Goodbye public option, we hardly knew ya

[shadow9d9]

Which is basically shifting the cost from the one who won't pay anyway to higher prices for the one who would be forced to pay.

Our education system is failing. Having more people with insurance so prices will go down is cost shifting? Did you even read it?

 

[shadow9d9]

Why do state public insurance program see their costs raise as fast or faster than private insurance? Shouldnt they be seeing similar cost savings? Why has Madicare and Medicaid far outpaced initial forecasts?

They are too small and too limited. Use that tiny thing called your brain.

 

[Patranus]

No, I just showed how lower labor costs helps the executives and capital investors, while HARMING the worker and the consumer.

You cite that higher labor costs force employers to off-shore thus hurting the employee.

You cite that the company must off-shore to keep product costs the same.

Therefore, the higher labor costs not only costs jobs but if not offset with off-shoring would hurt the consumer.

 

[Patranus]

They are too small and too limited. Use that tiny thing called your brain.

Approximately 100 million people were enrolled in Medicare and Medicaid in 2006. Medicare and Medicaid account for 25% of the federal budget.

I would hardly call those programs "too small and too limited".

 

[Fern]

By Genx87

Why do state public insurance program see their costs raise as fast or faster than private insurance? Shouldnt they be seeing similar cost savings? Why has Madicare and Medicaid far outpaced initial forecasts?

They are too small and too limited. Use that tiny thing called your brain.

What?

If you're saying Medicare/Medicaid is too small and too limited to show similar cost savings that seems ridiculous.

Our Medicare/Medicaid program is several times larger than the UK plan you guys always tout.

Fern

 

[PrinceofWands]

You cite that higher labor costs force employers to off-shore thus hurting the employee.

You cite that the company must off-shore to keep product costs the same.

Therefore, the higher labor costs not only costs jobs but if not offset with off-shoring would hurt the consumer.

Incorrect. I showed that was how the corporations CHOSE to respond to the natural and necessary increases in labor costs (which must occur in order to keep up with inflation and cost of living). There were many other options available that were not chosen.

I showed that these corporations achieved a lower per product production cost by offshoring, but kept the consumer price the same (or in some cases even higher than inflation would have forced). The subsequent increase in PROFIT for the company was passed directly to the executive and investors ONLY, not to the workers or the consumers (and certainly NOT to product development/quality). In other words, I disproved the free-market bullshit talking point that lower production/labor costs lead to lower costs for the consumer (on equivalent quality products that is).

Moreover, by choosing executive and investor profits over worker and consumer well-being they forced an out of control slope, as the now unemployed workers required greater government and private assistance to survive, driving up taxes and other costs for everyone, while creating an entire class of persons without the economic resources to purchase the products and help sustain profit levels for the company that caused the problems in the first place.

Big newsflash - an overall higher/stronger economy (as measured in volume, gdp, market levels, or other indicators) does NOT indicate a long term positive outcome. Individual employment levels, income levels, and sustainability/stability are INFINITELY more important than growth. America is ONLY as strong/profitable as its middle class. Period.

 

[woolfe9999]

This 1/2 price thing keeps getting brought up over and over again.

So someone explain how we get health care for 1/2 off? If you eliminated the insurance companies you would get maybe 5%.

You could reimburse below cost and bankrupt the providers, or you could severely ration health care.

Just how is this magic to be done and please don't say "Private insurance sucks..." because they are a very small part of the two trillion paid each year. You might as well say that that ten dollar raise a week will allow you to go from a Geo Metro to a Mercedes.

So how precisely does this work?

I don't know if the 1/2 off is accurate or not. There are a lot of statistics floating around about healthcare systems in other countries, and they can be mistated, over-generalized, and manipulated.

However, if your question is serious, I can provide a general answer.

Currently, about 22% of our healthcare costs are administrative. That is private bureacracy, and it has to do with our system of billing for medical services. A typical hospital employs 50-100 people who do nothing but sit around and compile bills, noting every pill dispensed to every patient, every syringe used, etc. That is a massive private bureaucracy. There is then a second bureacracy which mirrors it in the private health insurance companies. Those are the people who review all the bills from the providers and go through every line item, and determine what will be paid and how much, etc.

In a single payor system, the billing system is greatly simplified as hospitals do not generate itemized bills. They are instead paid on a monthly basis, presumably an adjustable amount based on the size of the facility, number of employees, patient volume, equipment, etc. The typical hospital in a single payor system might employ 2-3 people in a billing admin capacity, and the insurance end, which is now public, employs far fewer people to determine payment than private insurers do as the payments are based on certain simple metrics and are vastly less complicated.

This kind of system eliminates jobs for people who work in private insurance, and for people who work in admin on the provider end. That is obviously the tradeoff. However, the benefit in reducing costs is threefold: first, it eliminates most of the enormous admin cost in healthcare. Second, it eliminates insurance company profits from the equation. Third, they don't really allow medical malpractice lawsuits in those systems.

