[mike777]

PassedOut, on Mar 3 2010, 11:07 PM, said:

Because the US spends twice as much per capita for medical care as do countries with more advanced systems -- while obtaining poorer results -- it is obvious that around 50% of the money spent is wasted. Even folks who are not in business can grasp that, but to business people that fact stands out like a sore thumb.

Quote

Consider this: For every dollar the nation spends on health care, 50 cents is wasted.

According to a 2008 report by Pricewaterhouse Cooper's Health Research Institute, wasteful spending accounts for $1.2 trillion of the $2.2 trillion spent on health care in the United States. The medical waste includes costs associated with inefficient insurance claims processing, defensive medicine, preventable hospital readmissions, medical errors, and unnecessary emergency room visits.

"Our best estimate is that for the country as a whole, probably half of what we're spending on health care delivery today is technically waste from a patient's perspective. There are better ways of doing it," said Dr. Brent James, chief quality officer for Intermountain Healthcare, a nonprofit health system in Salt Lake City, Utah.

The way a doctor chooses to treat a patient may also contribute to waste. Variations in treatments waste the health system $10 billion annually, according to the report. When a hospital like Intermountain swaps out expensive procedures for cheaper, equally effective treatments it actually loses money. It can no longer charge for those pricier procedures.

Because there is so much waste, any reasonable measures taken now cannot help but cut medical costs. There is just too much low-hanging fruit ready to be picked. With the amount spent on medical care in the US today, every US citizen should be receiving the best medical care in the world -- with the money left over being applied to the national debt.

I've mentioned before that I wish Obama and the democrats had gone more aggressively after the waste in the system, but I understand that they had to consider the firestorm of opposition from those who feed on that waste. However, it is absolutely clear that the reforms Obama advocates will cut costs now and in the future.

Because anyone with a head for business can see that too, I suspect that one of the reasons the republicans have been trying so hard to block reform is solely to prevent Obama from having the long-term success he is certain to gain if the bill ever becomes law.

this really repeats many posts here on the forum.

USA health care costs 100% more than most western countrieswith poorer results.



Funny enough no one, that means me and you, have a solution.

ya attack waste, right....
--------


OP repeats the issue that most of us care less about costs...we do not pay for it or so we think.

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



The perception...worry is that the EU sucks at innovation and health care.......that is the unspoken worry...

That the EU is going broke on govt health care and that govt health care in the Eu really sucks..damn the who studies......

[kenberg]

I'm still working on the basics.

Browsing around, I see that the health care bill is estimated to cost the government about a trillion over the next ten years. So figure 100B a year. It appears that this is about three times (on a per capita basis) what the Massachusetts bill costs their state government. Cherdano has observed that what Romney suggests looks a lot like what Obama suggests. But if the Obama bill costs the government three times as much, one would hope there are some productive things in it that are not in the Massachusetts plan. What are they?


Also I am still wondering about the notorious Cadillac plans. Are they substantially better than what senators have? The announced intention, or at least a frequent argument, is to offer everyone in the country the equivalent of what a senator has, right? But the implication seems to be that the Cadillac plans are excessive. In what way are the Cadillac plans so much more extensive than what the senators get? Are the senators ok with this?

I don't know if I have a head for business, probably I don't. But I have little tricks that help me out. A billion dollars of government spending is about three dollars a person. 100B is about $300 a person. Kids won't be paying (too young) and the poor won't be paying this $300 (no money), and those with low incomes won't be paying much. So I suppose that I will, if the books are to be balanced (don't hold your breath for that), be paying maybe $1200 to $1500. That's to pay for the government plan. I will still need to pay medicare and my supplemental insurance. I guess I can come up with the money, but I would like to know what I will be getting for it. And if Massachusetts can do roughly the same thing at a third the cost, I wouldn't mind.

[PassedOut]

As someone who looks at charts and graphs a lot, I use this trick that helps me out: When I see a cost line taking off like a rocket for outer space, I want that line to begin an arc that returns it back to earth.

Without government control, health care costs right now are heading for outer space, and nothing is in place to stop that momentum.

