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Thread: Ok in another attempt to stimulate discussion....

  1. #1
    Administrator Peck's Avatar
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    Default Ok in another attempt to stimulate discussion....

    I want to ask another question to see how you feel about a topic.

    Todays topic is near & dear to my heart & in this one case our friends from across the pond as well as those north of the border can bring some first hand knowledge to help us along.

    Socialized health care vs. Private pay as you go health care.

    Where do you stand on the issue and why?

    I'd like to see where this goes.


    Basketball isn't played with computers, spreadsheets, and simulations. ChicagoJ 4/21/13

  2. #2
    Jimmy did what Jimmy did Bball's Avatar
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    Default Re: Ok in another attempt to stimulate discussion....

    I think our health care system is a mess (as far as costs go). It's really a case where I feel the genie is far out of the bottle and I don't know how you get it back in there.

    Costs haven't been based on market forces directly of the consumer but instead on the deep pockets of insurance and government. The unchecked greed and spiraling costs have led to insurance rates increasing which just makes things even tougher at a certain income level.

    I'm inclined to think that employers offering medical benefits has been a bad thing in the long run as it's become part of the problem, not the solution. And spiraling costs have not been good for employers either.

    A system where the consumer directly controls the money they spend might be the best compromise, but now that prices are where they are at I'm just not sure how it would ever balance out. Right now, the checks and balances are mostly gone.

    I'd like to read other's thoughts on this. Against my normal leanings, I find myself leaning toward socialized medicine. At least to some degree.

    -Bball
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    Default Re: Ok in another attempt to stimulate discussion....

    I believe that there should be public health care in these areas:

    Pre-natal
    Childhood to age 16

    Taking care of health issues in these areas would result in such a massive reduction in health issues & costs later in life - as well as simply being society protecting its' children - that I completely support it.

    I'd have to ask Kaufman if he knows the latest numbers but what's the payoff in health care costs for taking care of pregnant women and children - 5:1? 10:1?

    Whatever it is, it's well worth the $$$.
    The poster formerly known as Rimfire

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    Default Re: Ok in another attempt to stimulate discussion....

    Quote Originally Posted by Bball
    [B
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    Costs haven't been based on market forces directly of the consumer but instead on the deep pockets of insurance and government. The unchecked greed and spiraling costs have led to insurance rates increasing which just makes things even tougher at a certain income level.[B]
    -Bball
    Perfect statement Bball. The habit or continued fleecing by the Medical Institution (this includes hospitals, clinics, and Drs.) of the patients is vampirism. How many assorted tests are ordered that a patient really doesn't need? For years there has always been the story if this country went to some type of socialized medicine we would no longer get the quality care. That if a test we needed was too expensive or if little Jimmy needed a heart then you're SOL. This is no joke, Dr.s are told to order tests that a patient doesn't need to make more money. The more expensive the test (not needed) the better.

    What's even scarier is the wonderful trend of outsourcing. You think it's bad when you have to call another country for support to find out a problem with your computer, your telephone, credit card, etc. Well thats not even close to being a problem when compared to your medical records being shipped out somewhere else and now your xrays are being read by Drs. in other countries. It is taking place right now.

    One final personal thought. Back to the old Jimmy doesn't get a heart thing because of socialized medicine. This maybe true, but because of the deep seated problems now Uncle Jerry and Aunt Em can't afford their medicines the way things are now either. This may explain why the VA use to get a number of their drugs from Canada.
    You know how hippos are made out to be sweet and silly, like big cows, but are actually extremely dangerous and can kill you with stunning brutality? The Pacers are the NBA's hippos....Matt Moore CBS Sports....

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    Administrator Unclebuck's Avatar
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    Default Re: Ok in another attempt to stimulate discussion....

    This issue is so complex, that I don't have the time right now to even address half of what needs to be discussed. But I do want to say that instead of socialized medicine, I strongly believe we need to go in the exact opposite direction, we need to make it more like a free enterprise system. With the patients controlling their helath care dollars, what doctors they go to, and we also need to do something about the high cost of medical malpractice

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    Default Re: Ok in another attempt to stimulate discussion....

    UB, I take it you wouldn't have a great deal of confidence in a Wal-Mart doctor?
    You know how hippos are made out to be sweet and silly, like big cows, but are actually extremely dangerous and can kill you with stunning brutality? The Pacers are the NBA's hippos....Matt Moore CBS Sports....

  7. #7

    Default Re: Ok in another attempt to stimulate discussion....

    Just curious, Peck. Is Medicare socialized medicine in your definition? What about Medicaid?

    If one sees any form of governmental involvement in paying for health care as socialistic, then there is no sense having this discussion. As far as I can see, there is no solution to our current health care financing mess that does not include significant governmental financing and coordination.

    Yet I do not believe that socialized health care vs. private pay-as-you-go health care are the only choices.

