[kenberg]

Winston had a thread starting with Palin, Mike has a thread concerned with the legality of requiring insurance, I intend this thread to be for any comment relative to health Care.

Some opening thoughts:


It has been my view that constructive negotiations across the aisle would be the best approach to getting the best bill. Senator Baucus, standing alone, has presented the results of his best effort at this. I now conclude that either we will have a bill drafted by Democrats and rammed through by Democrats, or we will have no bill at all. The train is leaving the station, Republicans have opted to stay on the platform and toss rocks. The strongly liberal will say of course, what did you expect, but I ask the conservatives on this Forum if they agree that I have drawn the correct conclusion here.

[kenrexford]

This topic is sort of like trying to get a concensus on abortion. Too many strong feelings that are irreconcilable.

It would be nice if people could also quit with the all-or-nothing approach to all of this. Some reforms can be accomplished without overhauling everything.

For example, why is tort reform considered tied somehow to an entire reform? Can't we just enact caps on aspects of torts if we think that makes sense? Of course not -- this only gets addressed as a tat on the tit-for-tat. Even if some who "oppose" tort reform actually favor tort reform, they cannot give up that bargaining chip without something in exchange. So, nothing is done.

How about the "waste and abuse" in Medicare? Why wait? If "W&A" costs $500B, such that eliminating W&A would "pay for" some new plan, isn't that rather silly math? I mean, if you got rid of W&A now, we'd save $500B now. Then, if we did the new thing, that $500B would be an actual cost, not some sort of silly offset. So, we don't get rid of W&A because we need the ability to eliminate W&A as a means to cover costs of another plan?

I love that logic. I have a plan too. Let's set up a cashing burning plan. $1 million dollars each year is burned for no reason. Then, we can stop burning $1 million dollars each year for no reason and instead pay me $500K per year because I'm a nice guy. That will actually make money for the government.

It's sort of like the "jobs saved" idea. Estimate job losses high, and then claim jobs saved if we don't reach that job loss figure. Except, they screwed that one up by estimating job losses too low. Damn! So, re-estimate job losses even lower after-the-fact and then claim jobs saved! This is brilliant.

I like this. I could take that $500K and estimate that not giving me $500K would actually cost the government the $1 million PLUS another $500 K in economic losses nationally. Thus, the $500K to me would actually save government $500K and would save the economy another $500K.

[PassedOut]

kenberg, on Sep 17 2009, 07:43 AM, said:

It has been my view that constructive negotiations across the aisle would be the best approach to getting the best bill. Senator Baucus, standing alone, has presented the results of his best effort at this. I now conclude that either we will have a bill drafted by Democrats and rammed through by Democrats, or we will have no bill at all. The train is leaving the station, Republicans have opted to stay on the platform and toss rocks. The strongly liberal will say of course, what did you expect, but I ask the conservatives on this Forum if they agree that I have drawn the correct conclusion here.

I think you are correct. I had originally thought that a few republicans would pitch in to help with this, but the politics have played out in a way that makes it very difficult for moderate republicans to do so.

Clearly some of the political problems were caused by the white house "over-learning" the lessons from the Clinton failure and therefore deferring too much to congress. But Obama has certainly reached out to try to include republicans - tort reform is just one example - and has gotten no cooperation in return. And Baucus has worked very hard to forge a bipartisan agreement.

I have noted that some posters do not see reducing waste as a way to pay for a substantial portion of the cost of health care reform, but I disagree. Looking at the big picture, the US pays exorbitant amounts for health care and receives mediocre results. As a business person, I can say with confidence that this does not happen without a huge amount of wasteful spending.

Much of the waste occurs because of flaws in the current laws, and Obama has set the goal of fixing those flaws. To the extent that congress follows through, the savings will help offset the costs of reform. Some of the most wasteful items to eliminate are republican programs such as Medicare Advantage that exist only to provide an additional way to rip off seniors.

But tort reform to reduce the costs of liability insurance and unnecessary defensive testing is also important, and has been resisted by democrats in the past. Eliminating that waste, too, requires changing the laws. (Yes, I do know that states that have enacted tort reform to reduce medical costs have not achieved that result: it has to come as part of a comprehensive reform.)

So the democrats alone will have to ram something through, and it won't be as good as it could be or should be. That's too bad, but that's the reality. A vote against the democrats' plan will be a vote for the status quo, and the status quo is simply unacceptable.

[mike777]

"I have noted that some posters do not see reducing waste as a way to pay for a substantial portion of the cost of health care reform, but I disagree."


My guess is if the total amount of waste and fraud in govt paid health care equals X today then in 5 years or less the total will be closer to 2x not 1/2x.

