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Source: (consider it)
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Thread: Purgatory: Health Care
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by tclune:
I can see this as a problem if there were only one insurance company. But we have a wealth of insurance companies competing with each other, including many that are either non-profit (Blue Cross/Blue Shield) or are customer-owned (the various Mutual insurance companies). It still seems like a solution in search of a problem. I'd need a lot more reason to believe that the insurance companies are likely to engage in a conspiracy of price-fixing before I would find the public option at all compelling.
It is much easier for insurance companies to withold service from the expensive customers than to charge high prices -- you don't know that they'll stiff you on service unless you get sick and become an undesireable customer anyway, whereas everybody knows the cost of the insurance going in.
--Tom Clune
While it may be true that there is a "wealth" of insurance companies nationally, thanks to the U.S.'s federalist patchwork of state laws the private health insurance available to many Americans is essentially offered by either a monopoly (Alabama's biggest insurer controls 83% of the market) or a cartel.
Details on the insurance markets in individual state can be found on this openly pro-reform website. National report here [PDF].
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by ToujoursDan:
I get it, but find this completely crazy.
Surely, it would be more efficient to just put everyone on a public plan than put together a bureaucracy to monitor and fine those who can't/don't buy a policy.
...
A tax funded option would make more sense.
I'm not sure about that. ISTM that one of the reasons that medicine got so absurdly expensive in this country was because the consumer wasn't paying for it. It was magically provided by the employer, and kept going up at an astronomical rate.
If people have skin in the zipper, they pay more attention. And, realistically, making a universal plan paid for by taxes just has the same people paying, but not aware of the cost. Talk about crazy...
--Tom Clune
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by tclune:
quote:
Originally posted by ToujoursDan:
I get it, but find this completely crazy.
Surely, it would be more efficient to just put everyone on a public plan than put together a bureaucracy to monitor and fine those who can't/don't buy a policy.
...
A tax funded option would make more sense.
I'm not sure about that. ISTM that one of the reasons that medicine got so absurdly expensive in this country was because the consumer wasn't paying for it. It was magically provided by the employer, and kept going up at an astronomical rate.
If people have skin in the zipper, they pay more attention. And, realistically, making a universal plan paid for by taxes just has the same people paying, but not aware of the cost. Talk about crazy...
--Tom Clune
Given that in situations where the patient has even less "skin in the zipper" (e.g. most other Western, industrialized countries) are nonetheless able to provide superior care at less cost than the U.S. system, I'm not sure your assertion follows. I can't picture a lot of people running off to get needless colonoscopies just because they're cheap.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by Crœsos:
Given that in situations where the patient has even less "skin in the zipper" (e.g. most other Western, industrialized countries) are nonetheless able to provide superior care at less cost than the U.S. system, I'm not sure your assertion follows. I can't picture a lot of people running off to get needless colonoscopies just because they're cheap.
No, you missed the point. If one has a single-payer system, the government is controlling costs because they have the ability to do so and a strong incentive to keep their books in balance. That's not the system under consideration. The question that is being posed is, "How would adding a public option into the mix control costs?"
Single payer controls costs one way. Market systems control costs another way. Claiming that there can't be much of a market effect in a market-driven system because there isn't much of a market effect in a command system is just a non sequitur.
--Tom Clune
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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Darllenwr
Shipmate
# 14520
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Posted
A couple of points: First, on the logic that has been advanced, "Death Panels" should exist in a number of countries with publicly-funded health care, this one among them. No such panels exist, nor is there any suggestion that they should. However, there has been plentiful evidence in this thread that such panels, albeit covertly, already exist in the wonderful US of A. Will those who insist that Death Panels are the inevitable consequence of public health care kindly look at reality and stop daydreaming (or should that be day-mareing?)
Second, somebody please tell me exactly what I have missed? I see repeated complaints that the shortcoming of the NHS is that you have to queue for treatment ~ you cannot get anything done immediately. Aside of the fact that this is a gross over-simplification (ie, just plain wrong most of the time), can somebody tell me how having to negotiate with your insurer to obtain permission to proceed with treatment before doing so is in any practical way different from joining a queue, in so far as it introduces a delay? From what I have seen on this thread, the delays introduced by insurance companies far exceed anything caused by waiting lists in the UK today.
