[PassedOut]

Except for people in Virginia, I doubt whether many adults would be stupid enough to sign a binding refusal of care, but some folks seem to feel strongly about having that right. So let them have it (not children, of course), providing it doesn't put the burden on the rest of us. Over time, should be beneficial for the population as a whole (Darwin awards on steroids)...

I hope that most people discussing the current proposal know the basics of what's in it (for anyone on the internet, there is no excuse not to know). A number of items aim to get a handle on costs over time. For example, Prevention of Chronic Disease and Improving Public Health.

Quote

It directs the creation of a national prevention and health promotion strategy that incorporates the most effective and achievable methods to improve the health status of Americans and reduce the incidence of preventable illness and disability in the United States.

The Act relies on the innovation of small businesses and state and local governments to find the best ways to improve wellness in the workplace and in our communities.  And it strengthens America’s capacity to respond to public health emergencies.

The Act empowers families by giving them tools to find the best science-based nutrition information, and it makes prevention and screenings a priority by waiving co-payments for America’s seniors on Medicare.

And the proposal contains a long list of items to address obvious problems: Policies to Crack Down on Waste, Fraud and Abuse.

Quote

The House and Senate health reform bills contain an unprecedented array of aggressive new authorities to fight waste, fraud and abuse.  The President’s Proposal builds on those provisions by incorporating a number of additional proposals that are either part of the Administration’s FY 2011 Budget Proposal or were included in Republican plans.

Starting over is not realistic, and any politician who suggests that is just posturing for fools. Any lack of bipartisanship cannot be laid on Obama, and the republicans have yet another chance to contribute. If they don't, I certainly hope that the democrats ram this proposal down their throats. The US can't afford the status quo.

[luke warm]

PassedOut, on Feb 24 2010, 11:49 AM, said:

Any lack of bipartisanship cannot be laid on Obama, and the republicans have yet another chance to contribute. If they don't, I certainly hope that the democrats ram this proposal down their throats. The US can't afford the status quo.

there are many republican proposals that won't be accepted, or (if not republican) common sense ones... like, open up all insurance companies to all states, or limit (or eliminate) malpractice suits

[jdonn]

luke warm, on Feb 24 2010, 12:37 PM, said:

PassedOut, on Feb 24 2010, 11:49 AM, said:

Any lack of bipartisanship cannot be laid on Obama, and the republicans have yet another chance to contribute. If they don't, I certainly hope that the democrats ram this proposal down their throats. The US can't afford the status quo.

there are many republican proposals that won't be accepted, or (if not republican) common sense ones... like, open up all insurance companies to all states, or limit (or eliminate) malpractice suits

Perhaps not everyone agrees those proposals are common sense. Also I was under the impression Obama decided to be open to some sort of malpractice reform.

I'm wondering from your post, can you think of any non-Republican "common sense" ideas that won't be accepted?

[luke warm]

jdonn, on Feb 24 2010, 12:42 PM, said:

I'm wondering from your post, can you think of any non-Republican "common sense" ideas that won't be accepted?

hey, maybe you forgot but i'm already on record as supporting a single payer type system, if it's done right... that was a common sense proposal that (some) dems wanted, but was shot down (and not only by reps)

[jdonn]

You're right, I either forgot or never knew.

[PassedOut]

luke warm, on Feb 24 2010, 12:37 PM, said:

there are many republican proposals that won't be accepted, or (if not republican) common sense ones... like, open up all insurance companies to all states, or limit (or eliminate) malpractice suits

Obama certainly supports limiting malpractice suits as he has said many times. In itself, that would not reduce costs much, but over time doctors would stop ordering so many unnecessary and expensive tests -- a good thing. The proposed initiatives to study and make available the relative efficiencies of competing diagnostic techniques would also tend to immunize doctors against unreasonable suits.

Obama has also expressed support for opening up insurance across state borders, recognizing that that is a much more complicated situation given the differing insurance regulations and commissions in each state. But the proposed insurance exchange is a step in the right direction.

[hrothgar]

luke warm, on Feb 24 2010, 08:37 PM, said:

PassedOut, on Feb 24 2010, 11:49 AM, said:

Any lack of bipartisanship cannot be laid on Obama, and the republicans have yet another chance to contribute. If they don't, I certainly hope that the democrats ram this proposal down their throats. The US can't afford the status quo.

there are many republican proposals that won't be accepted, or (if not republican) common sense ones... like, open up all insurance companies to all states, or limit (or eliminate) malpractice suits

For the record, there are already significant numbers of insurance companies that operate in multiple states. Admittedly, these companies need to abide follow the laws that have been enacted by the various states; however, that's one of the costs of "Federalism".

