Darryl Issa's Idea for Replacing Obamacare

[piasabird]

The IRS is not an insurance enforcement agency. They should refuse to cooperate.

Better yet, where does all the money come from?

As long as all these companies and federal employees and everyone else that works for the government gets an exemption from the Unaffordable Health Care Fairy Dust, delusional, Health Care Dream, then everyone else should tool. Plus all the businesses have to pay their part also.

 

[piasabird]

It would be cheaper for the states to open up some free or low-cost clinics. Oh Yeah, we already have this.

 

[bshole]

Bshole's idea for Issa. We bury Issa up to his neck and use his head for a urinal. At least then he would serve a useful purpose.

This blight on the American political landscape should be excised at the earliest possible moment. Issa is a horrible politician and and even worse human being. Why isn't he moldering in solitary confinement at Quantanamo?

Obamacare is the first necessary and painful stepping stone towards socialized medicine. We are on the right course finally. The Republicans can all go to hell.

 

[woolfe9998]

Tort reform. Okay but I've been told on many occasions that this has a tiny effect on care costs.

We've had it here in CA since about 1976, a $250K cap on general damages in med mal cases, no medical liens in lawsuits so the plaintiff can only recovery out of pocket medical expenses, and caps on attorney's fees. The $250K cap wasn't that bad for plaintiffs in 1976 but it's never been increased to account for inflation. The only other state with this kind of reform is Texas, and I think there's is like 3 years old now.

AFAIK, our overall healthcare costs in CA are about middling for a US state. There are other variables so who knows. State run systems like Canada do have limitations on litigation to help control costs so it isn't exclusively a conservative idea.

I think to justify these caps there has to be hard evidence of a non-trivial lowering of costs because the concept is fundamentally unfair. Think about it. If someone runs you over and makes you a quadriplegic, you can get compensated millions for the loss of use of your body. If a doctor causes the same injury by accidentally severing your spinal cord, you get $250k. There's no justification for this kind of unfairness without a strong, quantifiable public benefit.

 

[PokerGuy]

Oh, I see you have some listed here. What does the government do to limit the supply of doctors?

The AMA limits the number of doctors (that's not the government), but another big limiting factor is the number of residencies that are available. The number of residencies funded by medicare is capped at 100,000 (and has been since 1997). That number needs to be increased so that more doctors can be trained and be available to increase the supply.

Intervene in the free market to stop drug companies from advertising. Check.

Last I checked that is already the case with cigarettes and other types of ads. This would not be significantly different. Medicine should be a matter of need, not want, so driving "want" with ads is pointless for society.

Tort reform. Okay but I've been told on many occasions that this has a tiny effect on care costs.

I don't know what the impact is, but it's not zero, so it should at least be considered. Any such changes would of course need to be carefully evaluated because they can have unintended consequences.

Ooo, number 4, death panels, always a conservative favorite.

Nothing to do with death panels. I said study the outcomes to figure out which treatments have the best bang for the buck, not have the government decide what treatment you are allowed to get. Try to keep up.

Assisted suicide. Pretty sure that will have next to no impact on costs.

Says you. I'm guessing there is a cost savings, but I don't have any hard figures either.

Finally we have a nice soapbox speech which would require government to intervene in everyone's lives to make sure they are eating right and exercising.

Why do you keep thinking government involvement? (that's the leftist mentality). Government does not need to be involved at all in that process. You're starting to see it now already in the private sector, with plans with deductibles and HSA's, and credits for those who engage in exercise or other healthy activity.

The question was, what are some of the things that can be done to lower the costs of care. I just threw out some possibilities. That's just a small list, subject to plenty of debate as to what is good/feasible/desirable. The point is that there are plenty of possibilities, but the focus has been squarely on who pays and how -- with zero focus on reducing the cost itself.

 

[Jhhnn]

The AMA limits the number of doctors (that's not the government), but another big limiting factor is the number of residencies that are available. The number of residencies funded by medicare is capped at 100,000 (and has been since 1997). That number needs to be increased so that more doctors can be trained and be available to increase the supply.

While you speak the truth about the AMA, you then propose more big govt intervention in the process of providing more doctors, which isn't exactly consistent with your overall view, is it?

 

[Fern]

-snip-
Tort reform. Okay but I've been told on many occasions that this has a tiny effect on care costs.

Tort reform, per se, isn't the way to go.

The medical profession, unlike other professions, lacks standards. It would seem they are just 'practicing'.

Accounting is a good example. We have standards for auditing and preparing financial statements. If you follow those, you're fine. Anyone can bring a lawsuit for any reason but if you've followed the standards you should be OK. Moreover, if you 'over' audit the client, thus driving up fees unnecessarily, you'll get in trouble.

