Health care

[mrsleeve]

^^^^^^^^^^^^^^^^^^

You bring up very valid questions and while I am a big supporter, of freeing up the markets. I really feel its one 1 part of a lager system and right now would have been a better option to go than to spend trillions on this folly we are being choked with.

[KenC]

I think we need to have the conservative fortitude(tm) to do what it takes to reduce costs (opening the market on insurance, tort reform, doing away with the anti-trust exemption, etc), however, I believe our society needs to be compassionate enough to subsidize care for those without acccess to it.

That is, I'm all for reducing costs where we can, but I'm not convinced it will be enough to reduce them enough to make adequate coverage universally affordable, which is where the public needs to step in.

[kishg]

Well sort of, Hospitals are only required to stabilize a patient regardless of insurance coverage or money, once they are stable it is entirely up to hospital to determine if they keep treating the patient. This is also the reason why people will get turned away after being stabilized even though they weren't fully treated.



I agree with you, The US Government has been subsidizing almost 40% of the entire healthcare industry for the past 20 years or more.



Well that's actually the question, is it about expanding coverage or reforming the way hospitals deal with the red tape of private insurance companies (which is why I state there is a difference between health CARE reform and health INSURANCE reform.) In my opinion, which is why I disagree with the bill, we need to get rid of the red tape from insurance companies, and return the power back to the doctors, then we open up policies across state lines, this will drastically lower the cost of insurance as well as improve healthcare. Thus making it far more affordable to purchase insurance and expand coverage. I'll give a better explanation and analogy below.



One of the easiest ways to lower premiums and expand coverage is by opening up coverage across state lines. Auto Insurance works on the exact same principle as Health insurance with two HUGE Exceptions, 1) it is required by both the state and federal government and 2) it is universal across state lines, whether I purchase my insurance in Texas and get into an accident in Maryland is irrelevant, Either way I'm covered. Nobody seems to be overly complaining about HAVING to buy auto insurance! Why is that?? National Coverage allows major companies to compete across the board, sure there are only about 5 major companies and 20 or so local companies per state (guesstimating) but the competition between those few has significantly driven down costs, which is why I have no complaints about paying $40 a month for liability for my e30. If we opened up Health Insurance coverage across state lines there would be 300+ companies available overnight, more than half will go out of business and leave us with 10 or so major players but premiums would drop drastically because of the competition, thus wildly expanding coverage. Combine that with thinning the red tape between Insurance and Pharmaceutical companies, doctors and their patients and you will boost revenue, immensely reduce wasteful spending and boost the overall care of patients. We also need to do far more to protect doctors from ridiculous malpractice lawsuits (ie TORT Reform) that way they can concentrate on taking care of a patient and not worry about their license and practice.

I'm only about 400 pages into the new 1990 page House Bill, but what I have learned from a few friends (judges, doctors and lawyers) this bill still does little to none of what I have mentioned. On the other hand the Republican bill that I have read (which is also the only one I can get my hands on) pushes directly in this direction and significantly reduces the deficit and creates real reform.



Well I think there were far more pressing issues like two wars and Social Security Reform (sadly failed) at the time.

once again, a reasoned discussion, i agree with most of your points.

[Hallen]

I see this as an issue because as any healthcare administrator, or physician for that matter, will tell you is that it is the lower-income populations that regularly require the most medical care. I think it will be necessary for the public to supplement this population just as they do the uninsured... but I guess that's just something that I feel we, as a society, are obligated to do.

I find it odd that it hasn't been addressed in this thread yet, but there is a underlying question that no one has posed: Is health care a right, or a privilege? It's a moral issue that is essentially impossible to debate upon, yet is still driving the heart of the reform debate.

As to that first point, we already do via medicare and medicaid. If we could correct the problems that cause the lower income people to "regularly require the most medical care", then we would really be making a difference. I would argue that is the real fix to that problem. Of course saying that and doing that is nearly impossible. Many of the poor are poor for a reason. Either drug addictions, lack of ethics, lack of drive, laziness, or just plain stupidity put a lot of people there. Fixing them would be a real challenge. Yes, I realize that a good percentage of them are not that way and are just a little trapped, but generally just a helping hand for a short while gets those people out of that situation. I'm all for that kind of help.


Your last question there is a good one. It is a moral dilemma. On the one hand, it is not my responsibility to take care of some asshole who got drunk and fell down the stairs. If that is expected of me, then I expect that once that person is healthy again that they are either required to pay me back, or they spend time in jail. A moral person would want to pay me back. An immoral person would consider it their right to free service.

