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Old 05-13-2009, 02:26 PM   #91
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Re: the new health care?

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Schneed -- the current health care system not only works like this, it promotes it. I am not insured. There is no way I'm going to the doctor at the first hint of being sick like I may with insurance. A simple doctor's visit for us uninsured can easily cost 250 bucks just to get in the door.

I was uninsured and went through treatment for Lyme disease. Each blood test cost me out of pocket 550 bucks to get the labs necessary to tell if I had Lyme and how to treat it. How much does this exact same test cost for the insurance company? That's right, 225 bucks. That's not how much the insured person pays, it's how much the lab charges. How in the hell is this fair? A service should cost a set amount regardless of if a person is insured or not.

45 minutes in a hospital left me with a 9000 dollar bill. Not including the 900 dollars a week for medicine x 8 weeks.

People are petrified of getting these types of bills for a reason. Hospitals are ridiculously expensive, there's a reason why people don't come in when they're starting to feel bad. Granted it compounds the issue the longer you wait, but you have to understand that people sit down and have to weigh bankruptcy with getting fairly basic health care in this country. That is not okay, in my book.
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Old 05-13-2009, 02:28 PM   #92
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Re: the new health care?

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Uninsured Unite!
Nope, learned my lesson. Personal coverage will kick in sometime this month!

Schneed -- are you able to go into specifics as to why uninsured and insured patients don't pay the same price for the same procedure? I just don't understand what's so pipe dream-ish about thinking that a service should cost a certain amount regardless. A procedure costs X amount, then add in however much to cover overhead/equipment/staff/profit/etc. Come to a fair price, that's your price. I know insurance companies say we'll only pay X amount, but couldn't the hospitals say 'fine' which would lead to consumers fighting for a real change to the system?
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Old 05-13-2009, 02:31 PM   #93
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Re: the new health care?

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Nope, learned my lesson. Personal coverage will kick in sometime this month!
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Old 05-13-2009, 02:37 PM   #94
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Re: the new health care?

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I was uninsured and went through treatment for Lyme disease. Each blood test cost me out of pocket 550 bucks to get the labs necessary to tell if I had Lyme and how to treat it. How much does this exact same test cost for the insurance company? That's right, 225 bucks. That's not how much the insured person pays, it's how much the lab charges. How in the hell is this fair? A service should cost a set amount regardless of if a person is insured or not.
The reason the insurance companies pay less than uninsured patients is that they negotiate bulk rates and ensure payment. The cost to you, an uninsured patient, reflects not just the cost of the service but, also, the expected returns and additional collection costs when extrapolated over a large population of patients. It's just good business.

Individuals w/out coverage get the same service, true. On average, however, the rate of collection for people w/o insurance is significantly lower. From ten insured patients, the hospital will always collect (and collect relatively promptly) $2,250. From ten uninsured paitients, the hospital may collect $5,500 but will likely collect significantly less and will collect it over a longer time (so it is worth less - 1.00 today is worth more than 1.00 tomorrow) and will incur additional costs in trying to collect it.

Universal insurance with good coverage, good care and cost effective solutions is a chimera. The current system is a Gordian's Knot of insurers, self-insurers, lawyers, doctors and multiple regulatory agencies. Health insurers are subject to regulation by each of the 50 states AND the federal govt. Additionally, doctors and insurers are regulated by different agencies. In the case of doctors, much of the regulation is self-regulation i.e. doctors regulating doctors. One of the reasons malpractice insurance and, thus fees, are so high is b/c bad doctors are allowed to continue practicing by other doctors.

Obama's stated desire to build on the current system sounds wonderful except the idea that he will simply create a govt. "insurer of last resort" is extremely expensive. If it can refuse no one, then it will get all those people too expensive to insure through the traditional coverages.

