Health Care Reform and the Law

[OldGreyEagle]

you know how to drive a surgeon crazy?

 

Ask him to identify the three best surgeons on staff at the hospital

 

Himself/Herself comes up immediately, its the other 2 they are not so sure about

[Eagle92]

Beav,

 

I do know in Canada it was illegal for docs to perform procedures that were not approved EVEN if the patient had the resources to pay for it! That court case went all the way to their SC, where the CSC stated that Canada's universal healthcare system had led to the deaths of its citizens; that folks who wanted to have private insurance could have it; and docs could do procedures not approved by Canadacare if the patient was willing to pay out of pocket for it. There is now a run on private medical practices, in which you must subscribe to healthcare provider and pay out of pocket for services.

 

OGE,

 

Sad this is, you are 110% correct on that last one!

[Beavah]

Yah, BA, of course there are going to be cuts in Medicare. Obamacare or not, MEDICARE IS A PONZI SCHEME THAT WILL GO BANKRUPT. That's status quo ante. In a population with a lower birthrate, an aging demographic, and an expectation of high-end, lifelong care by seniors who are no longer contributing to the system there MUST be cuts and increases in cost, for everyone.

 

Da way that works is Medicare cuts payments, and hospitals charge more to private insurers, and then the private insurers raise the rates on everyone, eh? Then uninsured folks come in for ER visits, and the hospitals raise the cost to private insurers to try to pay for da uninsured as well. That's why our current private-payer system has had runaway costs for th last 20 years that are breaking businesses from small to large.

 

What da ACA tries to do is force more younger, healthy woking people to buy into the system, which would improve private insurer profits. Presumably if there is competition, then prices will come down. Either that, or da private insurers will get richer finding creative ways to skim da demographic. All very conservative.

 

Where it fails is that it doesn't change da underlying economics. In an aging population, with fewer productive young people paying and people living longer and demanding expensive treatment as seniors, THERE IS NO WAY ANY SYSTEM CAN AVOID BOTH CUTS AND INCREASED COSTS. None, zip, nada. With no ACA, we will see increasing cuts and increasing costs, just as we have been. With the ACA, we will see increasing costs and cuts, but perhaps less in da short term and more in the long term.

 

Trying to blame increased costs on any one program is just ridiculous. It's a systemic issue.

 

Beavah

 

 

[Woapalanne]

You forgot to mention that the increased services demanded of the private insurers (by the new law) MUST increase premiums and increase them more than a little. It is estimated that there will be a 10% increase in the number of people covered (from the current 85% to about 95%) which is obviously not enough to offset the increased costs even if all the new ones are perfectly healthy (which is not likely).

 

I proposed a reduction in Medicare age to 60 during the debate. None of my representatives would even answer me. That's a win-win: Medicare would gain by having younger, healthier (that's the assumption) people paying in just as much, and private insurers would lose their oldest, most expensive clients.

[gwd-scouter]

Maybe we should just do away with health insurance altogether.

 

Rich folks, of course, will be able to pay for what they want or need and will keep the doctors, hospitals, medical device companies, etc. in business.

 

Poor people will have to rely on the generosity of strangers. How about all the faith-based and charity organizations we keep hearing about? Old people, those that aren't wealthy of course, will just have to die instead of getting expensive treatments to prolong their lives.

 

The rest of the population? The middle-class people? Well, presumably if they were allowed to keep more of their money instead of paying into Medicare, Medicaid, Social Security, etc., they would have plenty to put into medical savings accounts from which will come whatever they need to pay for health care for themselves and their families.

 

Doctors, hospitals and other medical services will post their prices and we, the consumers, can shop around until we find a price we can afford. Can't afford Dr. Bob's appendectomy? Maybe Dr. Jim has a better price. Imagine the competition! Dr. Bob has to lower his prices to compete with Dr. Jim until everyone can afford everything. Welcome to HealthMart!

 

The service providers will bill patients directly. Maybe ask for up front payment or at least a down payment. Can't pay? Sorry, no more healthcare for you.

 

At this time of year, can we all say "decrease the surplus population"?

[Woapalanne]

Actually, I paid 100% of the health care for my family - out of pocket - when my children were growing up.