And, before anybody complains about that last remark, yes, I know that the UK has had its share of horror stories about excessively long waits for treatment. But therein lies the point ~ they were horror stories. In other words, they represented extremely unusual occurrences.
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If I've told you once, I've told you a million times: I do not exaggerate!
Posts: 1101 | From: The catbox | Registered: Jan 2009
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by tclune:
No, you missed the point. If one has a single-payer system, the government is controlling costs because they have the ability to do so and a strong incentive to keep their books in balance. That's not the system under consideration. The question that is being posed is, "How would adding a public option into the mix control costs?"
Single payer controls costs one way. Market systems control costs another way. Claiming that there can't be much of a market effect in a market-driven system because there isn't much of a market effect in a command system is just a non sequitur.
--Tom Clune
Actually I was responding to your assertion that the reason U.S. healthcare is so expensive is because people will get a whole bunch of tests and operations they don't really need because the cost is covered by insurance.
The point about the public option has already been answered at least twice: it provides a reasonably-priced competitor to largely monopolistic private insurers so that mandating participation doesn't turn in to a huge handout to insurance companies.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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Honest Ron Bacardi
Shipmate
# 38
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Posted
The inefficiencies and iniquities of insurance companies are only part of it , surely. You still have all the issues of price gouging by the suppliers, unnecessary tests due to paranoia about getting sued/tort reform, and consequent insurance burden - to name but 3.5.
Where exactly did this bizarre "death panels" stuff come from? How come nobody else has them?
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Anglo-Cthulhic
Posts: 4857 | From: the corridors of Pah! | Registered: May 2001
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ken
Ship's Roundhead
# 2460
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Posted
quote:
Originally posted by tclune:
The question that is being posed is, "How would adding a public option into the mix control costs?"
Dunno. But as all the major developed countries that do it the mixed way have cheaper healthcare than the US, and better health outcomes, it obviously works somehow. France, Germany, the Netherlands and Japan all have mixed public-private systems with a number of competing insurance providers and all are cheaper than the US system.
They pay less than you do, and they get more.
Sounds like a no-brainer to me.
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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ken
Ship's Roundhead
# 2460
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Posted
quote:
Originally posted by Honest Ron Bacardi:
Where exactly did this bizarre "death panels" stuff come from? How come nobody else has them?
Its weird. Its not just that, there is all the rest of the nonsense. The Stephen Hawking stuff was only the most egregious. It looks as if someone on the far right, for some reason, is really running scared. So scared they've be dropped any pretence at actual political debate and have resorted to screaming obscenities into the wind.
Being a bit of an old political hack and a conmspiracy theorist I assume that there is big money from somewhere behind the lies. But I have no real idea.
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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New Yorker
Shipmate
# 9898
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Posted
quote:
Originally posted by ToujoursDan:
Let's say the proposed healthcare bill forces everyone to buy insurance, or else. What is the "or else"? Most people don't buy insurance because they can't afford it. Are we going to start penalizing the poor or those in financial distress because they can't afford the costs of a mandatory private plan? What would that mean? Fines? Jail time?
I suppose that this would be in the remit of the Death Panels. Wasn't it the Dead Kennedys who came up with Kill the Poor? I never thought I'd live to see such things in this country, however.
Posts: 3193 | From: New York City | Registered: Jul 2005
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ToujoursDan
Ship's prole
# 10578
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Posted
quote:
Originally posted by New Yorker:
quote:
Originally posted by ToujoursDan:
Let's say the proposed healthcare bill forces everyone to buy insurance, or else. What is the "or else"? Most people don't buy insurance because they can't afford it. Are we going to start penalizing the poor or those in financial distress because they can't afford the costs of a mandatory private plan? What would that mean? Fines? Jail time?
I suppose that this would be in the remit of the Death Panels. Wasn't it the Dead Kennedys who came up with Kill the Poor? I never thought I'd live to see such things in this country, however.
So your fear of these so-called death panels (that haven't actually been proposed by anyone) comes from a song?
I never thought I'd see a whole country lose its grip on reality. But here it is.