    I prefer a mixed system where the government helps assure access to affordable health care for everyone, but minimizes governmental control. At the same time consumers (taxpayers) must be given maximum control and choice over how one spends their own health care dollars. Giving citizens some control over how their own health care dollars are spent is a major step we need to take, if we have any hope of containing the growth of health care costs.

    Like it or not, I believe we can assume Medicare as it now exists, with prescription drug coverage, will continue to be tweaked and stay as the basis for how seniors get their health care.

    What to do about the rest of society is the question.

    I think most would agree that every child in America deserves to get adequate health care. Kids can't pick their parents; kids are also society's greatest asset. So, for practical reasons alone, humanitarian and moral reasons not even considered, we need a better plan to provide health care to our young.

    It seems clear to me that this country should find the will and money to formalize a program where families, as part of the tax system, get to choose a health care plan for their child, one that will assure affordable and necessary coverage. Governments at all levels already spend billions of dollars on health care coverage for kids, but much of the money spent is for paperwork and bureaucracy. In America today many kids wind up with inadequate health care because their parents don't have or can't afford family coverage at work, or who don't know how to enroll in government health care programs they already qualify for, or who don't have insurance and at the time of the illness don't qualify for government assistance.

    Figuring out a health care plan for all children --- one that makes sense financially --- should be a high priority for this country.

    So, it turns out, the most interesting and controversial aspect of the health care financing debate should be what to do about the rest of the population, the part that are not young nor yet of Medicare age. The part of the population that includes nearly all of us on this board.

  8. #8

    Default Re: Ok in another attempt to stimulate discussion....

    Get health care costs off the backs of industries that are trying to compete with competitors in other countries where employers don't bear the cost.

    sixthman's post is very sound, but I'd go all the way. Let's have a single-payer, multiple-provider system.
    And I won't be here to see the day
    It all dries up and blows away
    I'd hang around just to see
    But they never had much use for me
    In Levelland. (James McMurtry)

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    The New Gold Swagger travmil's Avatar
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    Default Re: Ok in another attempt to stimulate discussion....

    Quote Originally Posted by Unclebuck View Post
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    This issue is so complex, that I don't have the time right now to even address half of what needs to be discussed. But I do want to say that instead of socialized medicine, I strongly believe we need to go in the exact opposite direction, we need to make it more like a free enterprise system. With the patients controlling their helath care dollars, what doctors they go to, and we also need to do something about the high cost of medical malpractice
    UB, you are exactly right! The problem with the spiraling costs, is that the hospitals and doctors know the money isn't really yours. Your insurance company controls it, and their pocekts are WAY deeper than yours. My employer (a large local Pharma for those that don't know) recently announced a sea change in our insurance plans. People are up in arms over it, but they are looking at right now versus the big picture. The new plans have a sort of spending account feel to them, where there is money deposited on behalf of the insured. The money is given to us by our employer, but WE control who gets the money. If there is money left over at the end of the year, it rolls over on top of next years deposit. They cap your out of pocket max at a percentage of your salary, so a major surgery won't bankrupt you. They are trying to force us to make better decisions, to shop around so to speak. It's going to be a painful transition for a lot of folks, but it will be better in the long run when hospitals see that they aren't going to be able to price their services in the same way for much longer.

    [edit] I forgot to mention, under these new plans, ALL preventative care is covered at 100% without dipping into the deposit made on our behalf. This includes vaccinations, yearly physicals, mammograms, prostate exams, etc...[/edit]

  10. #10

    Default Re: Ok in another attempt to stimulate discussion....

    Quote Originally Posted by Putnam View Post
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    Get health care costs off the backs of industries that are trying to compete with competitors in other countries where employers don't bear the cost.
    There has not been enough conversation about the bad effects of an employer based health care system.

    Not only is the high cost of health insurance not a good deal for those companies trying to compete internationally, but it is not a good deal for the consumer either. Employees are much better off with a system of affordable health care that can come from somewhere besides work, if something good is not available at work.

    The notion that employers are the best, and for practical purposes, only source to purchase health insurance, is obviously a flawed notion that is not in the best interests of Americans.

  11. #11

    Default Re: Ok in another attempt to stimulate discussion....

    Quote Originally Posted by U2
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    Don't believe them when they tell me there ain't no cure
    The rich stay healthy, the sick stay poor
    I, I believe in love


    .
    And I won't be here to see the day
    It all dries up and blows away
    I'd hang around just to see
    But they never had much use for me
    In Levelland. (James McMurtry)

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    Administrator/ The Real Jay ChicagoJ's Avatar
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    Default Re: Ok in another attempt to stimulate discussion....

    Does socialized medicine provide good care for anyone? No, clearly.

    Does free-enterprise for medicine work? Not really.

    Does it make any sense to add the burden of employee healthcare cost to employers? No.

    But on the other hand, consumers get better "rates" for group policies vs. individual policies, so if not by employers, how do you effectuate group policies? (Hint: employer-sponsored groups in which the employees bear most of the cost.)

