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#215212 - 03/05/12 07:51 AM Re: Obamacare: What the ACA really is/does [Re: Phil Hoskins]
Ted Remington Offline
old hand

Registered: 07/09/08
Posts: 4890
Originally Posted By: Phil Hoskins
On the road to single payer, all health insurance organizations should be non-profits and the overhead, salaries of non-medical professionals should be regulated and the rate of return should be limited.

Then aggressive cost cutting should be implemented, including limits on benefits for those who are likely to die within 3 months.
Phil,

This plays right into the evil hands of the right wingers who have in the past and will continue in the future to scream "DEATH PANELS" at the top of their lungs. As you have pointed out in another thread we in the US are a culture which believes quite strongly in "life at any cost since life is sacred from the inseminating erection to the last secretion."

I am making the assumption that when we use the catchphrase "single payer" we are talking about one national insurance plan similar to Medicare. I have never liked the idea of having too much government in the medical arena, and my resolve is only stiffening when I think about what the underlying schema is going to look like. I keep pointing to the FEHBP as a model for a future insurance plan in which there will be a mixture of national and local insurance plans available in a portfolio which can easily be subsidized by the government for those who cannot afford full premiums.

It doesn't gain much traction because quite a few people believe that the profit motive should not enter into the overall formula. My response is that if you have widespread competition for health insurance dollars you will have widescale measures to cut costs in what could really be a cutthroat market.

What I am seeing locally in the health marketplace is that consortiums are competing to provide broad ranges of service. Most of the doctors my family sees are employees of one or another of these organizations. My personal physician has his own office nearby but he wears an employee badge for a hospital in Asheville, as do all of "his employees." When he orders lab work I walk down his hall to his lab, where an employee of an Atlanta lab does the blood draws and ships them off to Atlanta. My insurance company pays all the lab fees without copay because I am using their approved lab.

If I were to be hospitalized locally, the hospital is owned by or otherwise closely affiliated with the mega-hospital in Asheville, and it is also a preferred provider.

All of this is competition. The two major medical providers in Asheville are constantly trying to out-compete each other, with the result being good service and low cost to me. Some might argue that service goes away as costs go down, but we're talking medical treatment here. If I don't like the service there is another company I can go to just by switching insurance plans.

I particularly disagree that anyone except the employers should regulate the salaries of non-professional employees in the medical arena. All that does is piss off the people we have to deal with and create yet another level of bureaucracy. I can just imagine what Anne, the receptionist who always finds an appointment for me, at Doctor Mark's office would be like if she watched as her salary was regulated so we could pay more money for the professionals. That, to her, would be a sort of wage slavery. She should have to compete for her salary just as everyone else does.

Mark, my personal physician, and I disagree about end of life care. I recently told him that a doctor helped bring me into the world and I expected that a doctor would help me ease out of it by providing what I needed to do so when the time came, a time which is really my decision to make. His reaction was stone silence, driven almost undoubtedly by his religious convictions coupled with the cultural value that life is sacred. I realized I am going to have to find a new doctor because deep inside I know from his silence that he is going to try to dissuade me from controlling my own death. Read that as suicide when the time is right for me.

In all other areas Mark is a good doctor, willing to take time to listen and discuss whatever medical needs I have. But in the long run he is going to fail me just when I need him the most. Unacceptable. And this is the sort of thing that has to change in our culture (as well as in our religious beliefs.)
_________________________
Take the nacilbupeR pledge: I solemnly swear that I will help back out all Republicans at the next election.

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#215228 - 03/05/12 10:11 AM Re: Obamacare: What the ACA really is/does [Re: Ted Remington]
itstarted Offline
old hand

Registered: 01/27/03
Posts: 6354
Loc: Florida/Illinois
Not much to disagree with here.
As with almost every discussion about government and the private sector, we end up with a separation of the "wish fors" and the "way it is"... Ideals and Reality. Virtually impossible to find a common ground.

Some day, we'll have a thread about building a perfect government from scratch...

Until then, dealing with realities. My problem with the free enterprise system in healthcare, is that is not primarily a commodity, with success dependent on true supply and demand. By its nature, under the present sytem, healthcare is not "shoppable". Cancer, a broken leg, a heart attack, or a bad cough is not subject to comparison shopping, and as far as preplanning by selecting doctors, or a health plan already in existence, this is essentially a crap shoot, and the bottom line within the provider is driven by economies that leave the customer paying the bill in one way or another.

I think Iss led off with a good basis for a reality based discussion.
be back...
_________________________
In what concerns you much, do not think that you have companions: know that you are alone in the world. ~ Henry David Thoreau

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#215231 - 03/05/12 10:29 AM Re: Obamacare: What the ACA really is/does [Re: NW Ponderer]
Jeffery J. Haas Offline
veteran

Registered: 08/03/04
Posts: 10483
Loc: Downey, California
I very much want to agree with Keysersoze in principle but what forcibly changed my mind was the unbridled greed and avarice that I encountered.