In other words the gross amount of waste and fraud will increase not decrease.


As for the private sector I think alot of these assumptions seem to rest on on the absurd idea that the owners of companies do not care about waste or fraud and ignore it. We care! We want to maximize profits not lose profits to waste and fraud. OTOH if posters consider profit as waste or fraud ok...

[PassedOut]

mike777, on Sep 17 2009, 10:26 AM, said:

My guess is if the total amount of waste and fraud in govt paid health care equals X today then in 5 years or less the total will be closer to 2x not 1/2x.

In other words the gross amount of waste and fraud will increase not decrease.

I understand that's your guess, and I considered your view before I posted.

mike777, on Sep 17 2009, 10:26 AM, said:

As for the private sector I think alot of these assumptions seem to rest on on the absurd idea that the owners of companies do not care about waste or fraud and ignore it.  We care!

As a business owner myself, I certainly care about waste and fraud and know how to confront and address it in our businesses.

Our family's businesses are seriously affected by the wasteful spending in the current US health care system. Because it is demonstrably possible to cut waste, and because Obama's proposals (if enacted) do cut waste, I think it's nonsense to oppose those proposals because of vague fears and guesses. But it's a free country.

Where the waste is caused by current laws, as much of it is, the laws should be changed as Obama asks. Where the waste is caused by poor administration, that should be laid at Obama's feet, and he should be held accountable.

[barmar]

kenrexford, on Sep 17 2009, 09:00 AM, said:

It would be nice if people could also quit with the all-or-nothing approach to all of this. Some reforms can be accomplished without overhauling everything.

Perhaps, but sometimes it becomes easier to get things done if they're all part of a comprehensive package.

I think Obama sees this as his New Deal or Interstate Highway Act. If you have a project that says you're going to achieve N goals, you then don't have to start a new fight for each separate piece.

On the other hand, getting that comprehensive bill passed is a bitch. If Obama can get it done, it will almost certainly be his legacy.

[kenrexford]

I still dcon't get this fraud and waste argument. Let me see if I have this correct.

The current Medicare system has $500B in fraud and waste.
We are not going to eliminate the fraud and waste unless we reform the health care system to the Dem liking.
If the Dem's get what they want, then we will fix Medicare, to the tune of $500B, and that will pay for what the Dem's want.

There seem to be a few responses to this.

First, fix Medicare regardless of whether there are reforms or not. Then, we have $500B in the bank. Next, decide whether to use that savings on roads, schools, defense, tax reduction, or health care changes. Don't hold the People hostage to fraud and waste as a bargaining chip.

Second, if itty-bitty Medicare has fraud and waste, why should we believe that doubling down will eliminate waste? Won't the same practices repeat such that we have more fraud and waste in the end? That would be great, because then we could eliminate that $1T in waste for the next great idea.

[onoway]

Listening to an interview this morning and they commented that the current sort of hysteria surrounding the health care issue in the States was reminiscent of the same upheaval surrounding social security laws or/ and the civil rights laws being brought forward . "White people will become slaves! being about on a par with the "death panels will kill your grandma!!".

They suggested that Obama needs to come up with a different stance if he wants to get this through and suggested something along the lines of F.D.R. 1936 speech in Madison Garden would be required . I looked it up and it seems pertinent in so many ways. Although it doesn't touch on health issues specifically certainly almost everything else in the latter half of the speech could have been written in the last six months. The more things change the more they stay the same. Perhaps Obama also needs to draw the line in the sand if he wants to get something accomplished.
http://history.sandi...us/fdr1936.html

[RichMor]

PassedOut, on Sep 17 2009, 09:17 AM, said:

I have noted that some posters do not see reducing waste as a way to pay for a substantial portion of the cost of health care reform, but I disagree. Looking at the big picture, the US pays exorbitant amounts for health care and receives mediocre results. As a business person, I can say with confidence that this does not happen without a huge amount of wasteful spending.

Much of the waste occurs because of flaws in the current laws, and Obama has set the goal of fixing those flaws. To the extent that congress follows through, the savings will help offset the costs of reform. Some of the most wasteful items to eliminate are republican programs such as Medicare Advantage that exist only to provide an additional way to rip off seniors.

But tort reform to reduce the costs of liability insurance and unnecessary defensive testing is also important, and has been resisted by democrats in the past. Eliminating that waste, too, requires changing the laws. (Yes, I do know that states that have enacted tort reform to reduce medical costs have not achieved that result: it has to come as part of a comprehensive reform.)

I agree with what you wrote but, I also think we need to categorize federal expenditures for health care in more ways that simple binary good versus fraud/abuse.