So, I guess what I am saying is that it is not a right. It is something you earn and should be thankful for. That doesn't mean that anybody should be denied care. It just means that you are responsible for you. It doesn't matter if it is before the fact or after. We as a society are responsible for the overall system and for policing it. We are not responsible for the individual.

Insurance pools, whether government run or privately run, are all built off of risk and cost. Reduce one or the other or both and you will have substantial savings.

Reducing insurance costs is also difficult. Tort reform is the place to start.

You'd be very surprised at how much cost reduction a good tort reform package will produce. (eg, 10 years ago, NY doctors were paying on average $250,000 per year for malpractice insurance)

Competition in insurance via removal of the state barriers will most likely not lower quality. There will be a full range of choices.

If you pay for cheap insurance, then expect lousy service in your claim processing. Also expect a lot of hassles about what is and is not covered, much like Geico car insurance. It'll work sometimes, but it is going to be a hassle. Or, go for a slightly more expensive program and get much better service. It's up to you.

Look at the car insurance business for an example. They deal with risk pools and you can find insurance to meet your needs for reasonable amounts of money. Competition drives both cost reductions, often through innovation, and also will drive service up. People will not put up with horrible service if they have a choice (which I will point out that a government plan does not provide).

Those cost reductions do not equal a reduction in cost to provide medical care, it is a reduction in cost for insurance premiums. Combine that with tort reform, and we'll start seeing some major improvements overall.

What really needs to happen is detailed studies into why medical procedures cost so bloody much, and find where we can reduce or remove those costs. I can't tell you what a lot of that is because I'm not an expert, but I'm betting there's a whole lot of government regulation there that is getting in the way. I'm not saying to remove safeguards, I'm saying let the medical community come up with what those safeguards are and work at streamlining them. Then attack each cost the same way and I'll bet you could reduce the cost of common procedures by 50%.

One silly example: Have you ever watched a nurse work? If they are doing their job right, they are washing their hands a lot. Before every procedure involving a patient and after. Sometimes, they wash their hands 25 times per day. That's probably close to an 30 minutes of hand washing time per shift. Now, it's a very good thing because it reduces the transmission of infections from one patient to another and also protects the nurse. However, those procedures take tons of time and it can lead to hand problems for nurses that cause them to miss work. So, if you came up with an efficient system that reduced the time spent washing by 90% and increased the effectiveness, you just saved a bunch of cost. Stick your hands into the machine, 5 seconds later you are sterile and can move on. Fewer nurses can cover the same workload, fewer infections get spread, everybody wins. Yeah, I know it sounds silly, but that's just one goofy idea by a guy who knows little about health care.

[mrsleeve]

Again Hallen you have put much of my thinking much more eloquently than I would have.

[joshh]

The funny thing here is that if (thankfully it will never pass as is) this bill were to pass, you'd find many people going back to the insurance companies because of the huge fucking waits that would be required of the public option.
If the doctors we have are overwhelmed with patients, you'd better believe care will be worse.

[KenC]

As to that first point, we already do via medicare and medicaid. If we could correct the problems that cause the lower income people to "regularly require the most medical care", then we would really be making a difference. I would argue that is the real fix to that problem. Of course saying that and doing that is nearly impossible. Many of the poor are poor for a reason. Either drug addictions, lack of ethics, lack of drive, laziness, or just plain stupidity put a lot of people there. Fixing them would be a real challenge. Yes, I realize that a good percentage of them are not that way and are just a little trapped, but generally just a helping hand for a short while gets those people out of that situation. I'm all for that kind of help.


Your last question there is a good one. It is a moral dilemma. On the one hand, it is not my responsibility to take care of some asshole who got drunk and fell down the stairs. If that is expected of me, then I expect that once that person is healthy again that they are either required to pay me back, or they spend time in jail. A moral person would want to pay me back. An immoral person would consider it their right to free service.

So, I guess what I am saying is that it is not a right. It is something you earn and should be thankful for. That doesn't mean that anybody should be denied care. It just means that you are responsible for you. It doesn't matter if it is before the fact or after. We as a society are responsible for the overall system and for policing it. We are not responsible for the individual.

Insurance pools, whether government run or privately run, are all built off of risk and cost. Reduce one or the other or both and you will have substantial savings.

Reducing insurance costs is also difficult. Tort reform is the place to start.

You'd be very surprised at how much cost reduction a good tort reform package will produce. (eg, 10 years ago, NY doctors were paying on average $250,000 per year for malpractice insurance)

Competition in insurance via removal of the state barriers will most likely not lower quality. There will be a full range of choices.