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"Many people say I embarrass them with my humility" - Archbishop Peter Akinola
Facebook link: http://www.facebook.com/toujoursdan
Posts: 3734 | From: NYC | Registered: Oct 2005
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Timothy the Obscure
Mostly Friendly
# 292
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Posted
quote:
Originally posted by Honest Ron Bacardi:
The inefficiencies and iniquities of insurance companies are only part of it , surely. You still have all the issues of price gouging by the suppliers, unnecessary tests due to paranoia about getting sued/tort reform, and consequent insurance burden - to name but 3.5.
Where exactly did this bizarre "death panels" stuff come from? How come nobody else has them?
It was apparently made up by a talk-show host--NPR did a story on the origins of it, and played the tape in which she (I don't recall the name--it wasn't one of the really famous ones) claimed that on page 425 (or whatever number it was) of the bill there was a requirement that people over 65 be reviewed every five years to determine whether their lives are worth the cost of continued medical care. Pure fiction, of course, but that's the American right for you.
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When you think of the long and gloomy history of man, you will find more hideous crimes have been committed in the name of obedience than have ever been committed in the name of rebellion.
- C. P. Snow
Posts: 6114 | From: PDX | Registered: May 2001
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ken
Ship's Roundhead
# 2460
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Posted
quote:
Originally posted by ToujoursDan:
I never thought I'd see a whole country lose its grip on reality.
A whole country? What whole country? Most Americans aren't falling for these tricks.
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by ken:
quote:
Originally posted by tclune:
The question that is being posed is, "How would adding a public option into the mix control costs?"
Dunno. But as all the major developed countries that do it the mixed way have cheaper healthcare than the US, and better health outcomes, it obviously works somehow. France, Germany, the Netherlands and Japan all have mixed public-private systems with a number of competing insurance providers and all are cheaper than the US system.
They pay less than you do, and they get more.
Sounds like a no-brainer to me.
Wait! all those other countries don't speak English as their first language. That must be the key to lower costs!
The truth is that our costs are high because we had employer-supplied insurance, where nobody was paying attention to the costs until they became burdensome and our physicians had developed the expectation that they could become rich by working part time in a specialty like dermatology. Now, everybody gets their boils lanced by board-certified specialists instead of by grandma and the "customary and reasonable" reimbursement for that "surgery" is more than a typical person makes in a month.
Changing the mix of public and private insurers won't address our root problem. We need a single payer system to transform this bloated and self-serving medical establishment back into a service for patients instead of the mafia for physicians that it has become in this country.
--Tom Clune
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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Josephine
Orthodox Belle
# 3899
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Posted
quote:
Originally posted by ken:
Being a bit of an old political hack and a conmspiracy theorist I assume that there is big money from somewhere behind the lies. But I have no real idea.
According to Wendell Potter, a former insurance company executive who has seriously repented of his former actions, your assumption would be entirely correct.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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moron
Shipmate
# 206
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Posted
quote:
Originally posted by Josephine:
quote:
Originally posted by ken:
Being a bit of an old political hack and a conmspiracy theorist I assume that there is big money from somewhere behind the lies. But I have no real idea.
According to Wendell Potter, a former insurance company executive who has seriously repented of his former actions, your assumption would be entirely correct.
quote:
The practice is called "rescission" and Beaton's is not an isolated case. The House Energy and Commerce Committee found that the major private health insurers had rescinded the policies of approximately 20,000 people in a five year period, to avoid paying out approximately $300 million in benefit claims.
Appearing before the same committee, CEOs of the major health insurance companies stated that they would continue to use rescission, arguing that it is a necessary protection against fraud and abuse.
So while fighting 'fraud and abuse' the major private health insurers average 4,000 rescissions annually? Trying to be conservative ![[Biased]](wink.gif) I'll estimate they insure 50,000,000 people: .008%.
Even if you quadrupled the percentage the practice hardly seems out of control, which seems to confirm to what a seasoned insurance guy tells me: insurance regulators resolving conflicts typically err on the side of the consumer.
But ISTM this entire debate is shooting in the dark - IMO there's so much hyperbole being slung by both sides it's damn near impossible to really say what's going on. ![[Ultra confused]](graemlins/confused2.gif)
Posts: 4236 | From: Bentonville | Registered: May 2001
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mousethief
Ship's Thieving Rodent
# 953
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Posted
quote:
Originally posted by mjg:
So while fighting 'fraud and abuse' the major private health insurers average 4,000 rescissions annually? Trying to be conservative I'll estimate they insure 50,000,000 people: .008%.