    Healthcare is expensive for many reasons:

    (1) To cover everyone's malpractice insurance. You get the lawyers out of healthcare and the costs will start to come down. But that's not a popular answer in today's, "I've got the right to sue anybody for any reason, even if I have no chance of actually winning but I might get a settlement" culture.

    (2) As said above, most of the costs are currently absorbed by employers and are, therefore, invisible to the end-users. Many of which treat it like its "Monopoly money."

    (2) To cover "charity", because like it or not, people are entitled to certain levels of health care whether they afford to pay or not, so ultimately society is going to pay for this whether via taxes (so that the government compensates the medical providers for their efforts) or just higher prices for everyone at the doctor's office. Since this is inevitable, we just need to figure out how we're going to deal with it. Right now, we're paying via both channels.

    (3) Because of the goofy constraints by insurance that exist solely to protect the insurance companies from spending a lot of money on "optional" healthcare. For example, my knee surgeries were not a life-and-death decision, but they sure helped my quality of life. But how many extra doctor visits, physical therapy, and tests did I endure between (1) the decision that surgery was the best resort, and (2) the surgery itself? Many.

    (4) Because companies engaged with medical research and development spend a LOT of money, and deserve to be compensated for that spend of capital (which is a real problem when other countries have less-rigorous standards for the approval of drugs and devices and therefore don't allow the innovators the opportunity to compensated for their efforts, shifting all the burden onto the US consumers). I wish the pharma companies would stop selling products in the EU at prices that are based on the costs to manufacture, not the costs to develop, until the patents expire. If the EU doesn't want to pay for the development, they can wait for the "generics." But can you imagine the outcry if Merck (or Lilly) or whomever announced such a policy?

    Ultimately, because IMO certain levels of medical care are a necessity (and should be considered a "right") and others are optional (and should be considered a "privilege") then some type of hybrid system is unavoidable.

    What is avoidable is to continuously ignore the opportunites to fix the problem. Socialized heathcare, which would have many, many flaws in its implementation, would be an improvement over the current hodge-podge system. But, unfortunately, once you go there, there is no turning back.

    Jay's_Wife@Section19's grandmother recently passed away. She was 93, and she out-lived her life savings by a few months and eventually qualified for Medicaid. Its interesting to note the difference in quality of service given out in a mixed-pay facility, as the private-pay and medicare patients were able to receive more attention from the under-staffed nurses than the "charity"/ medicaid patients were. Not for medical care, per se, she'd get her medications on time and stuff like that, but for the little things that go a long way toward maintaining someone's dignity when they have lost most of the capacity to do things themselves.
    Why do the things that we treasure most, slip away in time
    Till to the music we grow deaf, to God's beauty blind
    Why do the things that connect us slowly pull us apart?
    Till we fall away in our own darkness, a stranger to our own hearts
    And life itself, rushing over me
    Life itself, the wind in black elms,
    Life itself in your heart and in your eyes, I can't make it without you


  13. #13
    Jimmy did what Jimmy did Bball's Avatar
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    Default Re: Ok in another attempt to stimulate discussion....

    This all reminds me of a recent Indy Star piece exposing pricing practices. It seems that the highest prices go to the uninsured. As I understood the article, hospitals set a 'suggested price'. Insurers then negotiate the fees they pay regardless of that 'suggested price' (it's only a starting point for the negotiated fees). Uninsured people don't have any such leverage. Hospitals can offer a 'cash price' but it is not nearly the discount that insurance companies get.

    Very interesting article. Maybe someone can find it.
    EDIT- I found out... see post below...

    -Bball
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    "A player who makes a team great is more valuable than a great player. Losing yourself in the group, for the good of the group, thatís teamwork."

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  14. #14
    Jimmy did what Jimmy did Bball's Avatar
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    Default Re: Ok in another attempt to stimulate discussion....

    http://www.indystar.com/apps/pbcs.dl...NESS/609030432

    Sticker shock: same care, different hospital bills
    Uninsured Hoosiers often charged far more than insurance companies


    By Daniel Lee
    daniel.lee@indystar.com
    Kellie Holland checked into the emergency room doubled over in pain from what turned out to be kidney stones.


    Those stones soon passed from her system, but the Plymouth woman's anger over her hospital bill burns on.

    Holland, who had no health insurance at the time, said she received $2,080 in hospital charges -- plus a few hundred more in doctor bills -- for what she described as a 1 1/2-hour visit to the ER at St. Joseph Regional Medical Center in Plymouth.

    She claims the hospital would have received only about $400 for the same visit had it been handled by Medicare.

    Even after receiving the hospital's standard 20 percent discount for the uninsured, Holland said her charges were still excessive compared with amounts paid by insurance companies.

    "I was treated unfairly," she said. "It's just that simple."
    Hospitals across the nation, in fact, charge some of their highest rates to those least likely to be able to pay: the uninsured. Experts say those without health benefits can face bills three times higher than what health insurance companies would pay for the same services.