I chased some Google links and found a few articles that quote the Medicare/Medicaid improper payment rate at between 3 and 4 percent. Because of the size of these programs the real money is a huge amount. But 3 to 4% wasted spending isn't huge.

I would not be at all surprised to learn that private health care plans make improper payments at a similar rate. Whould you ?

It is certainly a good idea to reduce outright fraud, but that's not enough to fund a public plan that would cover millions of currently uninsured.

I think we should also look at cost control from the perpectives of:
efficiencies of scale - covering X% more people while limiting administration cost increase to something less that X%,
efficient use of current resources - treat people in clinics instead of emergency rooms,
efficient payment for services - paying for results and not for test, procedures, etc.

Sound like good business to me.

RichM

[ggwhiz]

Many months ago, I saw a post to an article that highlighted the quality of care and cost efficiency of the Mayo Clinic model. Maybe someone can find it again?

The answers clearly exist even though the solution is certainly beyond me. Changing the status quo is a no-brainer but the tone of the debate and likelyhood of little to no progress is excruciating.

[PassedOut]

onoway, on Sep 17 2009, 12:22 PM, said:

Listening to an interview this morning and they commented that the current sort of hysteria surrounding the health care issue in the States was reminiscent of the same upheaval surrounding social security laws or/ and the civil rights laws being brought forward . "White people will become slaves! being about on a par with the "death panels will kill your grandma!!".

They suggested that Obama needs to come up with a different stance if he wants to get this through and suggested something along the lines of F.D.R. 1936 speech in Madison Garden would be required . I looked it up and it seems pertinent in so many ways. Although it doesn't touch on health issues specifically certainly almost everything else in the latter half of the speech could have been written in the last six months. The more things change the more they stay the same. Perhaps Obama also needs to draw the line in the sand if he wants to get something accomplished.
http://history.sandi...us/fdr1936.html

Thanks for the link to FDR's speech.

It's good to remember that the same kinds of arguments were made against social security in FDR's time (and later against Medicare during LBJ's tenure) as are being made against health care reform today.

I'm plenty old enough to remember Clinton's opponents arguing that his insistence on fiscal responsibility would lead to a depression. And of course I remember that every time a minimum wage increase comes up, the same arguments are made against it, and that the predictions of disaster always turn out to be wrong.

It's clear that many befuddled souls are fearful of changes in general and are angry at those working to bring about necessary changes to the US health care system. So it's good to look at some history these days to keep such things in perspective.

[PassedOut]

RichMor, on Sep 17 2009, 12:49 PM, said:

I think we should also look at cost control from the perpectives of:
efficiencies of scale - covering X% more people while limiting administration cost increase to something less that X%,
efficient use of current resources - treat people in clinics instead of emergency rooms,
efficient payment for services - paying for results and not for test, procedures, etc.

Yes, all these issues must be addressed, and more. But there is a lot of waste - not fraudulent waste, but legal waste - built into the current Medicare system as well. That needs to be fixed.

[RichMor]

PassedOut, on Sep 17 2009, 01:06 PM, said:

RichMor, on Sep 17 2009, 12:49 PM, said:

I think we should also look at cost control from the perpectives of:
efficiencies of scale - covering X% more people while limiting administration cost increase to something less that X%,
efficient use of current resources - treat people in clinics instead of emergency rooms,
efficient payment for services - paying for results and not for test, procedures, etc.

Yes, all these issues must be addressed, and more. But there is a lot of waste - not fraudulent waste, but legal waste - built into the current Medicare system as well. That needs to be fixed.

Yes, I agree that non-fraud waste in built in to Medicare/Medicaid.

That is what I meant by 'efficient payment for services'. I've seen and read several comments about the 'perverse incentives' of current programs.

Link

This link goes to a good article.

RichM

[kenrexford]

PassedOut, on Sep 17 2009, 01:04 PM, said:

onoway, on Sep 17 2009, 12:22 PM, said:

Listening to an interview this morning and they commented that the current sort of hysteria surrounding the health care issue in the States was reminiscent of the same upheaval surrounding social security laws or/ and  the civil rights laws being brought forward . "White people will become slaves! being about on a par with the "death panels will kill your grandma!!".

They suggested that Obama needs to come up with a different stance if he wants to get this through and suggested something along the lines of F.D.R. 1936 speech in Madison Garden would be required . I looked it up and it seems pertinent in so many ways. Although it doesn't touch on health issues specifically certainly almost everything else in the latter half of the speech could have been written in the last six months. The more things change the more they stay the same. Perhaps Obama also needs to draw the line in the sand if he wants to get  something accomplished.
http://history.sandi...us/fdr1936.html

Thanks for the link to FDR's speech.