A national health policy will also have a huge impact on the cost existing coverages. Currently, insurance is a giant ponzi scheme (shhhhhhhh!!) with the healthy funding treatment for the unhealthy. One of the effects of a national policy will be to remove the funding mechanism of traditional employer provided coverages because it allows people to "coverage dip" i.e. otherwise healthy people can dip into universal coverage for benefits but not provide the majority of its funding b/c they generally aren't taxed nearly enough to cover the costs. These large group consists, generally, of people who are young, healthy, w/out children or chronic health issues. If the govt. creates a universal catastrophic care system, then all those essentially healthy people will opt out of the already expensive coverages offered through their employers and rely on the universal national coverage. This then reduces the pool of people who pay premiums from the traditional coverages w/out really reducing the cost to provide for the remaining insureds. Guess who makes up the difference.

Ultimately, IMO, any national healthcare policy will end up being the world's biggest HMO with govt. bureaucrats as medical gatekeepers. To ensure the current number of uninsured for even just catastrophic coverage, I am betting that tax for "premium" would be significant and, further, as a side cost, the premiums for traditional insurance would increase for those who don't rely on the "National HMO".

So yes, universal coverage is absolutely possible. For the lower incomes it will provide minimal coverage where no coverage existed. For the vast number of middle incomes it will, IMO and in the long run, reduce coverage and quality of care and increase costs. For those with high incomes, their will be little or no effect other than to decrease their disposable income.
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Old 05-13-2009, 02:58 PM   #95
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Re: the new health care?

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Nope, learned my lesson. Personal coverage will kick in sometime this month!
Demonstrating my point of coverage dipping. Daseal is now part of a larger insurance pool. Being young and of relatively sound body, the odds are that he will not need insurance again for some time. I am betting his personal coverage is extremely expensive. Thus, he is exactly the type of person insurers need to be profitable and to make up for people like me. If Daseal, and others like him, are covered by a national policy, then people like me (married, kids) will simply have to pay more for insurance. In addition, we will be taxed to pay for Daseal's coverage and for those people my insurer rejected as being to expensive. Soon enough, people like me will not be able to afford our current coverages and have to drop into the national policy which, in turn, will just increase the cycle until the national policy is the only policy.

Is that a good thing? Not for me and those like me. Yes for the truly unisured or uninsurable - this would not include people like Daseal b/c he made the choice (either consciencely or not) to be uninsured. Eventually, under the current system, Daseal will likely reap its benefits. If it changes as Obama plans, then he will, basically, get the worst of both worlds.
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Old 05-13-2009, 03:08 PM   #96
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Re: the new health care?

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Originally Posted by JoeRedskin View Post
The reason the insurance companies pay less than uninsured patients is that they negotiate bulk rates and ensure payment. The cost to you, an uninsured patient, reflects not just the cost of the service but, also, the expected returns and additional collection costs when extrapolated over a large population of patients. It's just good business.

Individuals w/out coverage get the same service, true. On average, however, the rate of collection for people w/o insurance is significantly lower. From ten insured patients, the hospital will always collect (and collect relatively promptly) $2,250. From ten uninsured paitients, the hospital may collect $5,500 but will likely collect significantly less and will collect it over a longer time (so it is worth less - 1.00 today is worth more than 1.00 tomorrow) and will incur additional costs in trying to collect it.
Pretty good synopsis. Also, I'll add that assessing the cost of a certain procedure is incredibly difficult, even for financial wizards.

If you manufacture a widget, you know how much it cost to purchase supplies, how much you pay the people to make the widget, and how much overhead you need to cover. It's pretty easy.

But with hospitals and procedures, one knee replacement procedure for a 55 year old otherwise-healthy male may take 45 minutes in the OR and be fairly simple, requiring little in the way of resources. The same knee replacement for a 75 year old female with osteoperosis may be incredibly complicated, take 3 hours in the OR, and require more in the way of resources.

We have methods of averaging out costs for various procedures, but in the end they are just estimates. Hospitals have to cover their costs on patients who they can collect from to help subsidize the losses on patients who can't/won't pay a dime.
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Old 05-13-2009, 03:17 PM   #97
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Re: the new health care?

After reading Joe's post I guess I'll ask this...

Is not our FUNDAMENTAL problem in this country something that has nothing to do with costs and insurance companies but more to do with our attitude about health care and about insurance?