    For instance, Clarian Health Partners, the region's biggest hospital system, has a list price of about $8,143 for an uncomplicated birth, a price far greater than the $2,200 to $2,700 Anthem Blue Cross and Blue Shield would typically pay.

    Hospitals say they offer the uninsured discounts based on income or, in many cases, free charity care for the poor and indigent. However, those discounts can still leave the uninsured with hefty bills.

    St. Vincent Indianapolis Hospital charges $7,200 for that birth. The hospital said a family of three earning $30,000 a year would qualify for free care, but a family of three making $60,000 a year would still be left with a $6,000 bill.
    "This is gouging," said J. Patrick Rooney, founder of the Fairness Foundation, an Indianapolis advocacy group that focuses on the uninsured. "This is taking people for all they have."

    In the complex world of health-care pricing, it all comes down to something called the "chargemaster," or a hospital's master price list. It's a little bit like the sticker price on a new car -- a starting point for negotiations.
    A hospital's chargemaster price often is three times higher than its actual costs, said Jennifer Tolbert, principal analyst with the Kaiser Family Foundation in Washington.

    Typically, big health insurers negotiate deep discounts from that list price. The uninsured have no such clout.

    Bills from a lengthy hospital stay can quickly ruin a person's credit or add up to tens or even hundreds of thousands of dollars in debt, especially for those who do not qualify for charity care or government assistance.
    "When you as an uninsured person walk into a hospital, you have no bargaining power at all," said Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins University's School of Public Health. "None of us like to get a bill we can't pay, and we certainly don't want to get a bill that's three times what everybody else is paying for the same thing."

    A major illness or injury quickly can push even a family with health insurance to the financial brink.

    Almost half of Americans filing for bankruptcy do so because of mounting medical expenses, according to a Harvard study published last year. Of those with medical bankruptcies, the average out-of-pocket cost was $11,854, according to the study.

    Bills can pile up fast, especially if you're one of the more than 46 million people nationwide, including about 800,000 in Indiana, who have no health insurance.

    Many of the uninsured are poor, unemployed or transient. Others have lower-paying jobs that don't provide health benefits. Some own homes and have savings but may be between jobs, or have medical conditions that make it difficult for them to afford individual coverage.

    Not wanting to pay high monthly premiums, still others could afford coverage but are betting that they won't need costly health care.
    Holland, for instance, admits that she was taking a "calculated risk" by going uninsured after losing her health benefits when her job was eliminated. "It wasn't between health insurance and eating," said Holland, who owns a small farm.

    But she added that the $300 a month it would have cost to extend her benefits through the federal program COBRA was too expensive.
    Faced with the ER bill, Holland refused to fill out financial-aid forms at the hospital where she was treated, saying she feared putting her assets at risk.
    "I begrudgingly paid the bill," said Holland, adding that she wrote on her checks that she was making the payments only to preserve her credit. Holland now pays $137 a month for an independent plan with a $5,000 deductible.

    St. Joseph's said it does not comment on individual patients' cases, but the hospital said it has a policy that offers a minimum discount of 20 percent to the uninsured, with deeper discounts or free care depending on a patient's income.

    Hospitals of all sizes provide millions of dollars worth of free care for the poor and indigent. In addition, hospitals frequently offer financial aid to the uninsured or help eligible patients enroll for government programs.
    Indianapolis-based Community Health Network, for example, said that its uninsured patients are given at least a 30 percent discount off its list price, with additional help available depending on a patient's financial situation.
    "We work with each individual patient to understand their financial means," said Tom Fischer, Community's chief financial officer. "We don't sell full sticker price to anybody."

    The issue of health-care billing for the uninsured has risen to prominence in recent years, with more than 60 class-action lawsuits filed against hospitals alleging excessive and unfair pricing, according to research from the Kaiser Family Foundation.

    In one case, California nonprofit hospital chain Sutter Health last month settled a class-action suit by providing eligible uninsured patients with refunds or deductions of 25 percent to 45 percent off their bills.
    "The uninsured are victims of an exceedingly complex health-care system in which larger insurers and government payers set prices that are deeply discounted from hospital charges," Tolbert of Kaiser said, "while the uninsured have little negotiating power and are left to pay full charges."
    Price discounts negotiated by the insurance companies are often well below the original list price but still allow the hospital to turn a profit.
    Conversely, Medicare and Medicaid reimburse at rates that in many cases are lower than the hospital's costs. Hospitals also lose money when they provide charity care.

    Many uninsured patients, though, do not pay their bills. Hospitals typically collect only a dime from every $1 charged to the uninsured, Anderson said.
    For instance, Jay Brehm, CFO for St. Francis, said more than half of the uninsured patients being treated at St. Francis end up being turned over to collection agencies.

    Terry Hamilton, executive director of finance for St. Vincent Indianapolis Hospital, said many uninsured people don't take advantage of available help.
    "We're not in business at all to drive people into ruin," Hamilton said. "But what sometimes happens is some people get scared and they don't respond to calls."

