Health Insurance

[Beavah]

Congratulations, Gern, for admittin' that you enjoy lowerin' the level of discussion to da level of Sarah Palin. They say the first step to a cure is admitting you have a problem.

 

I liked your comment about da VA. Maybe you're not old enough to remember what the VA was not so long ago.

 

For years, the Department of Veterans Affairs' sprawling health care system was criticized by veterans groups and government investigators as a dangerous backwater of medicine. Report after report portrayed it as suffocating from top-heavy bureaucracy, dirty and unsafe hospitals, and little or no accountability. Thousands of eligible patients opted to get their care elsewhere. - Washington Post

 

Remember da decomposing bodies of three missing patients found on the hospital grounds? Remember da Tom Cruise movie "Born on the Fourth of July"?

 

The VA did pull a remarkable turnaround, due to some remarkable individuals. But of course yeh also remember that the fellow most responsible for the VA turnaround was forced out by special interest politics.

 

So which do yeh suppose is da norm for a government agency? High efficiency? Or special interest politics forcing out the best people, limited accountability, and suffocatin' bureaucracy?

 

It's a great act of unquestioning religious faith to "believe" in government.

 

Beavah

 

[GernBlansten]

Beav, I do admit I have a problem with schadenfreude skewering the Tea Party on their own petard. But I am working on it.

 

Vol, if your hypothetical review panel was made up of ordinary citizens, couldn't that also be called a jury? Or do you want to stack the panel with "experts" to reduce that public influence?

[OldGreyEagle]

"Try telling that to my friend who just sat in limbo for 2 weeks while her doctors worked to convince her insurance company to reverse their denial for the bone marrow transplant that she needs for leukemia."

 

 

The Insurance company did not deny the woman the bone marrow transplant, let me say that again, the Insurance Company did not deny the bone marrow transplant, they may have not agreed to pay for the Bone Marrow Transplant, but that is a heck of a lot different than denying the woman the bone marrow transplant. She can still have the transplant, the Insurance Company just doesnt pay for it

 

If the Doctors think the Bone Marrow transplant is her best treatment option, then they should do it and worry about money later, why haggle now?

[vol_scouter]

OGE,

 

The resources are limited. Even if the physicians work for free, there are significant costs to a bone marrow transplant. If services are continually given away, the hospital will go broke. My practice has ~17% medicaid and no pay. Medicare pays about 80 cents on the dollar whereas medicaid pays about 10 cents on the dollar of charge. At some point, the physicians will go broke as well. I know that you work with some well paid doctors but many are less well re-imbursed. At some point, 80 hour weeks, stress, and the threat of lawsuits that could wipe-out personal property is not worth the pay - that is why there are too few primary care doctors. So not everyone who needs expensive procedures and does not have the means to pay (third party payor + personal) could have it. Who should get the treatment?

[OldGreyEagle]

Vol Scouter you missed my point

 

The insurance company did not deny the woman the treatment, they said they would not pay for it

 

Insurance does not pay for everything, only what the policy covers

 

I said the Doctors could provide the treatment, not that they should, but that the act of the Insurance Company not paying for the treatment did not deny the woman the treatment

 

That the healthcare industry needs a good enema is hardly a revelation, I would like to see a less emotional one size fits all and lets move on mentality. Its easy to blame the current situtation on evil doctors, or evil insurance companies, or evil drug companies, or evil hospitals, or evil DME dealers, or Evil SKilled Nursing Facilities, or Evil whatever.

 

Can we take the emotion out and take a step at a time?

[evmori]

The problem, OGE, is insurance companies have built so many walls and procedures it's sometimes impossible to get the same answer from two different employees of the same provider! Insurance companies don't want to pay even though that's what they are in business to do. They are hoping we all get so frustrated we give up & drop the claim!

[OldGreyEagle]

But just because the Insurance Company does not pay for something does not mean that treatment is denied, that is all I am saying and apprently quite poorly

 

There is so much I want to express about this topic and find myself not doing any of it well

[evmori]

But just because the Insurance Company does not pay for something does not mean that treatment is denied, that is all I am saying and apprently quite poorly.

 

I understand!