Under this system, the employer no longer has to pay for the employee's healthcare. Healthcare costs are an enormous burden on American business and they make us non-competetive with foreign labor markets. Of course, taxes must be raised to pay for the public insurance, but the tax increase is less than the cost of current, private insurance, because healthcare is cheaper in this system for the reasons already explained. Also, doctors and nurses - the people who really matter as healthcare providers, can make the same money they do under the current system. It is the admin side that takes the hit, not the actual providers.

I used to oppose single payor because I thought it was too much government intervention. However, I have changed my position after reading studies of single payor in comparison to our current system. It's virtue is not that it covers everyone. We can do that here without single payor, and it looks like we're going to do it. The problem is you can't have universal healthcare without reducing the costs or it ends up being paid for entirely by taxpayors and insurance companies get a huge windfall. The virtue of single payor is it covers everyone and is a net savings.

I don't know about 50% savings. You probably can't achieve that without reducing the quality of care, but I can see saving about a third off our current system.

- wolf

 

[Slew Foot]

I don't know if the 1/2 off is accurate or not. There are a lot of statistics floating around about healthcare systems in other countries, and they can be mistated, over-generalized, and manipulated.

However, if your question is serious, I can provide a general answer.

Currently, about 22% of our healthcare costs are administrative. That is private bureacracy, and it has to do with our system of billing for medical services. A typical hospital employs 50-100 people who do nothing but sit around and compile bills, noting every pill dispensed to every patient, every syringe used, etc. That is a massive private bureaucracy. There is then a second bureacracy which mirrors it in the private health insurance companies. Those are the people who review all the bills from the providers and go through every line item, and determine what will be paid and how much, etc.

In a single payor system, the billing system is greatly simplified as hospitals do not generate itemized bills. They are instead paid on a monthly basis, presumably an adjustable amount based on the size of the facility, number of employees, patient volume, equipment, etc. The typical hospital in a single payor system might employ 2-3 people in a billing admin capacity, and the insurance end, which is now public, employs far fewer people to determine payment than private insurers do as the payments are based on certain simple metrics and are vastly less complicated.

This kind of system eliminates jobs for people who work in private insurance, and for people who work in admin on the provider end. That is obviously the tradeoff. However, the benefit in reducing costs is threefold: first, it eliminates most of the enormous admin cost in healthcare. Second, it eliminates insurance company profits from the equation. Third, they don't really allow medical malpractice lawsuits in those systems.

Under this system, the employer no longer has to pay for the employee's healthcare. Healthcare costs are an enormous burden on American business and they make us non-competetive with foreign labor markets. Of course, taxes must be raised to pay for the public insurance, but the tax increase is less than the cost of current, private insurance, because healthcare is cheaper in this system for the reasons already explained. Also, doctors and nurses - the people who really matter as healthcare providers, can make the same money they do under the current system. It is the admin side that takes the hit, not the actual providers.

I used to oppose single payor because I thought it was too much government intervention. However, I have changed my position after reading studies of single payor in comparison to our current system. It's virtue is not that it covers everyone. We can do that here without single payor, and it looks like we're going to do it. The problem is you can't have universal healthcare without reducing the costs or it ends up being paid for entirely by taxpayors and insurance companies get a huge windfall. The virtue of single payor is it covers everyone and is a net savings.

I don't know about 50% savings. You probably can't achieve that without reducing the quality of care, but I can see saving about a third off our current system.

- wolf

50 people in billing making 50K year= 2.5 million dollars. Total amount paid to Johnson and Johnson by UC Davis for Orthopedic implants in 2008 =$48 million dollars.

Youre not going to get any real cost savings until you start cutting the costs of medical equiptment and prescription drugs.

 

[woolfe9999]

50 people in billing making 50K year= 2.5 million dollars. Total amount paid to Johnson and Johnson by UC Davis for Orthopedic implants in 2008 =$48 million dollars.

Youre not going to get any real cost savings until you start cutting the costs of medical equiptment and prescription drugs.

Dunno, but admin is about 22% of our aggregate healthcare cost. Also in single payor, they don't pay anywhere near the full freight for prescription drugs. Not sure about medical equipment in those systems versus ours.

- wolfe

 

[Carmen813]

Hahahahahahaha! You don't look for debate either. We all just shout our own opinion, conservatives, "progressives", it's all the same.

He called me a hack because I support tort reform. All it is is signing a piece of paper and *guaranteed* that expenses are reduced. Seems simple enough to me. Everything about the rest of the reform, the public option, etc., the cost estimates & savings are all based on guesses. Why I would be called a hack by supporting the one guarantee out there, you tell me, since you seem to be so smart

Critical thinking fail. Perhaps the cost of individual cases would go down, but then more cases would be started in the first place. No guarantee tort reform would lower costs at all.

 

[IronWing]

Tort reform isn't really about limiting actual damages, at least not any I would support. It's about limiting "punitive' danages. Punitive damages are arbitrary and often excessive. Punishment for malpractice, or anything else for that matter, should be applied equally per offense and not based on whims of a jury (composed of non-professional in the matter) driven by the slick words of a tort lawyer who stands to make a killing if successful.