Just looking at numbers is misleading. What's the percentage in terms of dollars? They're going to reciss (if that's the right word) the really expensive stuff. Stuff that bankrupts people.
quote:
Even if you quadrupled the percentage the practice hardly seems out of control, which seems to confirm to what a seasoned insurance guy tells me: insurance regulators resolving conflicts typically err on the side of the consumer.
Somebody has to look out for the consumer. God knows the insurance companies sure as hell don't.
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This is the last sig I'll ever write for you...
Posts: 63536 | From: Washington | Registered: Jul 2001
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moron
Shipmate
# 206
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Posted
quote:
Originally posted by mjg:But ISTM this entire debate is shooting in the dark - IMO there's so much hyperbole being slung by both sides it's damn near impossible to really say what's going on.
quote:
Originally posted by mousethief:
Somebody has to look out for the consumer. God knows the insurance companies sure as hell don't.
Sigh.
Posts: 4236 | From: Bentonville | Registered: May 2001
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Erin
Meaner than Godzilla
# 2
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Posted
The right wing has gone off the rails. YouTube video of lunatic. I just don't even know what to say.
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Commandment number one: shut the hell up.
Posts: 17140 | From: 330 miles north of paradise | Registered: Mar 2001
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Crœsos
Shipmate
# 238
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Posted
Ironically enough, the "Heil Hitler" woman (that's how she's going to be known on the internet after this) is wearing an IDF shirt.
The only remaining question is how long before she gets an hour-long segment on Fox News?
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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mousethief
Ship's Thieving Rodent
# 953
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Posted
quote:
Originally posted by Crœsos:
Ironically enough, the "Heil Hitler" woman (that's how she's going to be known on the internet after this) is wearing an IDF shirt.
The only remaining question is how long before she gets an hour-long segment on Fox News?
Hour long? She'll get her own weekly show.
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This is the last sig I'll ever write for you...
Posts: 63536 | From: Washington | Registered: Jul 2001
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Timothy the Obscure
Mostly Friendly
# 292
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Posted
She does sum up the conservative case against health care reform--"all I want is to get them [she says those who have been in office too long, but she clearly means Democrats] out of office." The Republican position is quite clearly "We don't care what might actually work to improve the health care situation (or even reduce costs to taxpayers, supposedly their big issue) we just want to hand Obama a defeat." It's a waste of time trying to compromise with conservatives because they don't believe in compromise.
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When you think of the long and gloomy history of man, you will find more hideous crimes have been committed in the name of obedience than have ever been committed in the name of rebellion.
- C. P. Snow
Posts: 6114 | From: PDX | Registered: May 2001
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CorgiGreta
Shipmate
# 443
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Posted
Why doesn't her husband have coverage? Doesn't her plan offer spousal coverage? Is it not provided at any of her husband's two and a half jobs?
If her husband, God bless him, gets sick, will he stroll into an emergency room for free treatment at the expense those of us who pay for our coverage?
Greta
Posts: 3677 | Registered: Jun 2001
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New Yorker
Shipmate
# 9898
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Posted
quote:
Originally posted by ToujoursDan:
So your fear of these so-called death panels (that haven't actually been proposed by anyone) comes from a song?
Not really.
quote:
I never thought I'd see a whole country lose its grip on reality. But here it is.
I think that happened on Election Day!
Of course the House Bill does not mention "death panels" per se in the infamous section 1233, but even the left-wing Washington Post raised a concern over the DPs. Their columnist Charles Lane wrote:
quote:
.... at least as I read it, Section 1233 is not totally innocuous.
So even the left is concerned about the DPs.
Here is his whole column.
And here is a link to the actual House bill.
Posts: 3193 | From: New York City | Registered: Jul 2005
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mousethief
Ship's Thieving Rodent
# 953
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Posted
So you admit you know there are no death panels, and still you use that rhetoric to make some kind of rhetorical point.
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This is the last sig I'll ever write for you...
