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Old 09-11-2009, 09:38 AM   #61
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Re: The Health Care Reform Address Thread

What are they doing?: Demanding that everyone buy at least basic health coverage.

Why?: There's a federal law that says hospitals can't turn people away from the emergency room, whether you have insurance or not. So people without insurance go when they get sick. Most of them never pay the hospital bill. Guess who pays that bill? Those of us who are covered have higher insurance premiums to pick up the uninsured's slack. If everyone has to buy coverage, then ER visits will actually be paid for by those who go to the ER.

How will they do it? Pretty simple, pass a law. You must buy coverage. How they enforce it will be interesting to see, but that's doable through the threat of fines, etc.

How will it help? When everyone is covered, their insurance actually will pay for their ER visits. Your premiums should stop going up as fast. And it's fair after all, as long as ERs have to care for people, then someone has to pay for it. If you want to play, you have to pay, it's only fair. There will still be people who choose to break the law and go uninsured, but when they end up in the emergency room for who knows what, they'll end up with a fine for being uncovered.
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Old 09-11-2009, 09:44 AM   #62
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Re: The Health Care Reform Address Thread

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Originally Posted by joethiesmanfan View Post
They changed our health coverage at work, I now pay nearly 400 bucks a month. If it wasn't to cover my son I would just let the tax payers pay for me whenever I go to the emergency room and not pay the cost of health insurance. In my opinion any kind of insurance is a scam.
Well, and with all due respect, your opinion is BS. Putting aside the health care issue for a moment, insurance is an absolute neccessity for business. If there was not someway to insure against risk, substantially fewer risks would be taken - buildings wouldn't be built, investments wouldn't be made. Risk pooling (insurance) allows big risks and big investments to be made.

Back to health care - and as to mandatory universal coverage, my main concern is that I don't see enough in this plan to address costs. To me, as I have stated elsewhere - the tension is between "can we afford this program now" and "if not, when?".

I am unconvinced - b/c I can't unravel all the economic implications of all the legalese - that the bill as written does much, if anything, to attack costs and the natural anti-market forces at work within the healthcare system. While the mandatory coverage aspect is significant, the economics of it and its relation to the public option are of concern. If the public option is the cheapest and provides bare minimum coverage (the level of coverage being mandated is something I am still trying to decifer), it will attract the poor and the young healthy uninsured. If that occurs, then the system may not, and I stress may, be cost prohibitive. On the other hand, if private insurers provide better service then the public option - (hate on private insurers all you want, I suggest that the public option will be just as difficult and likely moreso to deal with) - at the same mandated cost, only the poorest and uneducated will end up in the public option. From an actuarial stand point, I am pretty sure this is one of the most expensive groups to insure.

Looking through the bill (and it may be obvious), do the affordability credits only apply to the public option?

Right now, I oppose this bill b/c (1) - I don't understand it and the myriad of economic changes it proposes; (2) - based on my understanding of its function, I am unconvinced that it does anything to truly attack costs; and (3) - I am just not convinced that this thing will be in any way affordable.

Obama, I think identified many issues that need to be addressed, but as Schneed said earlier there is MUCH to be ironed out. Too much, I think for this bill to pass.
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Old 09-11-2009, 09:45 AM   #63
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Re: The Health Care Reform Address Thread

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Originally Posted by Schneed10 View Post
So let's get to it:

What are they doing?: Trying to reduce malpractice costs.

Why?: Because doctors pay out the nose to keep themselves covered, all because juries keep awarding people multi-millions. That cost of malp insurance drives up the cost of doc appointments as docs pass the cost on.

How will they do it? Unknown at this point, no specifics are available, but ultimately the only way to substantively reduce this cost is to somehow reduce the amount of money awarded to victims of malpractice.