I was cherry picked when I was hale and hearty, romanced, wined, dined and charmed, all by mail, with tempting offers for affordable plans, and when I joined the Editor's Guild I found my healthcare package to be a dream.

But I hardly ever had need to use it.

All that changed very quickly as my needs escalated and I ultimately found myself without coverage and searching for more.
COBRA helped me for a while but ultimately I could no longer afford my plan and had to search for something else.
I was turned down almost everywhere and when I pressed the issue the minimal package I was finally offered equalled more than a mortgage payment with a deductible that would choke a mule.

When over half the workforce in this country cannot afford an absolutely necessary commodity, it is no longer a commodity, it's a luxury.

A lot of people speak of natural market forces.
I contend that natural market forces themselves are forcing the people to choose something that will ultimately put those powers that be behind the market itself to their doom if demand destruction doesn't get them first.

In other words, the powers that be failed to listen when they were told that they were killing the geese that laid the golden eggs.

All they had to do was dial back their greed a little.
Single payer is coming, whether they like it or not, whether we like it or not. The for profit model has had its day.
I contend that it was the people who ran the for profit model that screwed the pooch, not the American people.

No Mr. Gecko...greed is NOT good. It's greed, and in its pure state, it is volatile and destructive. Those who fail to regulate their own greed face a fate similar to those who live by the sword.

You play with the fire, you risk getting burned.
_________________________
"Our options for change range from basically what we have plus a little more Hayek,
to what we have plus a little more Keynes. Why?"

---Benjamin Bratton

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#215251 - 03/05/12 12:09 PM Re: Obamacare: What the ACA really is/does [Re: NW Ponderer]
keysersoze Offline
journeyman

Registered: 12/01/11
Posts: 880
Death panels already exist and they exist in the private and public sector. Decisions are made and coverage is denied and the option is to fund it yourself, get a lawyer, have someone toss a benefit for you, plead and beg or just give up and die.

A simple search of Medicare denying treatment will give you some rather shocking examples. The private sector has long made decisions based all to often on cost controls - otherwise know as "profit margin."

Someone mentioned administrative cots and for some reason two figures pop into my skull - 22% and 12% with the 22% being the the USA and the 12% being - I believe - Japan. I do recall that administrative costs are significantly less beyond our borders be it private or public.

On a personal note five years ago I had a series of heart tests done. I was getting periodic chest pains and nothing of substance could be discovered. At the time I was 62, my weight was perfect, all my screenings were within limits and I ran - and still do - eight miles a day. My doctor sent me to a specialist and I remember the person who handled his claims saying "You have the blue plate special" meaning I get the best of the best. No simple stress test but a nuclear heart scan simply because my insurance allowed it - most did not. I was clean but if something was wrong and I was in the low rent insurance district the end could result is dead meat.
_________________________
Only racists oppose my dictatorship.

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#215261 - 03/05/12 12:30 PM Re: Obamacare: What the ACA really is/does [Re: keysersoze]
Phil Hoskins Offline
Administrator
Carpal Tunnel

Registered: 06/07/04
Posts: 20552
Loc: West Hollywood, CA
Of possible relevance to this topic, why healthcare costs more in the US than anywhere else
_________________________
Life is a banquet -- and most poor suckers are starving to death -- Auntie Mame
You are born naked and everything else is drag - RuPaul

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#215265 - 03/05/12 01:07 PM Re: Obamacare: What the ACA really is/does [Re: NW Ponderer]
NW Ponderer Online   content
Moderator
veteran

Registered: 09/09/11
Posts: 11713
When I speak of "single payer" I think of the PEHB and FEHB (public and federal employee health benefit) programs, which I am familiar with, having been a State or federal civilian employee most of my career. For the bulk of my working life, with the exception of when I was on Active Duty, I received my health care through the same provider - Group Health Cooperative. Like Kaiser Permanante, Group Health is a non-profit cooperative that was established post-WWII. It provides a wide range of services in house and through a network of preferred providers. For most of that time, I relied on a steady dose of preventive care, minor corrections (splints) and medications. Three times, now, my wife or I have been hospitalized for major medical needs. Collectively, the bills would total nearly a million dollars. In all three cases, I paid almost nothing out of pocket.

That, to me, is the kind of service everyone should get. I pay premiums, I follow the service rules, and when a major life even happens, I have backup insurance. OMG - that is essentially what Obamacare provides! The only significant difference between the ACA and most employer - including government - employer health plans is the addition of coverage supplementation for those that cannot afford the premiums. The fact that it is a "mandatory" program is a blatant red herring, for reasons I am not going to get into right now.
_________________________
A well reasoned argument is like a diamond: impervious to corruption and crystal clear - and infinitely rarer.

