), even - to anybody who walks into the their shop - whether they're insured or not.

thats why this whole nightmare called 'healthcare' and 'insurance' is boiling down to nuthin but fraud, IMHO.

and its being institutionalized (legalized) by (the) obama'scare

leading to this grumpy ole yankee to declare its BS and nothing more than a trillion dollar giveaway to some of the biggest corporate hucksters in the US - another way of putting that would be: welfare for the rich - or yet more succinctly:

socialization of the risk and capitalization/privatization of the profit - read: exactly whats happnin with the big banks.

ayuh... why methinks the donkees have been rode hahd and put away wet/sweatin...

[radon]

Re: Chart Of New Health Care Law

Your example is purely theoretical, and more importantly, totally wrong.

No it is the result of spending several years speaking to hospital and private practice staff. And endless hours designing, coding and rolling out practice management solutions in the 90s. This is exactly the sort of thing that happens to recoup capital expenditures. It illustrates perfectly some of the inherent conflicts of interest in the American medical system.

Nope - you were the one that said that the health insurance companies were employing these practices otherwise they would lose money.

I've challenged you to demonstrate this. Chickening out?

I noticed you still haven't explained how an insurer with a rising medical loss ratio can remain profitable without raising premiums or seeking government subsidies. I'll stop "chickening" if you stop "ducking"". Are they going to magic the money out of thin air or are the going to raise premiums? You're claiming the former, I'm claiming the latter.

I love your strawman about NMRIs. I'm not sure it helps your argument though. The hospital has to run a lot of patients through those to make back that 2 million bucks plus operating expenses. Speaking of MRIs why don't you have a talk with some hospital IT staff and ask them how much a 510k compliant diagnostic imaging monitor costs? You won't find them at best buy. While your at it ask them about PACS software and licences, and all the hundreds of expenses that occur just for one study. Itemized everything and add them up then you'll have a better understanding of why things are more expensive in the US than your favorite medical paradise.

[radon]

Re: Chart Of New Health Care Law

I'm not aware for paying for electricity or a cleaning staff at a hotel either. It's built into the bill. They can still tell me what a bed costs per night.

If you were paying your hotel bill with insurance they wouldn't be able to and you probably wouldn't care. You passed off the negotiation of price to your insurer.

[radon]

Re: Chart Of New Health Care Law

My landlord’s mother is in her 80’s. They shop for healthcare just as they shop for the best deal on new tires. You can walk into a hospital here and ask how much a colonoscopy will cost, and they will tell you, and they will tell which nearby hospitals offer it cheaper and pretty much get the other hospitals’ prices right.

Is it typical to pay cash for medical services in Thailand, or is it predominately insurance based?