If you pay for cheap insurance, then expect lousy service in your claim processing. Also expect a lot of hassles about what is and is not covered, much like Geico car insurance. It'll work sometimes, but it is going to be a hassle. Or, go for a slightly more expensive program and get much better service. It's up to you.

Look at the car insurance business for an example. They deal with risk pools and you can find insurance to meet your needs for reasonable amounts of money. Competition drives both cost reductions, often through innovation, and also will drive service up. People will not put up with horrible service if they have a choice (which I will point out that a government plan does not provide).

Those cost reductions do not equal a reduction in cost to provide medical care, it is a reduction in cost for insurance premiums. Combine that with tort reform, and we'll start seeing some major improvements overall.

What really needs to happen is detailed studies into why medical procedures cost so bloody much, and find where we can reduce or remove those costs. I can't tell you what a lot of that is because I'm not an expert, but I'm betting there's a whole lot of government regulation there that is getting in the way. I'm not saying to remove safeguards, I'm saying let the medical community come up with what those safeguards are and work at streamlining them. Then attack each cost the same way and I'll bet you could reduce the cost of common procedures by 50%.

One silly example: Have you ever watched a nurse work? If they are doing their job right, they are washing their hands a lot. Before every procedure involving a patient and after. Sometimes, they wash their hands 25 times per day. That's probably close to an 30 minutes of hand washing time per shift. Now, it's a very good thing because it reduces the transmission of infections from one patient to another and also protects the nurse. However, those procedures take tons of time and it can lead to hand problems for nurses that cause them to miss work. So, if you came up with an efficient system that reduced the time spent washing by 90% and increased the effectiveness, you just saved a bunch of cost. Stick your hands into the machine, 5 seconds later you are sterile and can move on. Fewer nurses can cover the same workload, fewer infections get spread, everybody wins. Yeah, I know it sounds silly, but that's just one goofy idea by a guy who knows little about health care.

Back to the first point. The poor, for whatever reason (I think you alluded to some of them in your post) require the most care. If you could pin-point it and find a solution you would be the most sought after person on the plant. But the fact remains that they do. Even with a great decrease in overall premiums, one can logically assume that there will still be a large population of individuals that will only be able to afford the cheapest of the plans, which offer the smallest amount of coverage. Their medical bills mount and they can't pay them. Now do we cover them through increased premiums for insurance consumers as we do now, or through taxes (Medicaid expansion). I'm not sure which one is cheaper for the populace.

As one who is involved in medicine everyday, I can assure you that hospitals and physician groups are constantly and vigerously looking to increase their efficiency. It's a common assumption that through study and trials that efficiency in every process can be found. This is true in nearly every realm, however, the variables that exist within humans are extensive and the risks even greater. My beast analogy is the fully automated plant that VW built for the Phaeton; they had every process and step worked out perfectly and didn't even need a human on the floor. But let's say that every third chassis that rolled down the line had a different size, metal composition, or used different nuts and bolts? All of a sudden your perfectly calculated line is at a standstill. Such is the case in medicine as we all have differences in our genes. I'll agree that there are areas where improvements in efficiency can be made, but only to a certain extent when you have a human on both sides of the equation. The managed healthcare company that I work for opperates within an evidence-based "best-practices" delivery system and is one of the most efficient in the nation, but care delivery is expensive nonetheless. I would consider a drop in the cost of care delivery by 10% to be a great accomplishment.

In reference to your nurse handwashing example, we have automated dispensers of foaming alcohol hand sanitizer which offers 99% sterilization in less than 30 seconds... With lotion for skin :).

[KenC]

Forgot to address the tort issue.

I'll agree 100% that it needs to happen it's definitely a necessary reform, but I'm not convinced that even with comprehensive reform, that care delivery costs will drastically be reduced. It will reduce the costs of the physician, but that's still only part of the overall cost of care. There's still the nursing staff, technician staff, admin staff, equipment, space (OR/clinic), etc. Tort reform will do a lot, but not a much as people often assume.