When Republican's talk about opening up all states to all insurance companies, what they really mean is allowing insurance companies to incorporate in some hell hole like Texas and use this as an excuse to ignore any state regulations that they don't like.

Its truly remarkable to see the hypocrisy as the champions of state's rights attempt to gut states from enacting their own local regulations.

[PassedOut]

Another way to heat up competition among insurance companies, much less complicated than fixing the state-by-state situation, looks like it might come to pass quickly: Bust the Health Care Trusts.

Quote

President Obama on Tuesday announced his support of a House bill that would repeal health insurers’ antitrust exemption, and Speaker Nancy Pelosi signaled that she would put it toward an immediate vote.

It will be interesting to see by the voting on this who is, and who is not, in favor of competition.

[luke warm]

hrothgar, on Feb 24 2010, 01:05 PM, said:

Its truly remarkable to see the hypocrisy as the champions of state's rights attempt to gut states from enacting their own local regulations.

states rights? hell, that antiquated philosophy went out in 1913 or thereabouts

[Rodney26]

PassedOut, on Feb 24 2010, 11:49 AM, said:

Starting over is not realistic, and any politician who suggests that is just posturing for fools. Any lack of bipartisanship cannot be laid on Obama, and the republicans have yet another chance to contribute. If they don't, I certainly hope that the democrats ram this proposal down their throats. The US can't afford the status quo.

I agree the US can’t afford the status quo; it just seems impossible that further government intervention into health care will make it cheaper. Why wouldn’t it be more expensive than it is now? Consider:
1. The federal government has specifically intervened in the housing market to make housing more expensive in the last couple years.
2. Clearly, government intervention in the world of student loans has caused higher education costs to go through the roof to the point where the middle class can’t approach being able to afford college without taking on well into the 5 figures worth of debt.
3. Massachusetts, the state that has the closest thing to universal health care, has the highest per capita costs in the country despite being a relatively healthy state. The system isn’t the only driver of course (great hospitals & doctors, world class eye care & children’s care), but lower costs have not been realized.
4. The recent explosion in health care costs has occurred concurrently with state and federal governments’ increased roles as third party payers, which will soon cross 50%.
5. The idea that the profit motive for insurance companies is the major driver of rising costs is too often cited. The lack of competition is far more of a driver (and I agree Reich is onto something until he throws the public option out there, which is gamed competition). There are plenty of companies out there that have made billions of dollars for themselves and their shareholders, and yet a consumer gets a far better product for his or her money today than 20 years ago. Personally, I think medicine has gone in the opposite direction – twice as much money for the same or a slightly inferior product.
The wellness programs are a red herring as well I think. We’re far healthier in our habits than we were twenty years ago. These programs are great for us as a whole but economically they’re a nonfactor. Consumers need to care about how much things cost again. They’ll cross the street to save a penny on gas but 3 and 4 figure decisions in medicine are completely transparent to them.

[jdonn]

I think most of the last post is rubbish. For example, on 1 the specific goal of the government was to make housing more expensive! Or at the very least that was an obvious consequence of their specific goal and was not some unpredictable side effect. 3 is a non sequitor. And 5 contradicts the claim that government involvement wouldn't reduce cost.

[awm]

In response to HotShot's number five point, the observation I've seen and agreed with is that competition spurs innovation in the market.

This means if I'm running a restaurant, competition with other local restaurants will encourage me to produce better food (or I'll go out of business). If I'm running an auto company, then competition with other companies encourages me to produce better vehicles (or cheaper vehicles, or something) so again the competition has encouraged innovation.

But here the market is health insurance. Not medicine -- insurance. So competition will encourage companies to come up with more innovative insurance. Again, these companies are not designing better drugs or treatments. So what does innovation look like in insurance? Finding creative ways to kick the most expensive customers out of the plan as soon as they become expensive... check. Finding ways to get large numbers of healthy people to sign up for insurance by providing group rate discounts... check. Finding ways to accurately evaluate risk and refuse insurance to people with pricey pre-existing conditions... check. Finding ways to restrict (a.k.a. ration) coverage so that insured people don't get expensive procedures or visit expensive specialists... check!

Do we really want all this "insurance innovation"? Probably not.

And it's not just the company profits that are an issue here. Suppose that a big insurance company gets $5 billion in payments for insurance. If their choices are to spend $4.5 billion for medical care for the people they cover, or to spend $3 billion for medical care for the people they cover and $1.25 billion paying their employees to come up with ways to avoid paying the other $1.5 billion... they pick the second way. This makes their profits a bit higher (but only 15% overhead rather than 10%) yet the gap in payments received versus medical care is much higher. It's even in their interest to create annoying bureaucracy, to try to convince expensive folks to switch insurance if they can.