Posts: 63536 | From: Washington | Registered: Jul 2001
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by New Yorker:
Of course the House Bill does not mention "death panels" per se in the infamous section 1233, but even the left-wing Washington Post raised a concern over the DPs. Their columnist Charles Lane wrote:
quote:
.... at least as I read it, Section 1233 is not totally innocuous.
So even the left is concerned about the DPs.
New Yorker, you're getting lazy in your old age. The notion that any columnist who writes for the Post is per force a "left winger" will undoubtedly be news to Lane, Krauthammer, and Kristol while causing Novak to spin in his grave before he even gets into it. I sincerely doubt that you can find a single column from Lane that you would find to be to your left, let alone "left wing."
--Tom Clune
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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Imaginary Friend
Real to you
# 186
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Posted
What? A news outlet that presents more than one opinion on an issue? Well I never! ![[Eek!]](eek.gif)
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by New Yorker:
Of course the House Bill does not mention "death panels" per se in the infamous section 1233, but even the left-wing Washington Post raised a concern over the DPs. Their columnist Charles Lane wrote:
quote:
.... at least as I read it, Section 1233 is not totally innocuous.
So even the left is concerned about the DPs.
Here is his whole column.
My favorite "let them eat cake" moment from Lane's article was:
quote:
As it happens, I have a living will and a durable power of attorney for health care. I'm glad I do. I drew them up based on publicly available medical information, in consultation with my family and a lawyer. No authority figure got paid by federal bean-counters to influence me. I have a hunch I'm not the only one who would rather do it that way.
Why doesn't everyone just call up their attorney and deal with this themselves? While it may be true in the abstract that Lane isn't "the only one who would rather do it that way", the fact that the typical American doesn't have an attorney on retainer might be a bit of a stumbling block.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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New Yorker
Shipmate
# 9898
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Posted
quote:
Originally posted by mousethief:
So you admit you know there are no death panels, and still you use that rhetoric to make some kind of rhetorical point.
I admit that the phrase "death panel" is not in the bill but the concept to which the phrase refers is in the bill. Kind of like the word Trinity is not in the Bible....
Now, of course, the Senate has assured us that the DPs will be removed from the bill. Or, as US News reports Score One for Sarah Palin. How does one remove something from a bill if it is not in there?
Posts: 3193 | From: New York City | Registered: Jul 2005
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cliffdweller
Shipmate
# 13338
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Posted
What is being removed from the bill is what's been spun into "death panels"-- reimbursement for doctors for time spent counseling w/ patients about end of life issues-- i.e. letting them know what their options are.
Oh, yeah, that's progress. We may still have people bleeding to death in ERs or dying because their HMO keeps punting their request to fund a transplant, by by God we'll be protected from the inhumane nightmare of having an uncomfortable conversation about death.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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ken
Ship's Roundhead
# 2460
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Posted
quote:
Originally posted by New Yorker:
I admit that the phrase "death panel" is not in the bill but the concept to which the phrase refers is in the bill.
![[Snore]](graemlins/snore.gif)
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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mousethief
Ship's Thieving Rodent
# 953
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Posted
quote:
Originally posted by davelarge:
What? A news outlet that presents more than one opinion on an issue? Well I never!
That's those liberals all over.
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This is the last sig I'll ever write for you...
Posts: 63536 | From: Washington | Registered: Jul 2001
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Imaginary Friend
Real to you
# 186
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Posted
quote:
Originally posted by mousethief:
quote:
Originally posted by davelarge:
What? A news outlet that presents more than one opinion on an issue? Well I never!
That's those liberals all over.
One might even get the impression that they think about things. ![[Roll Eyes]](rolleyes.gif)
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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RuthW
liberal "peace first" hankie squeezer
# 13
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Posted
quote:
Originally posted by mjg:
So while fighting 'fraud and abuse' the major private health insurers average 4,000 rescissions annually? Trying to be conservative I'll estimate they insure 50,000,000 people: .008%.
That was Blue Cross of California (just the one state, not all of Blue Cross) and two other insurers in this state (source here). There's no way they cover 50,000,000 people -- there are only about 36,000,000 people in California. According to the California Healthcare Foundation, 6.6 million of us have no health insurance. And we don't have just three major healthcare insurers in California -- while there are places that have just a few, we have lots.* So 4,000 rescissions per year for three companies in California is a lot.