How will it help? Over time malpractice insurance premiums will drop for docs. They'll stop raising prices for their appointments.
Here's my question...and it's a lazy one I'll admit. I attended our local town hall meeting which was of course dominated by discussion on health care. It was a very civil affair with probably a good 70-30 split against the current debated HR3200. I live in a heavily conservative area so this is to be expected. Now there were a good amount of the "we simply don't like this crowd". Mostly base on philosophical grounds. The other side was better "prepared". They had answers for everything it seemed but a lot of it sounded like spin to me personally. One woman claimed that her husband had been studying the entire industry for years and that medical-malpractice as it stands now causes only a 2-3% increase in costs. This sounded baffling to me but I admittedly have no reason other than it seems like doctors say that isn't true. So what is the deal? What affect does malpractice judgement in general have on the system? Is it only 2-3% or is it more or even far more? Anyone have anything that answers this conclusively?
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Old 09-11-2009, 09:49 AM   #64
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Re: The Health Care Reform Address Thread

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Originally Posted by joethiesmanfan View Post
In my opinion any kind of insurance is a scam.
I'd love to call you out on this man but I am not even sure what you are trying to say.

How is it a scam?
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Old 09-11-2009, 09:51 AM   #65
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Re: The Health Care Reform Address Thread

What are they doing?: Offering an OPTIONAL non-profit insurance coverage option through an online marketplace.

Why?: Insurance premiums are primarily driven by the number of people who belong to the plan. The more in the plan, the lower the premium (because then the insurance plan has more negotiating power with hospitals & docs and can demand lower reimbursement rates to providers). But if you work for a small business or if your employer offers terrible coverage, you end up in a very small "risk pool" (the number of people in your plan), which results in very high premiums. The online marketplace allows you to join a plan (or risk pool) with a large group of people.

How will they do it? The how part is very interesting. Obama said a non-profit insurance firm would have much lower overhead costs, because they won't need to generate a profit for Wall Street, and because they'll be able to reduce administrative costs. I buy the first part, that there will be no profits - that does help. But I don't buy the reduction of administrative costs. He underestimates how much regulation must be worked through within this industry - a non-profit will have just as much administrative overhead to work through, and will need just as many people to do it. And that assumes they'll operate with the same efficiency as a for-profit (I don't like those chances).

How will it help? Even if administrative costs can't be cut out, this still should give Americans with a semi-affordable coverage option. I just don't think it will be as cheap as he thinks, and plenty of the currently uninsured will still find it tough to afford. But it will still be better than options availabe now.
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Old 09-11-2009, 09:55 AM   #66
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Re: The Health Care Reform Address Thread

Quote:
Originally Posted by Schneed10 View Post
So let's get to it:

What are they doing?: Trying to reduce malpractice costs.

Why?: Because doctors pay out the nose to keep themselves covered, all because juries keep awarding people multi-millions. That cost of malp insurance drives up the cost of doc appointments as docs pass the cost on.

How will they do it? Unknown at this point, no specifics are available, but ultimately the only way to substantively reduce this cost is to somehow reduce the amount of money awarded to victims of malpractice.

How will it help? Over time malpractice insurance premiums will drop for docs. They'll stop raising prices for their appointments.
Again, I will raise my idea again - mainly b/c I think it's f'ing brilliant, but here it is actually relevant.

Eliminate malpractice liability as a tort action. Instead establish a Medical Injury Compensation Commission similar to Workers Comp. Patients no longer need to show negligence caused their injury, instead they just need to demonstrate an injury to receive compensation. As in Workers Comp, recoveries are based specific losses, temporary/permanent, and partial/permanent disability.

Instead of paying high malpractice insurance costs, all hospitals, doctors and medical professionals pay MIC insurance (just like all employers pay Worker's Comp insurance) - it won't be cheap, but it should be less than current malpractice. Plus, it has the added benefit of spreading costs of all professions amongst all practitioners (instead of huge premiums for Obstetrics and ortho's). Malpractice litigation is all but eliminated and replaced with MICC litigation which, like Workers Comp, follows a more formulaic approach.