Physicians OTOH have no such standards. Therefore you not only have defensive medicine but other sorts of motivations for unnecessary and redundant procedures. What if the patient keeps pushing for other test etc., test that are unnecessary? Well, if his/her insurance covers it the physician is only motivated to provide it. The New England Journal of Medicine (with the AMA IIRC) did a study looking at health care provided to different patients who were as identical as possible. They found that for the same type of patient with the same medical condition that treatment varied by as much as 6 figures (hundreds of thousands of $'s). They then examined these differences in treatment and concluded that there was no valid reason for them.

Professional standards would fix this.

This is the solution to escalating medical costs pushed by some members of the HC industry and no one is listening to them, at all.

Fern

 

[Fern]

While you speak the truth about the AMA, you then propose more big govt intervention in the process of providing more doctors, which isn't exactly consistent with your overall view, is it?

You don't need "big govt intervention" to fix that. Just let federal law allow for a different avenue to be a licensed physician. I.e., you can choose an 'AMA' physician or the new type.

Fern

 

[her209]

Tort reform, per se, isn't the way to go.

The medical profession, unlike other professions, lacks standards. It would seem they are just 'practicing'.

Accounting is a good example. We have standards for auditing and preparing financial statements. If you follow those, you're fine. Anyone can bring a lawsuit for any reason but if you've followed the standards you should be OK. Moreover, if you 'over' audit the client, thus driving up fees unnecessarily, you'll get in trouble.

Physicians OTOH have no such standards. Therefore you not only have defensive medicine but other sorts of motivations for unnecessary and redundant procedures. What if the patient keeps pushing for other test etc., test that are unnecessary? Well, if his/her insurance covers it the physician is only motivated to provide it. The New England Journal of Medicine (with the AMA IIRC) did a study looking at health care provided to different patients who were as identical as possible. They found that for the same type of patient with the same medical condition that treatment varied by as much as 6 figures (hundreds of thousands of $'s). They then examined these differences in treatment and concluded that there was no valid reason for them.

Professional standards would fix this.

This is the solution to escalating medical costs pushed by some members of the HC industry and no one is listening to them, at all.

Fern

I'm guessing the doctor's malpractice insurance is probably going to demand the physician to do X, Y, Z tests or they not going to payout on the judgement amount in cases where the physician is found to be at fault. After all, the costs to do the tests aren't comin out of the insurance company's profit margin.

 

[Jhhnn]

You don't need "big govt intervention" to fix that. Just let federal law allow for a different avenue to be a licensed physician. I.e., you can choose an 'AMA' physician or the new type.

Fern

Oh, you mean Nurse Practitioners & Physicians' Assistants, right?

That doesn't change the artificial scarcity of MD's in this country. We lag well behind many other first world nations-

http://data.worldbank.org/indicator/SH.MED.PHYS.ZS

It's why they can charge as much as they do.

 

[her209]

You don't need "big govt intervention" to fix that. Just let federal law allow for a different avenue to be a licensed physician. I.e., you can choose an 'AMA' physician or the new type.

Fern

Why need a federal law at all? Just do away with the current ones and let the free market determine the standards.

 

[rudder]

Obamacare is the first necessary and painful stepping stone towards socialized medicine. We are on the right course finally. The Republicans can all go to hell.

We'll I for one am glad you are dedicating over 10 years of your life to studying medicine and putting up with the expense of med school.... To become a government doctor and earn a lot less that your private counterparts. Isn't socialized medicine great!

Oh wait.... You are expecting someone else to do that.

 

[Jhhnn]

We'll I for one am glad you are dedicating over 10 years of your life to studying medicine and putting up with the expense of med school.... To become a government doctor and earn a lot less that your private counterparts. Isn't socialized medicine great!

Oh wait.... You are expecting someone else to do that.

Funny that. People seem to be entirely willing to do so in most of the rest of the First World.

http://www.practicelink.com/magazine/vital-stats/physician-compensation-worldwide/

Most of the other first world nations subsidize physicians' education more heavily, I suspect.

 

[WhipperSnapper]

I'm curious, what would you do to control costs? Can't we do both simultaneously? Try and get more people covered while also getting at costs from the other side?

...Every other first world nation in the world seems to be able to do it at a much lower % of GDP than we spend (and in terms of dollars per capita) and they have 100% coverage, zero medical bankruptcies, a more contented populace that isn't terrified of job (and benefits) loss, and businesses and an economy that aren't burdened by insurance concerns.

Maybe we should look at how other nations are dealing with health care?

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

 

[WhipperSnapper]

YHear that sucking noise? That is the sound of all the doctors who will leave the healthcare industry as obamacare matures.

I'm having a difficult time hearing the sounds of the doctors leaving amidst the noise generated by all of the college pre-meds who are competing to get into medical school. Going to medical school is so popular that a large percentage of applicants never gain admission. Go figure.

 

[Mr. Pedantic]

I don't know how Darrell Issa got to be that rich if he's that dumb.

I don't know how Linus Pauling got to get a Nobel Prize (2, actually) when he says some of the stupid-ass shit he does. The fact of the matter is that people (i.e. politicians/Linus Pauling) don't do well when they're outside their field of expertise (i.e. lying and wasting people's time/Chemistry).

