Universal Healthcare

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Well, that's VERY true, T2. After Mrs. Chandos' last stay in the hospital, I have to say that I can see why in SOME instances the insurance companies watch everything as close as they do: Just trying to make sense out of the bill required a PhD in "hospital speak." It seems as if, that along the way, everyone has his hand out for as much money as they can grab, while the insurance companies want to pay as little as they can, and the patient is stuck in the middle.

 

Overtesting (primarily to justify purchasing the shiny, new [insert latest piece of equipment here]) and overcharging are two area the medical community needs to reform. It's absolutely ridiculous the huge difference between the amount the doctors and hospitals charge and the amount they accept in payment from medicare and insurance companies. Regulating prices to medicare prices would go a long way to helping the issue.

 

You failed to mention that the number one reason for all of the overtesting is because there isn't any "tort reform" in any version of health care bills (the trial attorney lobby would never allow it). I recently cracked a rib while skiing, I was stunned and thrilled when my doctor poked and prodded me and told me I had a cracked rib and that it would heal in a month. He told me that with many of his patients he would have sent them for an X-Ray, but he knows I'm not to keen on being radiated if I don't have to be and I pretty much already knew what the problem was. Many doctors would never consider doing such a thing for if they miss the diagnosis they will get sued.

 

Texas already has tort reform and my premiums never went down. In fact, they went up.

But I'm sure the hospital makes no money on all those tests.

 

Torte reform has been done in Ohio and apparently hasn't helped to reduce costs to the consumer (but has increased health care provider profits). And it won't, and neither will any market driven approach while health care providers have an effective monopoly. Also, when you are about to die do you think you have a choice?

http://www.fiercehealthcare.com/story/states-tort-reform-hasnt-cut-health-costs/2010-03-22

 

I think tort reform can only work if there is a punitive system in place for substandard medical personnel. Inclusive with this would be a method to track those substandard personnel and ensure they do not work in the medical field again.

 

Or you could just let the government run it all. Would cut out two of the middle-men, the insurance providers and the people making money running hospitals. From my outside point of view it just seems like an immense amount of healthcare money is lost to those middle men instead of paying for the actual care.

 

On the contrary, the punitive system is in large part the problem. Since 'substandard' is such a subjective word here, there's bound to be tons of debate and the only way a doctor can guarantee that they're doing a 'standard' job is to order every test, drug, and procedure that any uneducated ninny may even suspect may possibly help, even if the doctor knows they won't. They do this in fear of a punishment for a subjective definition of 'substandard', because there is no objective definition that works.

The problem with this is that doctors want good pay. Unfortunately, in the US at least, most doctors didn't become doctors because they wanted to do community service, but because they wanted to make money. Government-run programs aren't known for being high-paying, and if they are, someone will complain.

In short, the problem with government run health care is that you tend to loose a lot of doctors because the pay goes down so much. Not always, but often, and pretty much guaranteed in the US.

 

As much as I like this idea, this really could be construed as a government takeover of health-care since the government would then be setting prices for an entire industry. I'm sure we could find are other ways if we looked hard enough, but I really only see one way to handle this without telling hospitals what to charge for their services -- mandating coverage for everyone. If everyone is insured, the insured don't pay more than the uninsured because, at least theoretically, the uninsured don't exist.

I do agree with you. Just as it is ridiculous for hospitals to get paid more by the uninsured than insurance companies for the exact same service, it is equally ridiculous that a small insurance company end up paying more than a large one. I just don't see this getting fixed.

Regarding tort reform, the numbers are pretty clear. It won't save the medical industry all that much money in the grand scheme of things. I still don't understand why the democrats are dragging their feet so much when it comes to implementing it. Setting reasonable caps on malpractice sounds pretty damn sensible to me, and would likely have a profound effect on the amount of defensive medicine being practiced today. The republicans have a point here, and while I think they ask for too much in their proposals, there's plenty of room for negotiation on how much is too much.

 

Well that doesn't kick in for nearly another four years. There's a lot of early returns in the bill that passed though, some of which will go into effect as soon as the bill is signed, and others that will be phased in within the next six months. The exchange is not one of those items.

and

That have been analyses done on how much money tort reform would save, and it turns out that while there are some very large settlements when doctors screw up badly, it is not a big contributor to total costs. The analyses that I have seen (I'll try looking them up and will post if I find them) indicate that if there was a cap on settlement values, it would reduce health care costs by approximately 0.5%. Shaving 50 cents off of every $100 you spend in premiums is simply not a big savings to the consumer. Even if you have a really nice health care insurance plan that costs you $10,000 out of pocket, tort reform would save you about 50 bucks.