Except for stronger tort reform, which the republicans could have had in exchange for a few votes, Obama's health care bill contains every feasible cost-cutting measure suggested by health care experts -- democrat, republican, and independent. Over time, these measures will start to bring the cost line back toward earth. That's what is meant by "bending the cost curve."

To vote against Obama's bill is to vote for letting the cost line continue toward outer space. That would be a continuation of the fiscal irresponsibility that took hold after Clinton left office.

[y66]

No offense but I think arguments by kenberg and lobowolf about the finer points of cost cutting are copouts.

Yes, there are many unknowns about how the real long term costs of the proposed health care reform will shake out and yes these unknowns are worrisome as are unknowns in general.

I don't understand the argument for fearing these unknowns more than the known, continuously worsening problems that proposed reforms attempt to remedy, however imperfectly.

Spare me the boogey-man stuff. It is time to pass this bill.

[Lobowolf]

y66, on Mar 16 2010, 11:37 AM, said:

No offense but I think arguments by kenberg and lobowolf about the finer points of cost cutting are copouts.

None taken, since I didn't make one.

[PassedOut]

y66, on Mar 16 2010, 11:37 AM, said:

Yes, there are many unknowns about how the real long term costs of the proposed health care reform will shake out and yes these unknowns are worrisome as are unknowns in general.

When a system is already run efficiently, it can be very painful (although sometimes necessary) to cut costs. I know.

But when a system is bloated with 50% waste as is the US health care system today, cost cutting could hardly be easier. Any reasonable approach will work, so Obama is pretty much guaranteed to have success if his reforms pass. And people in business necessarily understand that.

Personally, I don't like to be in positions where I have to spend time convincing other people that essential actions should actually be taken, so I conduct my life and business accordingly. But the government can't really dictate all necessary actions, nor would we want it to, so its approach must be different.

To reduce waste, the government can alter incentives in ways that make it advantageous for businesses and professionals to work on cutting waste in their own particular arenas. I can say from experience that business people do respond quickly to changes in incentives.

If you look at the Obama reforms, that is exactly they accomplish. He's put in pretty much every good cost cutting idea that anyone has proposed, regardless of which party proposed it, except for stronger tort reform.

[helene_t]

mike777, on Mar 16 2010, 09:17 AM, said:

The perception...worry is that the EU sucks at innovation and health care.......that is the unspoken worry...

I don't think EU sucks at health care. Maybe compared to Japan and Taiwan and South Korea. But compared to USA? No way. Now this may or may not be relevant to this discussion. Even if USA copied the Dutch or the French health care system (which nobody is suggesting) it may turn out that the excessive US health costs are related to other things which cannot be addressed through health care reform. Then again, it might not.

Yeah, EU sucks at innovation, compared to USA. What does that have to do with anything? You guys are not talking about socializing insurance, let alone socializing hospitals. Maybe the scope for innovative declarations of unnecessary or fictive treatments, or for innovative ways of avoid people with health issues becoming customers of one's insurance company, will be reduced. Maybe not. But if it happens it won't be a bad thing.

BTW it is not exactly an "unspoken" worry. The anti-reform propaganda produces loads of ridiculous nonsense about how bad the British health service is.

[kenberg]

y66, on Mar 16 2010, 11:37 AM, said:

No offense but I think arguments by kenberg and lobowolf about the finer points of cost cutting are copouts. 

Yes, there are many unknowns about how the real long term costs of the proposed health care reform will shake out and yes these unknowns are worrisome as are unknowns in general.

I don't understand the argument for fearing these unknowns more than the known, continuously worsening problems that proposed reforms attempt to remedy, however imperfectly. 

Spare me the boogey-man stuff. It is time to pass this bill.

No offense taken by me either, but I do not intend it as a cop out. I also don't agree that what I am saying is worrying about some vague unknowns. "Don't bother with the small print buddy, you want the car don't you?" Some sort of estimate can be made of the cost, and I gather that the one trillion over ten years is a more or less agreed upon ballpark figure. I am not worried that it may not be exactly on target, rather I am trying to estimate what this will cost me. It appears that the cost will be around $300 per person per year for the program. I could phrase it as a question, asking if that's about right, but it's what a trillion bucks over ten years works out to, approximately. It is certainly a given that not every citizen will be paying $300. If the books are to balance, I think estimating my cost at $1,000 per year is conservative, and make it $2,000 counting my wife.