The debate about whether health care is a right is one that I think really has no concrete answer but it seems to me we want to be able to provide everyone with Ferrari health care. At least philosophically. And to compound it we (massive generalization here) treat insurance not like real insurance but more like a sugar daddy. In a real economic market some people can afford Ferraris and some can afford Hondas. Both get you from place to another. In neither case do we pay in just a little over time to be able to get either of them. Shouldn't we change our mindsets to read insurance as simply disaster prevention? We should need to pay for basic medical care as we have to pay for basic groceries to live. I know this drives incentive to not go to the doctor but if we reduce demand on Medical care doesn't it lower the price? I knwo this is simplistic to the max but it just strikes me that we as a society rely on health insurance to just pay for everything and that drives everything out of whack right up the line.
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Old 05-13-2009, 05:44 PM   #98
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Re: the new health care?

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After reading Joe's post I guess I'll ask this...

Is not our FUNDAMENTAL problem in this country something that has nothing to do with costs and insurance companies but more to do with our attitude about health care and about insurance?

The debate about whether health care is a right is one that I think really has no concrete answer but it seems to me we want to be able to provide everyone with Ferrari health care. At least philosophically. And to compound it we (massive generalization here) treat insurance not like real insurance but more like a sugar daddy. In a real economic market some people can afford Ferraris and some can afford Hondas. Both get you from place to another. In neither case do we pay in just a little over time to be able to get either of them. Shouldn't we change our mindsets to read insurance as simply disaster prevention? We should need to pay for basic medical care as we have to pay for basic groceries to live. I know this drives incentive to not go to the doctor but if we reduce demand on Medical care doesn't it lower the price? I knwo this is simplistic to the max but it just strikes me that we as a society rely on health insurance to just pay for everything and that drives everything out of whack right up the line.
I think a Health Savings Account is just that. Small stuff (i.e.: basic medical) you pay for yourself, and big stuff (i.e.: non-basic medical) is covered by insurance. There is incentive to avoid unnecessary doctor visits, because you have to pay for it yourself. However, you don't have to worry about not being able to cover the big stuff.
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Old 05-13-2009, 06:19 PM   #99
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Re: the new health care?

Obamaites can call me a naysayer if they please, but to me this statement is simply foolish:

"Our health care system is broken," Obama said. "We are not going to rest until we've delivered the kind of health care reform that's going to bring down costs for families, improve quality, affordability, accessibility for all Americans." Pelosi: House taking up health care by late July - Capitol Hill- msnbc.com

Sorry, you cannot decrease costs and increase quality of care and service. Do I hope I am wrong? Sure. Do I think this is a utopian statement that is either intentionally misleading or so incredibly naive as to be idiotic? Yes.

How does he intend to fund this pollyanish plan? Through a mix of tax increases and restrictions on current tax breaks. The biggest is repealling all or a portion of the tax-break for employer based health care payments. Essentially increasing premiums for this type of insurance (whether I am paying the insurer or the govt. or a combination thereof, the cost for insurance increases).

As FRPLG said, one of the fundamental problems is that people are looking for a Ferrari but seem to think they can get it at the cost of Hyundai. If we want top quality universal health care coverage, it comes with an incredible price. I don't see the vast majority of americans willing to pay that price. In fact, I don't see the vast majority of insured Americans (82% or approximately 202 million) willing to increase their costs for what will result in a benefit to minority of americans (18%, approximately 46 million) and a likely detriment to themselves (i.e. more costs or worse, more costs and worse benefits).

Is reform necessary, sure - every system needs should be reviewed to ensure or try for improvement. Is creating a universal national health care policy funded by tax increases and restrictions on benefits the answer? Not in my opinion. Rather, focus on cutting medical costs by revamping doctor oversight which will help lower litigation cost and thus lower malpractice rates and payouts. Find ways to lower the costs to become a medical professional. Possilby create a workman's comp type system for malpractice awards (just throwing that one out there off the cuff)- i.e. get rid of the traditional defenses to malpractice and require only that an injury occurred to get a payout, in return, the payouts will be set up like worker's comp. no puni's. These two thing may help cut down the cost of malpractice insurance which, in turn, cut down fees which will cut down costs to insurers.