[der affe]

ok here is something that has not brought up...i think. i was burned in an accident at work, no big secret there. because i was burned at work it was concidered an industrial accident and workman's comp took care of the bill. i was also privy to every bill/statement sent to the insurance company as i recieved a copy in detail along with every proceedure.

at one point i was having to wear compression bandages/garments on my arms and hands. 3 pairs of sleves and gloves replaced every 2 months. the cost of one set according to the statement sent to me was $2500.00????
that was for 2 gloves and 2 sleves! (that is $7500.00 every 2 months in addition to everything else like meds, bandages etc, Dr visits, and surgeries. BTW right now my bill is over 3 mill and i am having more surgery around Xmas time.)
i was shocked by this and asked my case worker (which you are assigned in every WC claim) what was up with that. she did a little investigating and found out that they only pay 60% of that for the garments, because they have an agreement with the medical supply company that makes them (Hanger) that they will give them the business if they give them a discount. this was no secret to me that insurance companys have agreements with medical suppliers and care givers to get a discount on fees, sometimes using strong arm tacticts.

next i talked to the the Hanger Rep without my case worker present about this pricing deal, after all they are just tight fitting custom garments similar to this http://www.compressionmanagement.com...rngarments.htm
not some super high tech machine.
the rep told me that they set the pricing so that after they give the discount to the insurance company, they are still getting the money that they want/need to get for the product no matter what and that this was really nothing unusual. i asked her what if someone paid for them out of pocket, what would the price be then? she told me that it would be the full price, but that 99.9% of the time it is coved at least in part by insurance so that is never really a concern that comes up.

so at least in my opinion, based from talking to alot of Dr's that i have been having to deal with in the last 2 years along with other health professionals i know the insurance companies are at least partially to blame for the spiraling costs. they force a discount to cut their cost, the supplier/Dr/hospital raises their price to make up for the discount given, the price goes up. nothing is really accomplished in the way of cost spending control. i don't have an answer for this though. the insurance companies pay the med bills that keep things going (however difficult they are to deal with!) so that gives them the leverage to demand the discount, but in the end it really is not a discount, and the price of health care continues to rise.

i know that this is not totally to blame and there are other factors to the equasion, but i thought i would bring up that point.

[KenC]

Hospital bills can be shocking and hard to dechipher. The "uninsured" price is often misleading and necessarily inflated because hospitals only receive a small amount of what they bill. It's all a "volume discount" situation. Groups buy insurance to get a volume discount, insurance groups provide clincs with large groups of patients in turn for a discount on service. The discounted price given to insurance companies is often VERY close to the actual cost to provide the service (in the case of Medicaid/Medicare, it's less). That is, hospitals aren't overcharging insurance companies to greatly increase profits... The increased opperating costs are often reflected in their "uninsured" sticker price, but that's not what they're getting paid for the service/supply. I'm curious to see the profit margins of the insurance companies. I know there is a lot of competition between equipment companies.
So again we come back to the question regarding insurance premium reductions. In order to stay competative, how much are the companies willing to decrease their profits? Or will they reduce coverage instead?

[der affe]

i realize this, but what i am saying is that there is plenty of blame to go around the whole system. it is i cut you a break because you "scratch my back so i'll scratch your back" but i am not really going to give you a break, but i am going to let you think i am giving you a break.....who's on first.....

i really feel that the coverage or service will be reduced to lower the premiums, not the insurance companies profit margins. i am supprised that noone has seemed to bring that we really have no idea of the insurance companies profit margins.

i hope things do not turn into treatment the way it was when i was taken to county hospital here in AZ after my accident (it is the 2nd best burn unit in the US) while in the burn unit things/treatment was excellent. once i was stabilized and moved into the regular burn unit, it was a whole different world. county is like the indigent hospital in greater phx, they incurr the greatest amount of non paying patients of any of the hospitals in greater phx. while they did keep me alive, it was pretty horrible there, but they were doing the best they could with what they had to work with. i can not fault them with that at all and am greatful for what they did for me.
a good analogy would be county hospital is like going to a the MASH 4077th they scoop you up patch you together and get you stable. good sam, st joes, or scottsdale memorial is like when they ship you down to tokoyo to finish the job.

[LEANE30]

Affordable and healthcare do not go in the same sentence. Sorry, it just doesn't go well. How can you ask for the best and brightest when your arm gets chopped off and then want to pay "Shade Tree Mechanic" rates? You have to pay to play this game of life. If you can't afford healthcare then you can't afford to live. As you can see I'm no bleeding heart.

Wow, you have no soul.

and you are a waffleswaffleswaffleswaffleswaffles.











all i will add to this very decent thread is that it's all about natural selection.

We slow the herd down to the point where the lame and weak can keep up and then the entire group fails to escape. ...but atleast we kept everyone together and didn't loose any individuals on the way to our inept failure to arrive as a species to our targeted destination.