[packsaddle]

I think OGE's point is well taken. What is happening is that insurance companies, in the structure of their policies, are deciding the 'shape' of the selective pressures brought by denial of coverage. This is the 'business' way of health coverage that we have chosen and I just wish people would credit Darwin with the basic idea behind it. There is no denial of medical care if you have the money or resources to pay for it. Otherwise, you're out of the gene pool. The private health insurance industry just makes the selection process clearer to those who have coverage. It's called 'the policy'.

[scoutingagain]

"Otherwise, you're out of the gene pool. The private health insurance industry just makes the selection process clearer to those who have coverage."

 

Now if they would only get terminally ill before they procreate you might have something. Perhaps the Death panels could also do genetic screening and sterilize those folks who will become terminally ill and can't pay for their own helath care so we can break that cylcle.

 

SA

[packsaddle]

Terminal illness is not required. All that is required is anything that suppresses reproductive capacity. Your advocacy of sterilization would be a bit more honest with regard to intent, but it's not necessary if considering the long view.

[Beavah]

Yah, I just don't get da social Darwinism bit, eh?

 

What yeh have is a limited resource: high end medical care. Whenever yeh have a limited resource, yeh have to allocate it somehow. There are lots of ways.

 

Yeh can do it by market economics. Those who can afford da limited resource are able to purchase it, others can't. That has the advantage that it provides capital for the resource to expand to meet the needs of the unserved market... as long as there isn't a monopoly control of da resource. Da market does need some regulation, though, to guard against fraud.

 

Yeh can do it by having da government allocate the resource. That doesn't provide capital or incentive for expanding the resource (or for shrinking an underutilized resource). And while yeh can point to some successful versions of this, governments by and large are interested in themselves, eh? Like as not the resources are goin' to go to the "friends" of those in power... or to buying such "friends".

 

Yeh can have "experts" allocate da resource. That can work better than government at deliverin' the resource where it's most needed, but again it doesn't provide incentive for expanding da resource. And a lot of technical experts aren't used to dealin' with the sort of personal and political pressure that comes with such a role.

 

Packsaddle is right, of course. From a "health of the national economy" perspective, the best investment is to fully fund health care for children and young people. Anything yeh do to extend or improve da quality of their productive years is good for the nation. Just like investing in education.

 

By the time yeh get to my age, it's a worse investment, eh? Diminishing returns. Will that open heart surgery really give me enough more productive years to merit da economic cost? Is multiple surgery and radiation and chemo really warranted if I got Stage IV cancer? Not economically. It would be bad investment for the nation, unless perhaps I was involved in a research program that might help others. It'd be a poor risk pool for an insurer.

 

Of course, I'd want da open heart surgery, eh? I'm on good enough terms with my Maker, but I'd just as soon not test that quite yet! And frankly, I'd just as soon someone else paid for it. But I'm not sure that's a reasonable thing to ask; certainly it doesn't seem like a reasonable thing to demand, especially if I were to need a bypass because of my love of a good prime rib. Charity, of course, is a different matter, but I'd never consider receiving other people's charity a "right."

 

What we've done with Medicare is create a right to high end care for the group that provides the least economic return for that national investment. Essentially, da cost of Medicare is causing young people and families to go uninsured or without medical care, which is a terrible social policy. It's like cutting K-12 schools to provide a free public education to 90-year-olds.

 

And frankly I'm appalled by da mores of my generation that thinks nothing of considering it a "right" to rob our grandchildren and impoverish and weaken da nation that our own grandparents built at great sacrifice for us.

 

Beavah

 

 

[skeptic]

Amen Beavah.

[gwd-scouter]

Probably a stupid question that I'm sure someone will point out, but this is something I've been wondering about. It has to do with Medicare.

 

I believe Medicare was established because seniors had difficulty finding insurance on their own, for many reasons including no longer working so they couldn't get it from their employer, costly because of seniors' diminishing health, pre-existing conditions, etc.

 

If the new healthcare law says insurance companies can't turn people down for pre-existing conditions, and if everyone actually does wind up purchasing health insurance, thus expanding the coverage pool, and the exchanges are set up in the states to allow people to shop around, then why would we still need Medicare?

 

 

[Moggie]

If you're interested the BBC produced an article on the NHS budget, they included many graphs but one that caught my eye compared spending on health care as a percentage of GDP. It would appear that most western countries spend roughly simillar amounts (7-8% of GDP)

 

This link should take you to the web page

http://www.bbc.co.uk/news/magazine-11686396

 

Cheers

 

Gareth