Further, this could be done separate from the current bill and, in fact, could be drafted as a companion to it so to show how the two would work in conjunction.
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Old 09-11-2009, 10:00 AM   #67
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Re: The Health Care Reform Address Thread

Quote:
Originally Posted by FRPLG View Post
Here's my question...and it's a lazy one I'll admit. I attended our local town hall meeting which was of course dominated by discussion on health care. It was a very civil affair with probably a good 70-30 split against the current debated HR3200. I live in a heavily conservative area so this is to be expected. Now there were a good amount of the "we simply don't like this crowd". Mostly base on philosophical grounds. The other side was better "prepared". They had answers for everything it seemed but a lot of it sounded like spin to me personally. One woman claimed that her husband had been studying the entire industry for years and that medical-malpractice as it stands now causes only a 2-3% increase in costs. This sounded baffling to me but I admittedly have no reason other than it seems like doctors say that isn't true. So what is the deal? What affect does malpractice judgement in general have on the system? Is it only 2-3% or is it more or even far more? Anyone have anything that answers this conclusively?
I can tell you that at our healthsystem malpractice premiums account for about 3-4% of our total expenses.

Malpractice premiums are increasing at about 15% per year.

So while the rest of our costs increase at about 6% per year, because malpractice is going up by 15%, it is responsible for a half of a percentage increase in overall expense growth within healthcare.

Reducing overall healthcare expenses across the nation by a tenth of a percent would cut the deficit drastically. This could be accomplished by getting malpractice premiums to increase by only 12% instead of by 15%.

Small changes in expense growth accumulate to massive savings across the system, at least when compared to the projected deficit.
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Old 09-11-2009, 10:05 AM   #68
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Re: The Health Care Reform Address Thread

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Originally Posted by Schneed10 View Post
I can tell you that at our healthsystem malpractice premiums account for about 3-4% of our total expenses.

Malpractice premiums are increasing at about 15% per year.

So while the rest of our costs increase at about 6% per year, because malpractice is going up by 15%, it is responsible for a half of a percentage increase in overall expense growth within healthcare.

Reducing overall healthcare expenses across the nation by a tenth of a percent would cut the deficit drastically. This could be accomplished by getting malpractice premiums to increase by only 12% instead of by 15%.

Small changes in expense growth accumulate to massive savings across the system, at least when compared to the projected deficit.
OK...but aren't people more concerned simply with the cost to themselves? When I am think about costs ultimately I am thinking what can we do to get those people paying $700 a month for insurance to only pay $600.

Also...the costs you cited...do they included the so called "defensive medicine" that doctors cite as causing issues?
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Old 09-11-2009, 10:13 AM   #69
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Re: The Health Care Reform Address Thread

I know zero about this and have not seen a doctor for myself since I was in college but what is annoying is that doctors are so afraid of malpractice suits that they go over board on eveything. When my son gets sick we call his PED and ask for advice, now people with kids know they are only really sick between 12 and 3 am, as soon as we call the PED before you can say boo he is like take him to the ER, whatever. Ever trip to the ER is a $100 for me and the worst part is the waiting.

My son had a bad cough boaderline kroup last winter, call the doctor he says go to the ER, shocker. We get there, slowly it is getting worst more like a dog bark we have been waiting two hours. A nice lady in the ER who was waiting also said take him outside for like 15 minutes (cold air). So we do it come back in wait another 30 minutes and he is much better, so much we head home it is now 6:30 am the PED opens at 7:30 am. Take him to the PED he says oh yeah that will work (taking him in cold air) but I can't tell you that on the phone, WTF! Still got charged $100 and my insurnace got charge as well just for sitting in the waiting room. For the record we don't go to the PED anymore.
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Old 09-11-2009, 10:16 AM   #70
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Re: The Health Care Reform Address Thread

Quote:
Originally Posted by FRPLG View Post
OK...but aren't people more concerned simply with the cost to themselves? When I am think about costs ultimately I am thinking what can we do to get those people paying $700 a month for insurance to only pay $600.