 

I had excellent insurance, but in those days it was hospitalization insurance, not attempting to cover every little scratch, immunizations, checkups, shots, etc. It was for serious illness or injury. Fortunately we had none of that, but were well covered if that should have happened. Office visits were, of course, not covered, even when my son needed stitches, or setting a broken nose.

 

I submit part of the problem with today's excessive insurance cost is that we expect everything to be paid. That's wrong. Does your car insurance pay for oil changes and wiper replacement?(This message has been edited by Woapalanne)

[Beavah]

Have to agree with Woapallane, eh? Da purpose of insurance is to spread risk. The risk in health is that you'll pull da unlucky draw of the card and get a child with Cerebral Palsy, find your wife has MS, or have da car slide on ice over a bridge and everyone needs multiple reconstructive surgeries.

 

Not that yeh need to pay $50 for an antibiotic for strep throat.

 

There is a trade-off, though, eh? Insurance isn't coverin' any maintenance to your car. If yeh don't change the oil, you'll be staring at an engine overhaul that's on you. Health coverage isn't like that. If yeh avoid physicals and therefore don't catch da high blood pressure, insurance will pay for your stroke. So the economics are such that payin' for the routine stuff does pay, because it helps prevent da big stuff.

 

There's another trade-off, too. Your neighbor's car can't infect your car, eh? Problem is, your neighbor's child can infect your child. If your neighbor doesn't pay for routine treatment, it can affect you. If we leave lots of poor folks in the cities with untreated illness, that's how viruses and bacteria mutate, eh? Lots of interactions, lots of transmission vectors. That "poor people's problem" very quickly can become our family's problem when the disease gets transmitted.

 

So it's tough, eh? Da principle of insurance is to spread risk, and in that way, insurance that covers daily routine stuff is a poor choice. Da principle of public health, by contrast, is prevention and early response.

 

Best thing to do might be to provide the basic care to everybody (meet da public health need the way we meet the public education need), then leave folks on their own, with private insurers, or with charities to cover the effects of aging or medical catastrophes. Problem with that is yeh still have da case like the scout mentioned above who loses his shot at college or bankrupts his family because he has a medical catastrophe without insurance. We all don't like that.

 

No easy answers, nuthin' but hard choices. But no matter what, it comes down to that as a nation, we cannot afford unlimited high-end medical care for da non-productive elderly. Unless we solve that very emotional issue, we can't even come close to anything that will make da rest of the system work.

 

Beavah

(This message has been edited by Beavah)

[vol_scouter]

Woapalanne,

 

You are absolutely correct. Physicians and hospitals should be paid by the patients only. The patients should collect whatever is owed to them by third party payors and then pay the providers of their medical care. That way the patient employs the insurance company and the medical care providers. It could significantly decrease costs and improve choice.

 

I read several years ago about a large internal medicine practice in the Pacific Northwest that decided to accept NO payments from third party payors. They got rid of their billing department and asked patients to pay upfront for the visit and as leaving for any lab or extra studies. The physicians saw their incomes increase, their costs plummet, they were able to decrease the charge to the patients, and they could give free care to those who could not pay (if you accept medicare, it is illegal to charge anyone less for the same service than you charge medicare). Their patient satisfaction improved. The federal government has since forbidden paying for medical services unless there is a contract with the physician. The federal government then tells the physician what they will be paid - the physician ha no input.

 

 

Beavah,

 

Physicians are effectively told what they must do. A few years ago, physicians were told that for a specific diagnosis that all patients must be discharged on a certain drug. Physicians knew that in the study that showed improved mortality rates that those patient had been and needed t be selected carefully due to a dangerous complication. Medicare keeps a 'report card' on all physicians and if you do not do what medicare wants, you can be removed from the program. Ultimately, physicians must earn a living to care for their families. As was to be expected, the mortality for the condition soared and medicare had to rescind the requirement. Physicians are required already to provide only certain options. Obamacare only increases the control as the physicians will work increasingly for the federal government.

[Eagle92]

Vol,

In my neck of the woods, the hospitals are forming subsidiary companies in which doctors' practices have been sold to company. That way all billing, med records, etc are handled by the subsidiary, and the docs do only medical work.

[Woapalanne]

I don't advocate individuals having to pay hospitals, it's too large a chunk. That's what insurance is for.

 

As for the arguments about neighbors kids infecting mine because they don't get shots - bogus argument. None of those scenarios were common when insurance was hospital insurance.First, when people have responsibility, they usually own up to it. Second, schools require the shots.