That would only work if the compensation paid by Medicare greatly increased. One of the reasons why there is a shortage of primary care physicians is that the reimbursement rates are terrible for regular office visits - especially in the case of Medicare/Medicaid. Some doctors do not accept it all, and no doctors wants most of their patients to use it, because they do not even make enough money from those visits to break even. Compensation levels from Medicare from a typical office visit are just $27. When you have payroll for your staff, bills for heating/air conditioning, electricity, water, and equipment maintenance, it costs them more to see those patients than they make.

My brother is a doctor, and one of the biggest factors that played into his decision to become an ER doctor was that he would be a salaried employee, and that it would be the hospital that would deal with billing and with the insurance companies. Any private doctor will tell you that they wish they could spend more time seeing patients and less time with insurance companies.

 

That's why we have jury trials. I suppose some don't like the outcomes of those trials, but that is the due process of law. We use the same system in many civil and criminal trials, even putting people to death. If a person dies because of poor care, which does happen, what is the price of human life? And to his family?

My doctor tells me that the tests he orders are mostly standard procedure directed by the health care provider he works for, which is to provide the best care possible for the patient. The tests are largely a matter of routine policy but very lucrative for the provider.

 

I agree with the increasing medicare part -- it would even be more complex than that ... there would need to be cost of living adjustments for different areas of the country and an exclusion for "high quality care."

But I think Medicare does need to revamp payments (it should be done annually).

 

I just read an article that there are already several states challenging the Constitutionality of healthcare reform, and the grounds that it is a mandatory direct tax that forces people to purchase a commodity.

While it is doubtful that these challenges will be successful (or will even see the inside of a courtroom for that matter), it is worth pointing out as the article does, that if healthcare reform is a mandatory direct tax that forces people to buy a commodity, and is thereby unconstitutional, so is Social Security and Medicare. Of course, such a result may be fine and dandy among many in the GOP, but my understanding of the situation is a lot of retired people kind of like that check they get from SS, and would be none too pleased if it were taken away.

I also hear a lot of members of Congress claiming that they will "repeal" healthcare reform. As far as I can tell, that is empty rhetoric, and totally impossible prior to 2013. Even under the best case scenario during the midterm elections, let's say that the Republicans take back the House (recent polling shows about even odds of that happening) and the Senate (recent polling shows this is remote - current projections show the Dems losing 5 Senate seats which would make the Senate composition 54-46 in favor of the Dems).

But for shiggles, let's assume that 2010 is a "change" election in much the same way 2008 was a "change" election and the Republicans control both chambers of Congress. Remember those fillibuster rules the Democrats were so annoyed with when the Republicans employed them? You can bet your ass that the Democrats would do the same thing if the Republicans tried to repeal healthcare reform. Of course, that's not the biggest hurdle to overcome. As near as I can tell, Obama is still going to be the President until at least January 20, 2013, and would veto any measure that would repeal healthcare reform.

Therefore, the only way Republicans could possibly repeal any of this prior to 2013 would be if they not only won a majority in both chambers of Congress in the midterm elections, but also won a supermajority that could override a Presidential veto. Such a scenario far surpasses even the rosiest pie-in-the-sky GOP projections.

 

I am still flabbersgasted that some Reps are saying that this is "tyranny" or "dictatorship" or whatever -- it was passed by a majority of elected officials, correct? It may have been a slim majority, but it was all done according to the democratic process, was it not? I mean, rhetoric is rhetoric, but this is BS. I'm sure that if we cracked open the archives we could find a Republican initiative in that past that was passed by a similarily sized majority.

 

The states certainly have no problem forcing us to buy auto insurance, which is also a commodity. I realize it is a little different, in that you can choose, or not choose to buy a car, but there was a time you could get a car without having to pay the insurance companies. At the time, Republicans said that it was "the responsible thing to do." Now, it's the reverse, and dems are making the same argument for health insurance.

The thing for me is, YES, by all means, remove the provision for the insurance mandate. Nothing will sink the insurance companies faster than removing the mandate from the new heath care laws. The Republicans just might give us single-payer, universal care faster than the liberal Dems could have ever hoped to.

 

Can you explain this a bit further? My understanding of the personal mandate was that since you can no longer deny coverage on the basis of a pre-existing condition, without a personal mandate people could simply wait until they got sick to apply for insurance. Or, more simply, the people who presently want insurance but cannot get it because they already have a pre-existing condition are all going to sign up. If we add a whole bunch of sick people without also adding healthy people, the insurance companies will raise the rates on everyone. By adding more healthy poeple than sick people, the thinking is that rates won't increase as much.

I do not see how removing the mandate would sink insurance companies - wouldn't they just charge more?

 

Yes, but people would only have to get insurance once they actually HAD a condition. The rest of the time they wouldn't need it, since there are no longer any restrictions.

 

So your assumption is that many people who already have insurance would drop it, and just hope they didn't get into a car accident or something where they would need insurance immediately? (Or really in any situation where you'd have to go to the emergency room.) I'm not sure that would happen.