Also...the costs you cited...do they included the so called "defensive medicine" that doctors cite as causing issues?
Well ultimately cost is all tied together. Naturally, slowing the growth of malpractice saves providers money. Over time, providers get pressured by Medicare, Medicaid, and commercial payers to bring down their reimbursement rates to account for these savings. And providers will oblige under political pressure.

Once growth of reimbursement rates to providers is slowed, that puts more money back in the pockets of Medicare, Medicaid, and your insurance company. They then will slow the growth of your premiums.

It's all connected. It will take time for the savings to work their way through the system back to the consumer. But it will happen.
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Old 09-11-2009, 10:18 AM   #71
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Re: The Health Care Reform Address Thread

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Originally Posted by FRPLG View Post
OK...but aren't people more concerned simply with the cost to themselves? When I am think about costs ultimately I am thinking what can we do to get those people paying $700 a month for insurance to only pay $600.

Also...the costs you cited...do they included the so called "defensive medicine" that doctors cite as causing issues?
No, defensive medicine expenses are separate from the numbers I cited. The growth in actual malpractice premiums is entirely attributable to jury awards.

Wasteful utilization due to defensive medicine is a whole other cluster of expense that can also be cut.
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Old 09-11-2009, 10:28 AM   #72
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Re: The Health Care Reform Address Thread

Schneed - as to malpractice. I understand the costs but, other than capping punitive awards, what can other ways are their to cut malpractice insurance? Even capping puni's (which this administration would have a hard time doing b/c of its allegiance to the trial lawyers) may not work - I am simply unsure of what percentage of awards they make up and what the trend is.
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Old 09-11-2009, 11:02 AM   #73
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Re: The Health Care Reform Address Thread

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Schneed - as to malpractice. I understand the costs but, other than capping punitive awards, what can other ways are their to cut malpractice insurance? Even capping puni's (which this administration would have a hard time doing b/c of its allegiance to the trial lawyers) may not work - I am simply unsure of what percentage of awards they make up and what the trend is.
Cutting puni's is it. Malpractice is a simple business.

The cash in to malpractice insurance firms comes in the form of premiums. Cash out comes in the form of paying punitive damages and settlements.

The settlements come down if punitive damages come down. It's pretty simple.
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Old 09-11-2009, 11:41 AM   #74
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Re: The Health Care Reform Address Thread

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Originally Posted by Schneed10 View Post
I can tell you that at our healthsystem malpractice premiums account for about 3-4% of our total expenses.

Malpractice premiums are increasing at about 15% per year.

So while the rest of our costs increase at about 6% per year, because malpractice is going up by 15%, it is responsible for a half of a percentage increase in overall expense growth within healthcare.

Reducing overall healthcare expenses across the nation by a tenth of a percent would cut the deficit drastically. This could be accomplished by getting malpractice premiums to increase by only 12% instead of by 15%.

Small changes in expense growth accumulate to massive savings across the system, at least when compared to the projected deficit.
The real cost of malpractice is something I've been looking for for a while. Can you reference statistics on the subject matter?
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Old 09-11-2009, 11:49 AM   #75
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Re: The Health Care Reform Address Thread

Learning a little as I go here. Tell me what you think of the validity of this study. http://www.citizen.org/documents/NPD...port_Final.pdf

I am not a numbers guy and this is a very statistic heavy study but it argues that the majority of malpractice costs are essentially due more to rising costs of care and lack of doctor disciplinary actions ("only 18 percent of doctors have been responsible for even a single malpractice payment" - yet only 33% of those doctors who have had 10 or more claims paid have been subjected to discipline).

The study relies on data collected by the "National Practitioner Data Bank" are you familiar with this entity? If so, do you believe it to be a credible data base?

Just from a general skimming of the information on the internet turned up by my search for "malpractice awards punitive percentage" seems to suggest that this is another one of those areas where stats don't support intuitive/common thought. Many states have capped punitive dams (~20), five don't allow them at all. PUNITIVE DAMAGE AWARDS, CAPS, AND STANDARDS. Even so, malpractice costs increase.

Not sure what all this means except that we are back to "no easy answers".
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