 

Bottom line: go back to us paying ourselves for the routine. Otherwise, IF (and that's only if) we want everything covered without personal payment, then be prepared for "universal single-payer (that's government)" coverage, with its attendant decline in quality and long waits for service. There's no other realistic alternative.

[Beavah]

Second, schools require the shots.

 

Yah, but isn't that da point of all these lawsuits? That it should be unconstitutional for the State to require purchase of a product?

 

But we require schooling, and da schools require vaccination.

 

All things in balance, eh?

 

I agree with yeh on the insurance bit, though. It should be a major risk pool. When it comes to payin' for routine stuff, all you're doin' is trading dollars with the insurer. You pay them $100, they pay the doc $60, you pay the doc $20, the doc pays $10 for his billing overhead, and only 70% of each dollar actually gets used for medical care. Economically, it's inefficient.

 

Public-health wise, hard to say.

 

Beavah

 

[OldGreyEagle]

Lets see, if you don't weigh within the governmental limits for your height and weight you shoudl pay 10-20p% more per every 10% you are above your ideal weight

 

If you do not eat the government reccomended diet high in macrobiotic grains and low in red meat, you pay 10% more for every pound of red meat you buy over 4 ounces a day.

 

Don't worry, grocery stores will report what you buy basedon the chip installed in your left ear or pass the laser wand over the tatto UPC across the back of your neck

 

If you smoke? heck this sounds familiar

 

Lenina Huxley: Ah, smoking is not good for you, and it's been deemed that anything not good for you is bad; hence, illegal. Alcohol, caffeine, contact sports, meat...

John Spartan: Are you ******** me?

Moral Statute Machine: John Spartan, you are fined one credit for a violation of the Verbal Morality Statute.

John Spartan: What the h***l is that?

Moral Statute Machine: John Spartan, you are fined one credit for a violation of the Verbal Morality Statute.

Lenina Huxley: Bad language, chocolate, gasoline, uneducational toys and anything spicy. Abortion is also illegal, but then again so is pregnancy if you don't have a licence.

 

 

 

[vol_scouter]

OGE,

 

Your comment about a surgeon is correct. You certainly want whomever is going to cut open your chest with a scalpel, stop your heart, cut on the blood vessels on your heart, and then (you hope) restart your heart to be a little self assured.

 

I was reading an online medical journal this past summer and discovered that the new medical care law requires all physicians to weigh patients on every visit and to report that to the federal government. The article pointed out that it is not just your primary care physician who is required to report your weight every time that you see them but your surgeon, pulmonologist, dermatologist, and even psychiatrist. The bill did not delineate the purpose of the reporting but your example is to close to the truth to be humorous.

[packsaddle]

OGE, since you brought it up, I'd like to thank the overweight persons who put my recent commuter flight over the weight limit so that the airline forked over $400 a pop to me and 5 other people, plus meals and hotel. Heck, the flight itself only cost $100! And I made the meeting on time!

 

I have suggested to the airlines in the past that they establish a baseline total weight allocation to each passenger (including the passenger and all bags) and then allow us to trade pounds or pay a surcharge at check-in. We pick up our bags, stand on a scale and look at the resultant surcharge (or else pound credits to sell to someone else). So far, no takers on that idea though. Oh well.

 

But THAT would be a great place for the feds to collect their data on weight demographics. It might even fall within the realm of Homeland (public health) Security. H'mmmm....now THAT would be a really cool twist for the Patriot Act!(This message has been edited by packsaddle)

[Beavah]

Yah, it's an interestin' thought, OGE.

 

A friend in the insurance industry tells me that it costs substantially more than is currently being charged for a smoker. In other words, all of us non-smokers are subsidizing the health care costs of the smoker through the insurance system.

 

I'm not sure that should be the case for matters of personal choice. If yeh choose to smoke (or use other drugs), insurance should pay for one round of quitting therapy, and then your cost should go up to pay the full freight for your risk. Same if yeh choose to be overweight. Why should someone else subsidize your lifestyle risk?

 

Yeh just have to make a hard-and-fast law against other kinds of demographic skimming based on things that aren't personal choices, like genetics, age, etc. The fact that right now we allow age-skimming works against da value of insurance to society.

 

Beavah