[jdonn]

Competition spurs better value, not (just) better products. Better value is achieved in either or both of two ways. Better products, and lower prices. Adam you seem to have ignored the second way entirely and thus reached a(n at least partially) faulty conclusion.

[hotShot]

awm, on Feb 24 2010, 11:59 PM, said:

In response to HotShot's number five point, ...

Have I posted in this thread?

[Rodney26]

awm, on Feb 24 2010, 05:59 PM, said:

But here the market is health insurance. Not medicine -- insurance. So competition will encourage companies to come up with more innovative insurance. Again, these companies are not designing better drugs or treatments. So what does innovation look like in insurance? Finding creative ways to kick the most expensive customers out of the plan as soon as they become expensive... check. Finding ways to get large numbers of healthy people to sign up for insurance by providing group rate discounts... check. Finding ways to accurately evaluate risk and refuse insurance to people with pricey pre-existing conditions... check. Finding ways to restrict (a.k.a. ration) coverage so that insured people don't get expensive procedures or visit expensive specialists... check!

Do we really want all this "insurance innovation"? Probably not.

And it's not just the company profits that are an issue here. Suppose that a big insurance company gets $5 billion in payments for insurance. If their choices are to spend $4.5 billion for medical care for the people they cover, or to spend $3 billion for medical care for the people they cover and $1.25 billion paying their employees to come up with ways to avoid paying the other $1.5 billion... they pick the second way. This makes their profits a bit higher (but only 15% overhead rather than 10%) yet the gap in payments received versus medical care is much higher. It's even in their interest to create annoying bureaucracy, to try to convince expensive folks to switch insurance if they can.

A lot of what you say is true, but the problem isn't the concept of insurance. It's the problem of the consumer not having the power to tell the insurer to pound sand since insurance is tied to one's job. Why haven't there been these types of double digit annual increases in auto insurance, home insurance, or life insurance? Those industries have the same incentive that you describe below to make money and control costs. The difference is they deal mostly with individuals who have competitive options. I could cry to my employer about how my health insurance company screwed me over, but in the end it isn't going to have any impact. If my auto insurance company screws me over, I can call a competitor right away and use them instead.

There's also I think an issue of perception. No one would think any less of Amica if they denied auto insurance to someone twice convicted of a DUI, or fire insurance to a pyromaniac. We accept that people on the coast should pay higher home insurance premiums than inlanders with all else being equal, since it is reasonable to do so because of climate associated risks. However, when it comes to human health, there are at times forces entirely outside of our control that change our perception. Someone is diagnosed with leukemia and the evil health insurance company won't cover them, even though it is a virtual certainty that the insurance company stands to lose money providing that care. I think a lot of what drives that is that we ourselves want to think we'd be taken care of if bad luck struck for us or our families.

Nevertheless, my main point is that there is no evidence that our medical costs will be less expensive if we go to single payer or some other federal provider program. Creating a monopoly always has the opposite effect -- those long distance phone bills from the 80's where ATT was allowed to declare that it costs 80 cents per minute to provide this service weren't that long ago. Too many people assume that cost reduction will be the case. It won't be.

I'd love it if we could go to the auto insurance model, stop "insuring" routine annual health care and ditch the corporate tax break so that we could make individual choices in terms of our insurance. The government could still charge a 2% tax or something on incomes to create a disaster pool for the unfortunate. We're a reasonable people when it comes to that sort of thing.

[PassedOut]

Rodney26, on Feb 24 2010, 07:38 PM, said:

Nevertheless, my main point is that there is no evidence that our medical costs will be less expensive if we go to single payer or some other federal provider program.

Every country in which the government takes responsibility for the health of its citizens gets better results for half the per capita cost.

[mike777]

Guys again note as been discussed over and over in the forum


Europe pays 50% in terms of GDP and gets better care than the USA does..

Somehow we need to cut our costs in half and add 50 million to govt paid health care.


Instead the debate seems to be.....add a few to health care and increase health care costs more and lose all innovation in health care.

------------


I just do not see anyone showing us the numbers how the usa can cut our current overall health care costs 50% and increase innovation.....


But if we can do it.....I am for it.

[mike777]

in fact we get hints..just hints that some parts of Europe...Greater Europe are falling apart over lack of money/productivity and lack of innovation....


In any case that is the worry.....

[mike777]

JUst to throw out one solution to discuss....

If the USA just withdraws from the world.....in terms of Defense etc.....perhaps that is one way to fund...partially fund these social programs.......I think that is how greater Europe does it....they spend less...alot less on defense and the ability to project troops thousands of miles away......

Most if not all European countries cannot project 200,000 troops half way around the world for years......


----------


Of course none of this cuts gdp costs in half...see Europe....

[mike777]

Of course the other debate is:


I dont care how much health care costs...we need to cover everyone.....and save everyone.....DAMN the cost.......