One industry estimate is that this happens to 1% of individual policy holders (source here) (it supposedly doesn't happen to people in group policies, which is yet another reason some people stay in jobs they can't stand, but of course sometimes in a small business one sick employee can blow it for everyone). One insurance company says rescission happens to .1% of its policyholders. But think about who they're likely to be looking at -- the really sick -- and think about the likelihood that those people, who need health insurance more than anyone, are going to get their policies cancelled. Read this and do some math:
quote:
It’s the 99th percentile, the people with over $35,000 of medical costs, who represent fully 22% of the entire nation’s medical costs. These people have chronic, expensive conditions. They are, to use a technical term, sick.
An individual adult insurance plan is roughly $7,000 (varies dramatically by age and somewhat by sex and location).
It should be fairly clear that the people who do not file insurance claims do not face rescission. The insurance companies will happily deposit their checks. Indeed, even for someone in the 95th percentile, it doesn’t make a lot of sense for the insurance company to take the nuclear option of blowing up the policy. $11,487 in claims is less than two years’ premium; less than one if the individual has family coverage in the $12,000 price range. But that top one percent, the folks responsible for more than $35,000 of costs – sometimes far, far more – well there, ladies and gentlemen, is where the money comes in. Once an insurance company knows that Sally has breast cancer, it has already seen the goat; it knows it wants nothing to do with Sally.
If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population). If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population. If, as I suspect, rescission is targeted toward the truly bankrupting cases – the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier – then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette.
*Having lots of healthcare insurers in California has not kept prices down. I spoke with the broker who found us our policy at work a while back just this morning -- he said that we were getting the best price possible for the kind of policy we have, and that the premiums would only go down if we got a policy that covered less stuff. The premiums are about to go up 11.35%; last year the increase was 14%. Hence my skepticism about competition between insurance carriers having any benefit for the consumer, and hence my belief that we need a public option.
Posts: 24453 | From: La La Land | Registered: Apr 2001
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by RuthW:
Having lots of healthcare insurers in California has not kept prices down. I spoke with the broker who found us our policy at work a while back just this morning -- he said that we were getting the best price possible for the kind of policy we have, and that the premiums would only go down if we got a policy that covered less stuff. The premiums are about to go up 11.35%; last year the increase was 14%. Hence my skepticism about competition between insurance carriers having any benefit for the consumer, and hence my belief that we need a public option.
Ruth, this is the sticking point for me: Blue Cross of California is not increasing its profits by 11 to 14% per year. It just does not appear to be the insurance companies that are, for the most part, the real source of the problem. I agree that there are problems that they represent -- denial of coverage, etc. But the growth in costs are not coming from the insurance companies.
I know that people are anxious to have something done about medical care. But I just can't get to a place where I can rationally believe that a public option addresses the real cost problems at all.
Single payer really does seem to offer the possiblity for reform where the problem lies. I would hope that it would include an honest enforcement provsion that would revoke those rare incompetent doctors' licences to practice, and then do away with the absurd malpractice morass that we have instead of real policing of the medical profession. But none of this is likely to happen until some half-way reform measure is tried and fails.
A public option just adds nothing positive to the mix. I can readily see it as poisoning the well further for a single payer option in the future, however -- "We tried a public option and it didn't help at all. Why should we turn the whole system over to something that has already been shown to not help?"
We need to acknowledge where the real problems are. They are in the way that medicine is practiced, not in how we pay for it. We need a lot less dependence on specialists and a lot more utilization of paraphysicians for primary screening, for example. We need to put more emphasis on wellness and less emphasis on treatment. We need to better determine whether drugs are as good for the patients as they are for the drug manufacturers and agressively pursue generics when possible.
No reforms of any sort in how medicine is practiced will be possible with a "public option." It is only possible with a single payer system, and physicians will fight it tooth and nail.
If we aren't going to do what is necessary to reform medicine, then we should just opt for tweaking the existing system with "insurance reform" that does not drag a "public option" into the equation at all. It will offer some genuine relief in the short haul and ignore the systemic problems. When they become impossible to ignore, we can revisit the issue without having tainted public involvement in the interim.