..and by "species" i mean "country."







fuck the Republi-crats, the stage is already set for an uprising of a new or possibly older dormant political "party".

for One, I'm gonna be on the sidelines enjoying the show. It's inevitable.

i realize this, but what i am saying is that there is plenty of blame to go around the whole system. it is i cut you a break because you "scratch my back so i'll scratch your back" but i am not really going to give you a break, but i am going to let you think i am giving you a break.....who's on first.....



i really feel that the coverage or service will be reduced to lower the premiums, not the insurance companies profit margins. i am supprised that noone has seemed to bring that we really have no idea of the insurance companies profit margins.

point made and made correctly.
Insurance is a leech type of business. they are middle-men. it's about time they were treated like the monkeys they are and the american public side-steps them entirely.

how many of you have sat down and added up how much money you've paid insurance in even just the past decade? ...how many times have you been to the doctor?


I'd be all for the government extending "healthcare lines of credit" that you pay into say via taxes... an account that is individual TO EACH CITIZEN, if you go into the red, then your "tax" percentage is increased till it's back in the black. if it stays in the black long enough with a high enough balance, then your percent can decrease, or even be withdrawn for living, similarly to social security. ...in a way that is currently feasible with modern technology for digital records and automated account management. the government would "get ahead" with all it's bad debt and failed ideas by being the holder of all health care funds, and thus being able to collect interest yields by title.

then there is no pointless phone line juggler and bureacratic skipper making wage bonuses on how many claims that they denied, hence saving the insuance company money on annual reporting intervals.

no "free ride" for people doing things that they shouldn't be doing AKA coined association with the term "illegal"

Extending healthcare to illegals without making them pay anything ..even the "fines" proposed in this legislation for non-coverage.. is a complete outrage.

...
I'm moving to another country asap, maybe with enough time away i'll come to truely appreciate all the BS that we put up with.

[kishg]

I'm moving to another country asap.

see ya!


funny how i never see the people making this claim ever leaving. please leave. same goes for the left wingers who made the promise to leave when bush was here, please go.

[joshh]

You don't need to leave, this shit for bill will never make it, thankfully.

[Hallen]

Yeah, well we all know that the dollar amounts shown on our bill is not what they insurance companies or medicare pay. However, that is the amount that an individual has to pay if they don't have insurance. One of the main reason that huge disparity exists IS because of medicare. The medicare payout system is based on a percentage of usual and customary. In order to get something close to enough money, the prices have to be hiked up. The insurance companies then go in and negotiate to get as close to medicare as they can. It is a racket for sure. But medicare payment practices are responsible for some of the problems here.

It would be good to completely remove the insurance companies. The only reason they exist is because very few people have a lump sum that they can use to start their own medical savings account. If you have just started working and are hurt, you wouldn't have near enough money to cover it. Sure, if you work for 10 years and keep paying into your own account, you'd probably have enough. So what would be nice would be the availability of catastrophic insurance, for those big ones, and then use your own savings (taken pre-tax directly from your check. That program exists today, btw, but I don't know what the cap is and you can't roll it over from year to year). So in essence, you are self insured. Then you pay a small fee for your catastrophic account. Pay something like $300 per month for your account in 5 years you'll have 18k for your medical payments, plus interest, minus any amount that you had to use.

But the current plan in the house won't let you do that, I'm pretty sure. You won't be allowed to self insure even though it is probably the best option out there. If you never need to use it, you can pull the money (probably after paying taxes on it). It's your money though.

Now, how to reduce costs? Ken makes a good point that there are people working on that kind of thing. Basic efficiencies won't get you everything. However, if medical supplies are anything like airplane parts, then there's a large amount of the problem. Getting certified to supply a medical product is probably a multi-year deal that costs millions (I know we pay $40k to $100k to get CE, FCC and UL certifications on our products and they aren't used for medical). Streamlining that process shouldn't be all that hard. I mean, $7500 for special sleeves? Why is that? Are they made out of wonderflonium (tell me the reference for that stuff ;) )? Or is the certification and verification process so extensive that it turns a $50 item into a $7500 item. I bet it is the latter. I know that spark plugs for an aviation engine used to cost $20 EACH (2 per cylinder). The going rate for a similar car plug was about $2. Sure, the aviation one was better. But it was the testing, certification, annual certification, and liability costs that drove the price as high as it was. And that's for something simple like a spark plug.

Anyway, like I said, I'm no expert. I realize that assembly line practices won't work for medicine... and thank goodness for that. I wouldn't want to be treated like a Ford truck. I also realize that none of this is simple. I just feel strongly that the plan that passed the house is absolutely the wrong thing to do.