It seems to me to be completely reasonable to ask if I have the fiigures roughly right. If the cost of $100B per year is right but the money won't be coming from me who will be paying it?

I could agree, sort of, that the stuff about the Cadillac plans is not particularly vital. But I get tired of hearing the argument that every citizen should be entitled to a health plan as good as the one available to senators. I seriously doubt that those who use that argument have thought it through to its logical conclusion. It's a snazzy slogan, but I expect that the senators have something at least somewhat comparable to the dissed Cadillac plans, so how could this work out? Of course what else is new. Arguments are not required to stand up to scrutiny to be useful.

Not only with health care but with general suggestions for government spending I often divide the proposed total by 300+ million to estimate my share of the bill. I find it useful. Maybe indeed this bill should be passed. Maybe I should buy a Porsche. Whichever is contemplated, I like to see the price tag prominently displayed before I put my signature to the contract.

[luke warm]

PassedOut, on Mar 16 2010, 08:08 AM, said:

To vote against Obama's bill is to vote for letting the cost line continue toward outer space. That would be a continuation of the fiscal irresponsibility that took hold after Clinton left office.

that doesn't necessarily follow... i've heard different motives for passing a (or this) bill... some say it's because there is a moral imperative to do so and some say to save money... some say both of those, and some say neither (just as there is philosophical objection by some, there is also philosophical support)... your arguments seem to lean toward the economics of the issue

but if the aim is to do either or both of those things, imo there is only one sure way - complete state-run health care with fees and salaries fixed... as long as there is a (real or perceived) difference in quality of care, the have nots will always have a bone to pick with the haves

[PassedOut]

luke warm, on Mar 16 2010, 02:19 PM, said:

but if the aim is to do either or both of those things, imo there is only one sure way - complete state-run health care with fees and salaries fixed...

You won't find universal agreement (to say the least) with your "one sure way," and it certainly wouldn't be able to pass congress any time soon. The current bill is the only way to get started with this in a serious way now, whether the bill is perfect (and I don't think it is) or not.

Otherwise none of the cost control measures will take effect, and health care costs will continue the trajectory toward outer space. The goal of equal care for all is not practical for now, but Obama's reforms will certainly bring better care for quite a number of people.

[Winstonm]

Are we talking here about the known unknowns or the unknown unknowns or the really creepy booga-booga unknowns?

Sincerely,

Donald Rumsfeld

[kenberg]

Winstonm, on Mar 16 2010, 05:45 PM, said:

Are we talking here about the known unknowns or the unknown unknowns or the really creepy booga-booga unknowns?

Sincerely,

Donald Rumsfeld

I don't know.

[kenberg]

PassedOut, on Mar 16 2010, 02:55 PM, said:

luke warm, on Mar 16 2010, 02:19 PM, said:

but if the aim is to do either or both of those things, imo there is only one sure way - complete state-run health care with fees and salaries fixed...

You won't find universal agreement (to say the least) with your "one sure way," and it certainly wouldn't be able to pass congress any time soon. The current bill is the only way to get started with this in a serious way now, whether the bill is perfect (and I don't think it is) or not.

Otherwise none of the cost control measures will take effect, and health care costs will continue the trajectory toward outer space. The goal of equal care for all is not practical for now, but Obama's reforms will certainly bring better care for quite a number of people.

I do accept that the Obama plan would substantially improve access to health care for many people, and perhaps on that basis it should be passed. I expect very little will be accomplished in the way of bringing costs under control. This is not because I have thoroughly analyzed the bill, really it is still in preparation and I won't be setting aside 72 hours for analysis when the final unveiling takes place. My dismal expectations are more a general result of experience. Many programs don't meet the claims of the advocates, and in this case the principal advocates are so desperate to get a bill passed that they will agree to almost anything. It would be a miracle for a good bill to come out of such a swamp, and I don't much believe in miracles.