With costs lowered, insurance becomes more affordable and fewer people are uninsured.

The emphasis, of course, is first to lower prices then find ways to cover the remainder.

Personally, I just don't see any of it happening. Far too many vested interests in the current system. Much will be talked about but I doubt any real change will come.
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Old 05-13-2009, 06:33 PM   #100
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Re: the new health care?

Your cynicism is dually noted. One thing I am fairly certain of is that the quality of care for 45 million people without coverage will improve. My employer still has the option of paying our HMO $$$ so I don't see how the quality of care will decrease. Maybe most employers decide to drop their HMO plans and rely on the government?

I guess having uninsured is good for the insured. Less competition is always good for the apex predator. Is anyone working a book titled "Universal Healthcare: Tragedy Waiting to Happen" yet?
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Old 05-13-2009, 06:46 PM   #101
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Re: the new health care?

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Your cynicism is dually noted. One thing I am fairly certain of is that the quality of care for 45 million people without covrage will improve. My employer still has the option of paying our HMO $$$ so I don't see how the quality of care will decrease. Maybe they will all decide to drop their HMO plans and rely on the government. I having uninsured is good for the insured. I suppose less competition is always good for the apex predator.

Is anyone working a book titled "Universal Healthcare: Tragedy Waiting to Happen" yet?
First off take that 45 million and cut that in half and thats closer to the number of people who cannot get or cannot afford health ins.
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Old 05-13-2009, 07:01 PM   #102
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Re: the new health care?

Very well thought out posts , Mr. Joe Redskin !!
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Old 05-13-2009, 09:34 PM   #103
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Re: the new health care?

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Originally Posted by JoeRedskin View Post
Obamaites can call me a naysayer if they please, but to me this statement is simply foolish:

"Our health care system is broken," Obama said. "We are not going to rest until we've delivered the kind of health care reform that's going to bring down costs for families, improve quality, affordability, accessibility for all Americans." Pelosi: House taking up health care by late July - Capitol Hill- msnbc.com

Sorry, you cannot decrease costs and increase quality of care and service. Do I hope I am wrong? Sure. Do I think this is a utopian statement that is either intentionally misleading or so incredibly naive as to be idiotic? Yes.

How does he intend to fund this pollyanish plan? Through a mix of tax increases and restrictions on current tax breaks. The biggest is repealling all or a portion of the tax-break for employer based health care payments. Essentially increasing premiums for this type of insurance (whether I am paying the insurer or the govt. or a combination thereof, the cost for insurance increases).

As FRPLG said, one of the fundamental problems is that people are looking for a Ferrari but seem to think they can get it at the cost of Hyundai. If we want top quality universal health care coverage, it comes with an incredible price. I don't see the vast majority of americans willing to pay that price. In fact, I don't see the vast majority of insured Americans (82% or approximately 202 million) willing to increase their costs for what will result in a benefit to minority of americans (18%, approximately 46 million) and a likely detriment to themselves (i.e. more costs or worse, more costs and worse benefits).

Is reform necessary, sure - every system needs should be reviewed to ensure or try for improvement. Is creating a universal national health care policy funded by tax increases and restrictions on benefits the answer? Not in my opinion. Rather, focus on cutting medical costs by revamping doctor oversight which will help lower litigation cost and thus lower malpractice rates and payouts. Find ways to lower the costs to become a medical professional. Possilby create a workman's comp type system for malpractice awards (just throwing that one out there off the cuff)- i.e. get rid of the traditional defenses to malpractice and require only that an injury occurred to get a payout, in return, the payouts will be set up like worker's comp. no puni's. These two thing may help cut down the cost of malpractice insurance which, in turn, cut down fees which will cut down costs to insurers.

With costs lowered, insurance becomes more affordable and fewer people are uninsured.

The emphasis, of course, is first to lower prices then find ways to cover the remainder.