    For his part, advocate Rooney said the uninsured who are aggressive in battling the hospitals can often get as much as 50 percent knocked off their bills.

    "If you fight this and have a good attorney," he said, "it turns out that the hospital will usually cave."

    -----------------------

    POSSIBLE PRICES FOR 2 PROCEDURES

    Insurance companies can negotiate big discounts with hospitals; the uninsured usually are billed far more.

    Here's a look at the range of prices for two procedures culled from six area hospitals, and what an insurance company would pay for the same procedure:

    CHILDBIRTH
    (without complications)
    $4,500 to $8,238
    at area hospitals
    $2,955 to $3,100
    with UnitedHealthcare insurance

    DEFIBRILLATOR IMPLANT
    (no cardiac catheterization)
    $73,200 to $128,754
    at area hospitals
    $27,000 to $35,000
    with Anthem insurance
    Nuntius was right. I was wrong. Frank Vogel has retained his job.

    ------

    "A player who makes a team great is more valuable than a great player. Losing yourself in the group, for the good of the group, thatís teamwork."

    -John Wooden

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    Default Re: Ok in another attempt to stimulate discussion....

    Quote Originally Posted by Jay@Section19
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    But on the other hand, consumers get better "rates" for group policies vs. individual policies, so if not by employers, how do you effectuate group policies? (Hint: employer-sponsored groups in which the employees bear most of the cost.)
    Jay, I'm not sure of the parentheses at the end of the quote indicates your preferred solution.

    Why should one's quality of health care depend on the ability of his or her group to exert leverage...to negotiate lower prices, or simply to obtain coverage at all? Just because a person works for a small employer with less leverage, why should they get less coverage or none at all?

    The only group that makes sense is the entire citizenry of the nation. There's a group with some leverage on the insurance companies.
    And I won't be here to see the day
    It all dries up and blows away
    I'd hang around just to see
    But they never had much use for me
    In Levelland. (James McMurtry)

  16. #16
    Cheeseburger in Paradise Los Angeles's Avatar
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    Default Re: Ok in another attempt to stimulate discussion....

    We already have a total free market system available to us. It's called cash.

    Many of the elite in LA do NOT have health insurance, and they go to doctors who do NOT have malpractice insurance. It's an entire system of doctors who charge you 60% what it would otherwise cost and you sign all sorts of paperwork releasing the doctors of liability.

    As I understand it, you get fantastic service for the money, including house calls, etc. It is truly the best care money can buy. And money buys it.

    So what do you do if you don't have the $200,000 cash laying around to cover a serious illness or injury?

    You slum it with the rest of the people. And here's where the mess starts.

    Personally, I live above the 50% mark in America. (I'm not bragging, there's a point to this). As a small business owner, I have to buy my own insurance, and I have to buy the best insurance that I can afford. Even at my level of "comfort" I am ridiculously underinsured. In fact, it's $500/month with no outside help from employers or government, and if I go into the hospital, I have to pay $500/day out of pocket. That places me about 3 weeks in the hospital away from having 0 capital. Add to that lost wages (as a small business owner, I don't make money when I'm not working) and I soon won't be able to make my insurance payments.

    Because I am a small business owner and insurance companies will not allow me to "group" with other small business owners to get the best rates from health care providers, everything is much more expensive to boot.

    That's right, being a free-market entrepreneur places me at a severe disadvantage, yet when I talk to Republicans about how unfair the system is, they talk to me like I'm a welfare check cashing crack baby that needs to get a real job. It gets old fast.

    If the wealthiest people were allowed to buy cars for 50% off, there would be an uproar. But if we're talking about chemo, sliding pay scales for the exact same service is fine? Sounds like a scam. That's because it IS a scam.

  17. #17
    Grumpy Old Man (PD host) able's Avatar
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    Default Re: Ok in another attempt to stimulate discussion....

    Long discussion in a short path:

    there is an amount needed for healthace minus insurance for lawsuits, minus the profit fo the hospitals involved minus the disgusting profits for the pharma industry (no, they are not returning that money into their product, though a seperate discussion, their research delivers patents, the patens deliver way over market(costprice) prices and allow them to make Billions of profit each year, hence they should pay for it themselves and be happy with "less" profit" and yes that also goes for oilcompanies)= a gross national cost for healthcare.

    this on general average will be around 2 - 3 % of the gross national income
    which in turn translates to approx 8 - 10% of the gross income of everyone counted over the first 50K

    I.E: The Dutch model (in depth studied by the former administration in a hope of implementing parts into the American society)
    No not the UK model, that has so many disadvantages (specially the whitecollar criminals running the system and bleeding it dry with yet another study, outdated system of seniority when it comes to "seeing patients" etc) that such a system is doomed anyway but a system where you pay X part of your salary, and the employer pays another part to in total cover that "base" above mentioned, and to those who make more (or are willing to pay for it) leave open insurance so they can "enjoy" shorter waitlists on breast implants, chin-lifts and other non-essential surgery, perhaps in private hospital, single person rooms instead of 4 person rooms etc.