Here, as elsewhere, people are outraged at what feels like a rigged game -- an economy that won't respond, a democracy that won't listen, and a financial sector that holds all the cards. - Robert Reich

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#215270 - 03/05/12 01:16 PM Re: Obamacare: What the ACA really is/does [Re: NW Ponderer]
Phil Hoskins Offline
Administrator
Carpal Tunnel

Registered: 06/07/04
Posts: 20552
Loc: West Hollywood, CA
NWP one major difference is that most health care insurers are for profit organizations, and as I posted in the link above, the system by which prices are set is too weak to reign in costs.
_________________________
Life is a banquet -- and most poor suckers are starving to death -- Auntie Mame
You are born naked and everything else is drag - RuPaul

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#215273 - 03/05/12 01:49 PM Re: Obamacare: What the ACA really is/does [Re: NW Ponderer]
keysersoze Offline
journeyman

Registered: 12/01/11
Posts: 880
http://www.beckershospitalreview.com/lis...-hospitals.html

Interesting list of non profit health care hospital systems.
_________________________
Only racists oppose my dictatorship.

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#215284 - 03/05/12 02:47 PM Re: Obamacare: What the ACA really is/does [Re: Phil Hoskins]
Ted Remington Offline
old hand

Registered: 07/09/08
Posts: 4890
Originally Posted By: Phil Hoskins
Of possible relevance to this topic, why healthcare costs more in the US than anywhere else


Phil:

Getting a handle on health care costs is like trying to catch a particular drop of rain during a monsoon.

My health insurance plan is a PPO plan. There are preferred providers who agree to a certain fee for each procedure/medicine/treatment, whatever. The cost to the insurance company is far less than the average charges that would pertain to a person who walked into the doctor's office without coverage. Unfortunately there was no listing in their sample procedures for an MRI, but there was a listing for a CT scan of the head, both with and without contrast.

This is from their comparison page:

Quote:
Description Network Allowance Plan Allowance
CT (CAT Scan) $169.65 $1,035.00
Head, with contrast

This tool is to provide you with basic information regarding the general cost of some standard health care services and the ability to compare our Network allowance with our standard Plan allowance. The amounts shown represent the most current data as obtained by the Plan. Rates are subject to change. The Network rate is based on the average PPO negotiated rate within a geographical area as determined by the zip code entered. Our Plan allowance is based on data gathered from health care sources that compare charges of other providers for similar services within the geographical area as determined by the zip code entered. This information is provided for illustrative purposes only. The amounts shown DO NOT include charges that may be incurred by a facility, such as a hospital, other professional fees, or prescription drug charges and also do not include copays or coinsurance. The actual provider charges may be different due to varying factors. Other charges from the provider may be associated with these services. Please refer to the current Plan Brochure (RI 71-009) for specific benefits. All benefits are subject to the definitions, limitations and exclusions of the Plan brochure. Please contact the Plan toll free at 1-888-636-NALC (6252) if you have additional questions.
emphasis added

What this means is that the company allows a charge of $170 for a CT scan. I may have to pay a small deductible, perhaps 20 percent, with a yearly cap on such payments. But The payment to the provider is $170, just about 1/6th of the street charge for the procedure. If I had to pay 20 percent of the $1,035, that would be more than the insurance company would pay the PPO for the same service, and since I would not have had the insurance company working for me I'd have had to pay the full $1,035.

I cannot prove this based on the lack of data in the site you provided, but I suspect quite strongly that what you are seeing is the US street charge versus perhaps actual charges in other countries. Certainly if you do not have the benefit of an insurance company working to reduce costs you are gonna get screwed royally, but if there is anyone who doubts the efficacy and utilitarian value of a health insurance company you have only to look at the numbers above.

Here are some more numbers:

Quote:
Description Network Allowance Plan Allowance
Venous Catheter Insertion $257.00 $420.00
Biopsy - skin sample $96.79 $177.00
Cataract Surgery $1,022.17 $2,500.00
EKG $35.49 $127.00
_________________________
Take the nacilbupeR pledge: I solemnly swear that I will help back out all Republicans at the next election.

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#215291 - 03/05/12 03:19 PM Re: Obamacare: What the ACA really is/does [Re: Ted Remington]
Phil Hoskins Offline
Administrator
Carpal Tunnel

Registered: 06/07/04
Posts: 20552
Loc: West Hollywood, CA
Ted, it would seem you are wrong, but have not the skill to know for sure. Link to actual study
_________________________
Life is a banquet -- and most poor suckers are starving to death -- Auntie Mame
You are born naked and everything else is drag - RuPaul

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