It will cost me money, it will add to the deficit, it will do me no good. I sure as hell hope it helps those in need because I don't expect anything else from it.

[y66]

Don can speak for himself.

I'm talking about the deficit-neutral unknown, for which Mr. Lobowolf is seeking a counter party for bets he wishes to place, presumably against, as if deficit-neutrality were particularly relevant (what is relevant is how much taxpayers will pay in taxes and in higher health care costs if nothing is done) and as if accounting methods required to measure this objectively are somehow less open to debate than, say, Statutory Interpretations. Another unknown, for which Mr Kenberg seeks comprehension, is how much this is actually going to cost real taxpayers. Granted, that's an important question but so is asking compared to what? The Congressional Budget Office estimates that cost-control measures in the current bills would save the government $1 trillion in the next 20 years, over and above the cost of covering the uninsured. The CBO isn't infallible. But they are objective and I think as good as you're going to get for purposes of assessing the costs of the bills.

[Winstonm]

Quote

It will cost me money, it will add to the deficit, it will do me no good. I sure as hell hope it helps those in need because I don't expect anything else from it.

Damn, Ken, you sound almost as cynical as me.

Here's what I expect - I expect the special interests who pour the millions into campaign chests to insure reelections and who offer to politicians after public service the lucrative revolving-door board-of-directors positions will get the bill they want and the rest of us will be stuck WITH the bill. If it happens to help a few people, that loophole will be closed in committee.

[Lobowolf]

y66, on Mar 16 2010, 08:11 PM, said:

The Congressional Budget Office estimates that cost-control measures in the current bills would save the government $1 trillion in the next 20 years, over and above the cost of covering the uninsured. The CBO isn't infallible. But they are objective and I think as good as you're going to get for purposes of assessing the costs of the bills.

If you're suggesting that this is a less subjective metric, I'd be happy to change my wager offer. I'll take the over. See you in 20 years.

[kenberg]

If a representative can return home and convincingly campaign on the assertion that he has cut government costs by a trillion dollars he will be in fine shape. Honestly this is the very first time I have seen that argument advanced. If it holds up, those who vote aye have nothing to worry about. Forget deeming, forget reconciliation, forget helping the needy, just go with the trillion in savings argument.

I remain skeptical, but perhaps it is so.

[y66]

Lobowolf, on Mar 16 2010, 09:14 PM, said:

y66, on Mar 16 2010, 08:11 PM, said:

The Congressional Budget Office estimates that cost-control measures in the current bills would save the government $1 trillion in the next 20 years, over and above the cost of covering the uninsured. The CBO isn't infallible. But they are objective and I think as good as you're going to get for purposes of assessing the costs of the bills.

If you're suggesting that this is a less subjective metric, I'd be happy to change my wager offer. I'll take the over. See you in 20 years.

You're on. Double or nothing on that Scott Brown bet, indexed for inflation, payable to heirs, assigns, etc.

[PassedOut]

It would indeed be wonderful if a vote today could really save a trillion dollars, but a lot of water will go over the dam before that total is reached.

It's much easier to screw things up than to fix them. Under Clinton the government was set to eliminate the national debt entirely, and we all saw how quickly and easily the Bush adminstration screwed that up.

Obama's health care reforms will clearly save a lot of money over present projections, probably a lot more than a trillion if untampered with, but future politicians could screw that up as easily as Bush did ten years ago. All you can really do is set things on the right path now and keep hammering away at how important it is to keep at it.

Still, I don't think that the possibility for future screwups should deter us from taking the responsible path now.

[luke warm]

PassedOut, on Mar 17 2010, 08:47 AM, said:

Obama's health care reforms will clearly save a lot of money over present projections, probably a lot more than a trillion if untampered with~~

exactly what does this mean? will the bill increase the deficit or not? i realize the final figures from the cbo aren't out yet, but how can you make such assumptions when even many congressional democrats don't do so?

Quote

Altmire echoed other House Democrats who are skeptical of the Senate bill, saying he wanted to strike the provision that exempts Nebraska from paying increased Medicaid expenses.

"The only absolute, definitive red line that there is for me is I will not vote for a bill that increases the deficit by even one penny," he said.