    No need to ask what you make, no need for CC's ad admittance, nothing, you are taken care of, you want extra's, have insurance or pay, the entire cost include GP practise and (if available generic, otherwise branded) medicine.

    Meanwhile forbid the free trips/computers/cars/financing etc of for instance the GP's prescribing certain medicines which cuts the overhead for the pharma industry considerably and you have a sustainable system where no one has to be uncomfortable when sick or go bankrupt after a sporting injury,
    So Long And Thanks For All The Fish.

    If you've done 6 impossible things today?
    Then why not have Breakfast at Milliways!


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    Default Re: Ok in another attempt to stimulate discussion....

    Quote Originally Posted by able View Post
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    I.E: The Dutch model (in depth studied by the former administration in a hope of implementing parts into the American society)
    No not the UK model, that has so many disadvantages (specially the whitecollar criminals running the system and bleeding it dry with yet another study, outdated system of seniority when it comes to "seeing patients" etc) that such a system is doomed anyway but a system where you pay X part of your salary, and the employer pays another part to in total cover that "base" above mentioned, and to those who make more (or are willing to pay for it) leave open insurance so they can "enjoy" shorter waitlists on breast implants, chin-lifts and other non-essential surgery, perhaps in private hospital, single person rooms instead of 4 person rooms etc.
    Slightly off-topic, but I can certainly vouch for the Dutch medical system. I managed to break my hand whilst driving through Holland on my way to the World Cup. I found the whole process very reassuring - little paperwork, excellent care & minimum of fuss. Only problem was the bright orange cast that they were so keen to put on me

    As for the level of care when I returned to the UK... less reassuring. Not sure I got "11% of my salary" value there.

  19. #19
    Administrator/ The Real Jay ChicagoJ's Avatar
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    Default Re: Ok in another attempt to stimulate discussion....

    Quote Originally Posted by Putnam View Post
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    Jay, I'm not sure of the parentheses at the end of the quote indicates your preferred solution.

    Why should one's quality of health care depend on the ability of his or her group to exert leverage...to negotiate lower prices, or simply to obtain coverage at all? Just because a person works for a small employer with less leverage, why should they get less coverage or none at all?

    The only group that makes sense is the entire citizenry of the nation. There's a group with some leverage on the insurance companies.
    You're right, my parenthetical is "Step 1" toward the realization that the right way for "group" insurance is with the largest demographic group possible.

    Step 1 is still better than completely eliminating the employer from healthcare without an alternative "group" structure in place. Although, imagine the outroar if IBM, Ernst & Young, Eli Lilly, and JP Morgan all discontinued group healthcare for their employees and they all had to pay market, individual (not group) rates. We'd make the jump to your option in no time.

    The solution is messy, because it involves declaring the availability of healthcare as a "right", which conservatives don't want to admit because it means the the taxpayers are obligated to pay collectively for everyone's healthcare. However, there has not really been an acceptable alternative (to all interested parties) proposed by the left. Keep in mind, if we want people to go to all the hassle of medical school, they need to be compenstated well enough to pay off their enormous student loans and make an appropriate return on their investments. R&D companies need to be compensated well enough to make an appropriate return on their investements.

    If this becomes a cost-squeezing exercise, a la Canada, there will be a shortage of doctors, nurses, and innovation. And then, everybody loses.

    + + + + + +

    Bball, what you've described is actually a well-documented problem. The people that pay the most for medical care are the ones who can't afford insurance.
    Why do the things that we treasure most, slip away in time
    Till to the music we grow deaf, to God's beauty blind
    Why do the things that connect us slowly pull us apart?
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  20. #20

    Default Re: Ok in another attempt to stimulate discussion....

    Quote Originally Posted by Jay@Section19 View Post
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    Keep in mind, if we want people to go to all the hassle of medical school, they need to be compenstated well enough to pay off their enormous student loans and make an appropriate return on their investments.
    Why not figure out a way to reduce the size of student loans necessary to get through medical school?

    What percentage of practicing doctors are still paying on student loans anyway?

    It would also seem a good move to pay medical school interns more, or, at least, give them larger credit toward their tuition payments. Aren't interns notoriously used as slave labor by hospitals.

  21. #21
    Administrator Peck's Avatar
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    Default Re: Ok in another attempt to stimulate discussion....

    This has been a wonderfull discussion. In fact one that is almost free of political preconceptions, which I find odd (fascinating but odd).

    Of course I have a lot of thoughts on the entire subject however I have very little time tonight to go over it.

    I will just make a few observations.

    1. As with many things in America we are not pure. We are not a pure democracy, we are not a pure Republic & we are not a pure free market health care system.

    As was asked of me earlier in this thread is Medicare a socialist system? Well you might as well throw in Medicaid as well when talking about this.

    The short answer is no.