--Tom Clune
[ 19. August 2009, 20:39: Message edited by: tclune ]
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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Imaginary Friend
Real to you
# 186
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Posted
quote:
Originally posted by tclune:
A public option just adds nothing positive to the mix.
It does have the potential to give the tax-payers' representatives more direct control over the costs. Does that count as one way of curbing the price of treatments?
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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aggg
Shipmate
# 13727
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Posted
Seems to me that the veteran British politician Tony Benn made some good points on Democracy Now! yesterday - see and/or read here
People don't have a problem with state controlled universal schooling so why not healthcare?
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Myrrh: please, in future refrain from replying to anything I might write
Posts: 567 | Registered: May 2008
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Olaf
Shipmate
# 11804
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Posted
quote:
Originally posted by RuthW:
The premiums are about to go up 11.35%; last year the increase was 14%. Hence my skepticism about competition between insurance carriers having any benefit for the consumer, and hence my belief that we need a public option.
Thank you. My premiums have tripled in two years, simply because of price increase. Nothing to do with age, changes in condition, changes in coverage, or adding dependents.
Prices are out of control. I certainly do not want the medical industry to be a for-profit industry.
Posts: 8953 | From: Ad Midwestem | Registered: Sep 2006
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by davelarge:
quote:
Originally posted by tclune:
A public option just adds nothing positive to the mix.
It does have the potential to give the tax-payers' representatives more direct control over the costs. Does that count as one way of curbing the price of treatments?
But that is only true if the reason insurance is so expensive is because the insurance companies are price gouging. That, at the very least, assumes facts that are not in evidence.
--Tom Clune
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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Clint Boggis
Shipmate
# 633
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Posted
You're right Tom. But how can we find out where the money's going?
Presumably big insurance companies have to file profit figures for tax purposes and their stock will be an indication of whether they're raking it in.
What about hospitals? Whether they're commercial or non-profit they must produce some financial reports which say whether their costs are rising as fast as their charges do.
What about drug companies? This may be harder because some are huge multinational corporations and will move cash around the world to reduce tax liability and fund research in the most favourable locations but their stocks will surely tell the story.
What about doctors and other individual health workers? They must file tax returns which show if their income is rising unreasonably fast compared with general costs.
Is the picture very hard to judge? Surely some journalists are looking into this kind of thing to find out where the vast sums end up and who benefits most.
.
Posts: 1505 | From: south coast | Registered: Jun 2001
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mousethief
Ship's Thieving Rodent
# 953
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Posted
quote:
Originally posted by aggg:
People don't have a problem with state controlled universal schooling so why not healthcare?
On the contrary, many people (the vast majority right wing) have a problem with the public schools, and have their kids in private schools, or homeschooled, as a result. Largely it has to do with the teaching of evolution.
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This is the last sig I'll ever write for you...
Posts: 63536 | From: Washington | Registered: Jul 2001
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Photo Geek
Shipmate
# 9757
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Posted
Clint said
quote:
You're right Tom. But how can we find out where the money's going?
Evidently you're not the only one wondering about the money.
Article in the Wall Street Journal Online You may Need to register in order to read it.
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"Liberal Christian" is not an oxymoron.
Posts: 242 | From: Southern Ohio, US | Registered: Jul 2005
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CorgiGreta
Shipmate
# 443
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Posted
Ruth,
The existence of a large number of carriers does not mean that the bulk of us have a wide choice when it comes to our coverage. Lots of companies offer coverage with just one carrier. Even the really large companies may offer only a handful of carriers, albeit with various plans.
Also, I am fairly certain that in most companies, the choice, if any, usually comes down to the same top four or five insurers. The result may not be a cartel or an oligopoly, but it would be fertile soil for one to grow and prosper.
I would guess that in a group as small as yours, the "choice" would be Blue Cross or nothing, but since I assume that you are in a liberal church group, perhaps it's Kaiser. Good on you if it is.
If your employer is trying to save himself or herself some bucks, you could be offered only a skimpy plan.
Greta
[ 20. August 2009, 00:50: Message edited by: CorgiGreta ]
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RadicalWhig
Shipmate
# 13190
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Posted
quote:
Originally posted by mousethief:
quote:
Originally posted by aggg:
People don't have a problem with state controlled universal schooling so why not healthcare?