It's good to remember that the same kinds of arguments were made against social security in FDR's time (and later against Medicare during LBJ's tenure) as are being made against health care reform today.

I'm plenty old enough to remember Clinton's opponents arguing that his insistence on fiscal responsibility would lead to a depression. And of course I remember that every time a minimum wage increase comes up, the same arguments are made against it, and that the predictions of disaster always turn out to be wrong.

It's clear that many befuddled souls are fearful of changes in general and are angry at those working to bring about necessary changes to the US health care system. So it's good to look at some history these days to keep such things in perspective.

Have you missed all of the discussion about social security going bankrupt in so many years? It seems that maybe the folks back arguing in the first half of the 20th Century were right, just wrong as to how long it would take.

[PassedOut]

kenrexford, on Sep 17 2009, 02:40 PM, said:

Have you missed all of the discussion about social security going bankrupt in so many years?  It seems that maybe the folks back arguing in the first half of the 20th Century were right, just wrong as to how long it would take.

Nope, haven't missed that. The subject comes up every so often as the demographics change and, of course, social security is always trivially easy to fix.

Over time, the so-called "retirement age" has to keep going up, even more than it has been. I know that the democrats don't like to acknowledge this because it scares some seniors, but there is no way around it. On the other hand, the democrats successfully resisted putting social security money into the hands of Bernie Madoff, Bear Stearns, Lehman, and Merrill Lynch.

[kenrexford]

PassedOut, on Sep 17 2009, 03:00 PM, said:

kenrexford, on Sep 17 2009, 02:40 PM, said:

Have you missed all of the discussion about social security going bankrupt in so many years?  It seems that maybe the folks back arguing in the first half of the 20th Century were right, just wrong as to how long it would take.

Nope, haven't missed that. The subject comes up every so often as the demographics change and, of course, social security is always trivially easy to fix.

Over time, the so-called "retirement age" has to keep going up, even more than it has been. I know that the democrats don't like to acknowledge this because it scares some seniors, but there is no way around it. On the other hand, the democrats successfully resisted putting social security money into the hands of Bernie Madoff, Bear Stearns, Lehman, and Merrill Lynch.

So, what fix do you have in mind for when we have to adjust changing medical expenses?

[PassedOut]

kenrexford, on Sep 17 2009, 03:46 PM, said:

So, what fix do you have in mind for when we have to adjust changing medical expenses?

My personal choice would be that basic insurance available to everyone would cover no-frills medical care (with an emphasis on preventive action) and catastrophic care, prioritized to match the funds available. I would leave out entirely all the heroic and costly end-of-life measures that drain so much from the system.

Private insurers would offer policies to cover those measures, as well as for any amenities not covered by the basic insurance, probably using a step system as is currently in place for medicare supplements.

But I'm not in congress, so am waiting like everyone else to see how (and to what extent) the US government actually fixes our broken health care system.

[awm]

A lot of discussion treats health care as if it's a uniquely American problem, and other countries have a working system. While it's true that the American health care system is unusually dysfunctional, there are serious problems with health care worldwide. Some interesting data is available.

The key point here is that health care costs are rising substantially faster than GDP in essentially every country. Health care costs per capita are rising quickly worldwide. While the United States has the highest health care costs per capita of any country, and is above the average in terms of the growth rate of health care costs per capita, the cost of health care is exploding worldwide (or at least in the modern, industrialized countries).

Some of this is due to an aging population. But it seems strange that the incredible advances in medical science are not making things cheaper. Technology does make most things cheaper (for example computers have come way down in price). It could be that our expectations are growing faster than the technology can bring costs down -- but even decades-old technologies (like an MRI) are expensive in the medical sector. It seems like there is a fundamental problem here which needs to be addressed. All the talk about moving the US to a system closer to the ones in other countries might help a bit with the current expense of health care (where most countries are doing substantially better) but the ridiculous growth rate in health care costs will take more than this to address.

[blackshoe]

Upping the "retirement age" is one thing, but along with that, we need to make sure that people who aren't yet of that age can still find jobs.

Social Security as originally envisioned was a workable system. It's what Congress has done to it since that's driven it into the ground. And at least half of the politicians involved were Democrats.

[Winstonm]

Quote

It has been my view that constructive negotiations across the aisle would be the best approach to getting the best bill

Why would anyone want to compromise with Atilla the Hun? The better avenue is to ignore the ignorant and forge ahead - if the ignorant find a way to stop the majority, that will be fine as they will then marginalize themselves even more and the next attempt at real change will be more successful.

Otherwise, all we will get is a bill that benefits the health care and insurance industries and makes no real difference in real peoples' lives.