    Why is it not socialized medicine? Simple, as a private health care provider you are not required by law to accept Medicare patients. Now you can't pick & choose what medicare patients you take so you either have to take all of them or none of them but you can choose to not take any federally subsidized health payor.

    Now in America you can not practice normal medicine without having older people use you in most cases so it is a hard system to avoid.

    However there are some providers than can get by without taking medicare. Dentist usually don't need the medicare money, plastic surgeons don't need it & there are others but most providers have to treat the elderly or disabled.

    Medicare at it's inception was a good idea however about 10 years ago, or so, Medicare became a monster that is killing our nations health care system.

    Why you may ask? At that point in time Medicare forced health care providers to accept assignment on all medical claims.

    To breifly explain what "accept assignment" means to those of you who may not know is this. You are forced to accept whatever Medicare decides you should recieve for your service no matter what special needs or problems that impacted your care.

    You only get 80% of what Medicare approves & you can only bill the patient the 20% that is not covered by Medicare.

    In simple terms as an example.

    You have a hospital bill for $1,000.00.

    Medicare approves $200.00

    Medicare will pay $160.00

    The provider can bill the patient for $40.00

    Now that is if the patient does not have Medicaid to go along with their Medicare. If the patient has Medicaid then you can not bill the patient a dollar & are forced to take $160.00 as your payment in full.

    That sounds great doesn't it? Well, for people on Medicare it is helpfull I will not deny that.

    However it's killing the rest of us & I'll tell you why.

    Let's go back & take that $1,000.00 bill. A Medicare patient will only bring the Hospital $200.00 of that bill.

    Hospitals cannot live on that kind of money at all, so how do you think that they make up for the defecits? They shift the cost to Insured patients & now Insurance companies are getting tired of being fleeced so they are negotiating with health care providers to accept a contracted rates. Why do Hospitals & others do this for insurance companies? Simple Insurers can tell their patients where they will & will not pay for their care.

    So again now the Hospital bill for $1,000.00 might actually get $500.00 from Insurance companies. In some cases you can bill the patient the balance, however some contracts prohibit you from doing this so you are forced to accept $500.00 for you $1,000.00 dollar bill.

    Again the Hospital can not lose this kind of money so where does the billing go? Now we go to the people who can least afford it, the uninsured.

    These poor souls get socked for the entire $1,000.00. If your an honest person & actually trying to pay your bills you can easily bankrupt yourself by using our health care system. However just as often as not health care providers can not collect on the claims, try as they might.

    Ok, I've got to stop now but I could go on & on about this.

    I haven't even gotten to the cost of health care workers, liability insurance, supplies, overhead, etc., etc.

    It's enough to make you insane.

    Also I want to point this out for anybody here in the states that wants socialized medicine. The health care industry is one of the largest employers in the U.S. with some of the highest paying wages in some parts of the field. Do you really think our economy would be the same if we turned over the system to the gov?

    I'll leave on this one last note & I hope to tackle this issue again tommorrow.

    Torte reform is the one single thing that we could do to begin to lower the cost of health care & stem the flow of red (no it's not blood either).


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  22. #22
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    Default Re: Ok in another attempt to stimulate discussion....

    Quote Originally Posted by Los Angeles View Post
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    We already have a total free market system available to us. It's called cash.

    Many of the elite in LA do NOT have health insurance, and they go to doctors who do NOT have malpractice insurance. It's an entire system of doctors who charge you 60% what it would otherwise cost and you sign all sorts of paperwork releasing the doctors of liability.

    As I understand it, you get fantastic service for the money, including house calls, etc. It is truly the best care money can buy. And money buys it.

    So what do you do if you don't have the $200,000 cash laying around to cover a serious illness or injury?
    I believe we need to enable everyone to be like the rich. That is what I mean by a more free market system. Through vouchers and healthcare savings accounts, we need to help people have "insurance" for the really serious stuff. But what you describe is the model we should go for

  23. #23

    Default Re: Ok in another attempt to stimulate discussion....

    Great summary, Peck. I look forward to the rest of your description of the problem.



    And by the way, "What was Raymond doing with his hands?"
    And I won't be here to see the day
    It all dries up and blows away
    I'd hang around just to see
    But they never had much use for me
    In Levelland. (James McMurtry)

  24. #24

    Default Re: Ok in another attempt to stimulate discussion....

    Quote Originally Posted by Unclebuck View Post
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    I believe we need to enable everyone to be like the rich. That is what I mean by a more free market system. Through vouchers and health care savings accounts, we need to help people have "insurance" for the really serious stuff. But what you describe is the model we should go for
    This may surprise you, but that is the direction I would go for adults also. But unless nearly everyone is able to pay for needed health care coverage at affordable prices, the system will always be FUBAR.

    The very first step is to initiate annual medical savings accounts for EVERY adult as part of our tax system. Every American should start each year with an account for medical expenses of, say, as much as a thousand dollars a year. The expansion of these accounts by contributions of employees and employers, beyond the thousand dollar limit for singles and two thousand for couples, would also be a priority.