Personally, I just don't see any of it happening. Far too many vested interests in the current system. Much will be talked about but I doubt any real change will come.
I can tell you that every single finance professional at my employer, the biggest Medicaid and under-insured provider in the state of Pennsylvania, agrees wholeheartedly with you.

From the chief financial officer down to the VP of finance down to the CFOs of the hospitals down to me as the manager of financial planning, we all think the same thing: wouldn't it be nice if Obama could get it done because it would mean a huge boost in funding for us. Quality would go up in the inner city hospitals who are currently underfunded, while quality would plummet at the suburban community hospitals in working class neighborhoods. And there are a lot more of them than there are of us.

It's an absurd pipe dream which shows how out of touch Obama can be with reality. He's a great leader, and strong on law and ethics, but his strength is not with financials. One look at the numbers tells you this: you can't cut the nation's overall healthcare bill without cutting quality. The only way he can make affordable healthcare happen is by having the rich subsidize it.

I named some areas in which expense savings could be realized earlier in this thread. But to accomplish what he wants (affordable healthcare for everyone), those savings would barely register as a drop in the bucket.

Someone just needs to do the math for him, and hopefully he'll come down to reality on this issue and get practical.
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Old 05-13-2009, 10:56 PM   #104
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Re: the new health care?

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Originally Posted by saden1 View Post
Your cynicism is dually noted. One thing I am fairly certain of is that the quality of care for 45 million people without coverage will improve. My employer still has the option of paying our HMO $$$ so I don't see how the quality of care will decrease. Maybe most employers decide to drop their HMO plans and rely on the government?

I guess having uninsured is good for the insured. Less competition is always good for the apex predator. Is anyone working a book titled "Universal Healthcare: Tragedy Waiting to Happen" yet?
1. With a national health plan, your employer's HMO coverage will eventually become more expensive. Initially, your quality of care will not decrease. At some point, as more and more people become "uninsured" and rely on the national plan, your employer's HMO become more expensive and he will eventually drop it leaving you with the national plan.

2. In general, and as I have pointed out above, having uninsured is NOT good for the rest of the insurance pool. Rather, having a large number of healthy young people paying for insurance lowers costs for all insureds.

3. I have not said that universal health care is a tragedy, rather, I suggest that to expect, in a nation of 250 million, high quality care at bargain basement prices is unrealistic. Clearly, universal healthcare improves coverage for the uninsured. I merely suggest that for a vast majority of americans, such changes will make their own insurance either more expensive or provide less insurance.

4. Wow!!! I get to be an apex predator?? Cool!! (usually, I am just some middle of the pack herd animal attempting to find todays veggies).
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Old 05-14-2009, 07:42 AM   #105
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Re: the new health care?

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1. With a national health plan, your employer's HMO coverage will eventually become more expensive. Initially, your quality of care will not decrease. At some point, as more and more people become "uninsured" and rely on the national plan, your employer's HMO become more expensive and he will eventually drop it leaving you with the national plan.

2. In general, and as I have pointed out above, having uninsured is NOT good for the rest of the insurance pool. Rather, having a large number of healthy young people paying for insurance lowers costs for all insureds.

3. I have not said that universal health care is a tragedy, rather, I suggest that to expect, in a nation of 250 million, high quality care at bargain basement prices is unrealistic. Clearly, universal healthcare improves coverage for the uninsured. I merely suggest that for a vast majority of americans, such changes will make their own insurance either more expensive or provide less insurance.

4. Wow!!! I get to be an apex predator?? Cool!! (usually, I am just some middle of the pack herd animal attempting to find todays veggies).
I think that is probably the case. How have the Cannucks and the Brits faired with similar idea's in mind. From the people I know that live or have lived in those countries, They have it........but it.......ain't great. Hard to see anyone for an appointment....marginal quality. I do not believe as you have stated it can be done "GOOD AND CHEAP". It will require a....shocking financial commitment. And finally "Apex predator"? That's sweet. Wil;l we be seeing you on the next episode of "the Cougar"?
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