On the contrary, many people (the vast majority right wing) have a problem with the public schools, and have their kids in private schools, or homeschooled, as a result. Largely it has to do with the teaching of evolution.
The irony is that a public single payer plan is very similar to a voucher plan, which the right supports for schooling. Both combine universal public funding with a choice of provision.
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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)
Posts: 3193 | From: Scotland | Registered: Nov 2007
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Soror Magna
Shipmate
# 9881
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Posted
quote:
Originally posted by Martin L:
quote:
Originally posted by RuthW:
The premiums are about to go up 11.35%; last year the increase was 14%. Hence my skepticism about competition between insurance carriers having any benefit for the consumer, and hence my belief that we need a public option.
Thank you. My premiums have tripled in two years, simply because of price increase. Nothing to do with age, changes in condition, changes in coverage, or adding dependents. ...
AIUI, insurance rates depend greatly on the state of the markets, because that is where insurance companies park their income. When the markets go down, rates go up. OliviaG
Posts: 5430 | From: Caprica City | Registered: Jul 2005
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Alan Cresswell
Mad Scientist 先生
# 31
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Posted
Medical costs of $35,000 doesn't seem to be very much to me. I'd have expected practically anything that gets you more than a couple of days in hospital and course of generic painkillers or anti-biotics to be taken at home to exceed that. Is it really the case that people lose their insurance (or, find they can only be insured by paying a significantly larger premium) if they contract an illness that has them in the hospital for a week?
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Don't cling to a mistake just because you spent a lot of time making it.
Posts: 32413 | From: East Kilbride (Scotland) or 福島 | Registered: May 2001
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by Alan Cresswell:
Is it really the case that people lose their insurance (or, find they can only be insured by paying a significantly larger premium) if they contract an illness that has them in the hospital for a week?
This varies by state. It doesn't happen in Massachusetts. There is something like three or four other states that regulate the industry in a way that precludes this to some extent. But MA is the champ currently in consumer protection wrt health insurance.
Many states have individual plans that run for something like six months. If you make a claim during that time, the company will not renew you because of your "preexisting condition" (the fact that you availed yourself of the insurance in the last six months).
It is not irrational to go without insurance in those states, but there's a catch. If you get medical services and pay for them yourself, you will pay retail. The insurance companies negotiate massively reduced prices for everything. My last bill for routine lab work showed that the bill was $400, but because I had insurance, the cost was $100, which my insurance company mostly paid.
One meaningful reform would be to just standardize the rates for services instead of selling medical services like we sell used cars. It is a shameful system all the way around. Reform is needed. Much of it can be improved for the individual in the way that Massachusetts did. But the really important reforms will require a structural change in how medical services are delivered, not just access to decent insurance even if your employer doesn't provide it.
--Tom Clune
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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Jason™
Host emeritus
# 9037
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Posted
Tom, I'm feeling extraordinarily thick today. Can you explain (again) why the public option does no good where the single-payer option would? I can tell there's something to what you're saying, but I can't repeat the argument in an understandable way.
My understanding of the difference is that the public option involves doctors employed by the state, whereas single-payer involves doctors employed by private companies, but bills for their services paid by the state.
In a single-payer system, what keeps the private companies from gouging like oil companies? And if there is price-cap regulation, is it still significantly different from the public option?
Posts: 4123 | From: Land of Mary | Registered: Feb 2005
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New Yorker
Shipmate
# 9898
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Posted
The government screws up a used car program, but we want it to run our health care?
But don't worry, Obama's friends are doing very well while the rest of the country tanks.
Meanwhile, Thomas Sowell makes sense as usual. Three of the better quotations:
quote:
Deception is not an incidental aspect of this medical care legislation, but is at the very heart of it.
quote:
As for those uninsured Americans who are supposedly the reason for all this sound and fury, there is remarkably little interest in why they are uninsured, despite the incessant repetition of the fact that they are.
quote:
No small part of our current medical care problems have been created by politicians who drive up the cost of medical insurance by mandating that insurance cover things that many people are unwilling to pay for.
Posts: 3193 | From: New York City | Registered: Jul 2005
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