    Additional assistance for those who can't afford full health care coverage would also be necessary. We do that now in a major way anyway with Medicaid, charitable private programs, and other assistance at every level of government.

    States would need to create statewide insurance pools where anyone could buy supplemental insurance at the best prices. If we want to be free, the work place or government must not be the only place where one can buy good health care coverage.

    Make health care coverage part of the unemployment compensation system.

    Subsidize and encourage non-profit community health care centers where consumers can purchase needed testing and medical services at fair prices.

    Major medical, catastrophic health care for everyone is critical. Health care providers will then be paid for expensive services provided, avoiding a major source of cost shifting in our current system. Also, if every adult has annual medical savings accounts combined with automatic catastrophic health care coverage, health insurance coverage becomes dramatically more affordable and competitive. The risk for those who want to provide health insurance has suddenly been lowered substantially, increasing competition in the insurance industry. Self-insurance by large businesses and governments also becomes more possible.

    Take the need for families to finance health care for dependent children out of the equation and out of the work place...Read this one twice...Certainly universal health care for young Americans is necessary. Cover every kid; Make sure health care providers are always paid for their treatment. Give every kid a chance to grow up healthy and with proper medical care, regardless of the family situation they were born into. This policy is moral, just, and a good investment for society. Give parents the right to choose the kind of health care program they want for their child. And give them a default program, if they don't choose.

    Cut out the bureaucracy as much as possible. See that providers get paid at the time of service as much as possible.

    Make it a goal that consumers will be placed in charge of their own spending as much as possible.

    Focus the health care system more on prevention, diagnostics, and healthy life styles, and less on paperwork and the billing and payment of medical services that have already been received.

    I don't think it is politically possible to initiate a single payer plan in this country, as some of my liberal friends often propose. Nor, do I think a single payer plan is the best answer. What matters is that we find solutions that will make health care more affordable and accessible to all, especially to middle income citizens who get the short end of the stick in health care right now in my opinion.

    A fair health care system for my country is my passion (along with the Pacers) I am ready to work for a presidential candidate of any party who will have the guts to propose a reasonable comprehensible plan for making health care in America affordable and as good a system as any in the world...If he or she will also have the honesty to discuss ideas about how we will pay for it on an ongoing basis...I understand nothing is free here, and everything has to be paid for...but the good news (and bad news) is that Americans are being ripped off by their current health care system and most of us are probably spending more for health care than we would if the system was fixed.

    Americans already spend, in taxes, out of pocket, and in the private sector, nearly twice per person what citizens of other industrialized nations pay. There is room to find a solution. Our current system is full of waste and inequities - and the results, compared to other nations, in nearly every area of performance comparison are unspectacular. We can do better, but it ain't going to be easy. This is a huge hot potato with billions of dollars and powerful special interests in play. Obviously, change will not be easy, but it doesn't mean we can't encourage those who are willing to try to make things better.

    Apologies for the length of this post. And I know few will read it, but, as I said, health care reform for the U.S. is a passion. And, the subject is definitely one that can not be covered with one-liners.

  25. #25
    Administrator/ The Real Jay ChicagoJ's Avatar
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    Default Re: Ok in another attempt to stimulate discussion....

    Last things first,

    Also I want to point this out for anybody here in the states that wants socialized medicine. The health care industry is one of the largest employers in the U.S. with some of the highest paying wages in some parts of the field. Do you really think our economy would be the same if we turned over the system to the gov?
    Bingo. Where do you draw the line? I, personally, want the government out of the medical/ scientific research business. That has been successfully commercialized so there is no reason for government-funded research. But if you include pharma and biotech tech companies inside the boundary of a socialized health care system, who is going to do the research? Most imporantly, who is going to make rational decisions about which research programs to pursue?

    And if you exclude those companies from the socialized health care system, how do you justify paying the premiums to support the large R&D efforts?

    R&D becomes the first casualty of socialized medicine. That's one of the many reasons that nearly all the R&D takes place in just a few locations.

    Frankly, we should make it illegal for our businesses to sell to other developed countries/ economies at lower prices than for domestic sales. The US economy is paying the burden of R&D for the entire world, whether developed or not. I can understand selling drugs to impoverished countries in Africa for cost (or, perferably, giving them away as 'charity'.) But why should the Canadians, or Germans, be excused from paying the full burden of R&D just because they've elected socialized healthcare and then discovered that it is expensive and ineffecient.

    Maybe I'm just pissed off because I've got the "by country" income statements for a major life sciences company up in excel right now, and the selling prices outside of the US and Japan are significantly different.
    Why do the things that we treasure most, slip away in time
    Till to the music we grow deaf, to God's beauty blind
    Why do the things that connect us slowly pull us apart?
    Till we fall away in our own darkness, a stranger to our own hearts
    And life itself, rushing over me
    Life itself, the wind in black elms,
    Life itself in your heart and in your eyes, I can't make it without you


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