...Every other first world nation in the world seems to be able to do it at a much lower % of GDP than we spend (and in terms of dollars per capita) and they have 100% coverage, zero medical bankruptcies, a more contented populace that isn't terrified of job (and benefits) loss, and businesses and an economy that aren't burdened by insurance concerns.

Maybe we should look at how other nations are dealing with health care?

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

That would never work, cause America's...different...and stuff.

 

[compuwiz1]

Bshole's idea for Issa. We bury Issa up to his neck and use his head for a urinal. At least then he would serve a useful purpose.

This blight on the American political landscape should be excised at the earliest possible moment. Issa is a horrible politician and and even worse human being. Why isn't he moldering in solitary confinement at Quantanamo?

Obamacare is the first necessary and painful stepping stone towards socialized medicine. We are on the right course finally. The Republicans can all go to hell.

ZOMG! The Liberal party has just identified their true agenda - socialism. Sorry, fuck you and never!

 

[IBMer]

ZOMG! The Liberal party has just identified their true agenda - socialism. Sorry, fuck you and never!

Its amazing that most of the aforementioned first world nations, that have socialized medicine, are still capitalist economies.

 

[yllus]

Its amazing that most of the aforementioned first world nations, that have socialized medicine, are still capitalist economies.

Secretly, we're not. We're communist client-states of Soviet Russia, who is behind everything socialist! And you would have been next, if not for the intrepid efforts of compuwiz1 and other heroes of freedom!

Seriously for a moment, I can only hope that people who get upset at the mention of socialism are over the age of 60. People who were raised in the post-Cold War era need to be smarter than that.

 

[Exterous]

Funny that. People seem to be entirely willing to do so in most of the rest of the First World.

http://www.practicelink.com/magazine/vital-stats/physician-compensation-worldwide/

Most of the other first world nations subsidize physicians' education more heavily, I suspect.

Or their education just didn't cost as much in the first place. If we address the costs of medical education then we can more easily address the issue of compensation

 

[bshole]

Secretly, we're not. We're communist client-states of Soviet Russia, who is behind everything socialist! And you would have been next, if not for the intrepid efforts of compuwiz1 and other heroes of freedom!

ROFLMAO!! You nailed it.

 

[Londo_Jowo]

Obamacare is the first necessary and painful stepping stone towards socialized medicine.

I doubt the US will ever have socialized medicine as both parties are owned by the medical industry and insurance companies. The ACA benefits both of these entities more than it does Americans.

 

[AViking]

The first step in trying to get Americans access to affordable health care is .... controlling the cost of the care and thus making it <gasp> affordable. obummercare does nothing to address costs.

It does one thing. They can simply not pay the high prices that a medical provider provides. Once enough people use the ACA then it might be hard for providers to not service ACA customers.

I went to a specialist about 8 years ago and the doctor would not accept my insurance. I was using Blue Shield and they said that they would only pay them $60 for my office visit so they would demand cash. I had to pay $200 for a 15 minute visit. I had a HSA so I didn't care that much but this high priced healthcare needs to stop.

Another good example is that I got an MRI and they said my health insurance wouldn't cover it. They billed me $5000 for an MRI of my back. Six months later my insurance paid them and settled it for something like $1500. Of course the reality is that an MRI for the back only costs about $300 so they were still overcharging by about 500%.

You can't stop them from trying to overcharge unless you make big changes. Obamacare is at least a start. At some point you have to ask yourself why you are using expensive insurance to overpay your healthcare providers. The more people get on ACA the cheaper it will become. Hopefully in the near future we'll see that US healthcare costs drop significantly below the 17% of GDP we currently pay.

 

[AViking]

Tort reform. Okay but I've been told on many occasions that this has a tiny effect on care costs.

In the states if I got sick and went to the doctor they would give me every test possible since if they didn't they risked getting sued. There are many cases where there's a .01% chance that it could be something different. They can't risk that.

Here they don't do that. They don't rush you in to get the expensive treatment until they actually have a cause to do so. They aren't in fear of litigation.

Now I don't know which metrics we should use to compare the two systems but cost (it's much less here) and average lifespan (it's higher here) seem like a good start.

 

[bshole]

In the states if I got sick and went to the doctor they would give me every test possible since if they didn't they risked getting sued. There are many cases where there's a .01% chance that it could be something different. They can't risk that.

Here they don't do that. They don't rush you in to get the expensive treatment until they actually have a cause to do so. They aren't in fear of litigation.

Now I don't know which metrics we should use to compare the two systems but cost (it's much less here) and average lifespan (it's higher here) seem like a good start.

And patient satisfaction..... in every single metric that matters, the USA is sucking hind teat and by a WIDE WIDE margin. The problem is that we have bunch of neanderthal conservatives that see SOCIALIZED medicine as some great evil and block it at every turn.

PS. ISSA is the problem, not the solution!