Why should the punishment for doctor who screws up be a large payment to some lawyer? Gawd, that makes no sense.

Fern

Arbitrarily limiting damages is a form of politically based economic subsidy. Generally we subsidize stuff or activities we want to see more of. Subsidizing malpractice through limiting liability should result in more malpractice. It is a perverse incentive for medical negligence. Giving judges more authority to modify jury awards might be a better solution to perceived runaway jury awards than any predetermined caps put in place by politicians who have no knowledge of specific cases and who are anything but independent players.

 

[Fern]

Arbitrarily limiting damages is a form of politically based economic subsidy. Generally we subsidize stuff or activities we want to see more of. Subsidizing malpractice through limiting liability should result in more malpractice. It is a perverse incentive for medical negligence. Giving judges more authority to modify jury awards might be a better solution to perceived runaway jury awards than any predetermined caps put in place by politicians who have no knowledge of specific cases and who are anything but independent players.

When speaking of "damages" one must be careful to differntiate between "actual" and "punitive".

If a doctor accidentially amputated the wrong leg, what is that leg worth? That's actual damages. I'm not advocating, nor are most tort reform proposals suggesting that be capped etc.

Now, after a finding that actual damages for a leg is $100K the jury will move to punative damages. What if the jury finds the loss of the one good leg so horrifying they award punative damages of $100M? So the $100M is to 'punish' the doctor for their error, does that make any sense? You commit a $100K error and get punished a thousand times over?

Also, we'll find in other similar cases juries may have awarded a much smaller 'punishment', does that make any sense? Should punishments be fairly similar for like offenses in order to be fair?

Right now the punitive part is just a (potential) big lottery for trial lawyers. IMO, that adds nothing of value (but does add cost) to the current HC system and needs to be changed.

Fern

 

[theeedude]

Considering that insurance company costs are only several percent of the 2 trillion dollars, how do you think you are going to cut that figure by $1,000,000,000,000?

Specifics, not pontification please.

This is pretty much the Dem equivalent of "If we depose Saddam, we'll have global terrorism under control". If you dared disagree, you were an idiot yet pressed for details, they ran to rhetoric.

Can you do better? BTW, there isn't a trillion in administrative waste so don't go there. Don't go "well France has"... France isn't derailing it's system for something else, and this isn't France.

Good luck, because no one has yet been able to answer this question with much more than "But THEY DO IT"

You are looking at it too narrowly. You are assuming that prices are fixed and all you can do is pick things on the menu. The reality is that a lot of the costs are excessive due to regulatory climate giving excessive pricing power to their providers. A lot of laws and regulations are paid for and written to maximize profits by various industries instead of promoting cost efficiency. For example, the Medicare prescription drug benefit that GOP passed explicitly forbids the government from negotiating lower rates for drugs, while paying for them, which is basically a ridiculous concept if you think about it.

 

[Xellos2099]

Our education system is failing. Having more people with insurance so prices will go down is cost shifting? Did you even read it?

Think of it this way, there are three group of people. 1. People will will buy insurance. 2. People who won't buy but be forced to buy due to penalty. 3. People that are too poor to buy insurance so they are government/taxpayer.

With the public option, both group 1 AND group 2 will be forced to buy health insurance. Group 3 will paid nothing so the it will HAVE to be coming out from group 1 and 2. Keep in mind there were people in group 2 who would no have bought the insurance if it is not mandatory. In a sense, cost of group 3 have been shifted to group 1 and 2.

 

[werepossum]

Think of it this way, there are three group of people. 1. People will will buy insurance. 2. People who won't buy but be forced to buy due to penalty. 3. People that are too poor to buy insurance so they are government paid.

With the public option, both group 1 AND group 2 will be forced to buy health insurance. Group 3 will paid nothing so the it will HAVE to be coming out from group 1 and 2. Keep in mind there were people in group 2 who would have have bought the insurance if it is not mandatory. In a sense, cost of group 3 have been shifted to group 1 and 2.

Not to mention that government routinely farms out all sorts of administration (including the federal government employees' insurance programs) because private firms are more productive and provide administration and lower costs, thus allowing more money to go to the original purpose. Moving insurance or health care to government bureaucracy will not yield a 50% savings, but rather a 10% cost increase on top of the extra people to be insured. Multiply that with the liberal requirement that everything be covered (free vaccinations, free office visits, and dental mental and psychic) and our health care costs are going to explode. Since we are already about as heavily in debt as we can manage, these higher costs will have to be offset by cutting care (especially to seniors, who use the most and the most expensive care) and by using queues and triage like other nations with socialized health care.

I'd be more impressed with liberals if they came out and said universal single payer health care is a human right and we're going to adopt Canada's system lock stock and barrel, and to hell with the health insurance industry, those people can apply for the government jobs. Instead they are trying to destroy the health insurance industry to get what they actually want, total government control. This is going to take our health care system down with it. And since we are more violent, drive more, smoke more, and are way fatter than Canadians, we're going to be dropping like flies.

 

[IronWing]

I'd be more impressed with liberals if they came out and said universal single payer health care is a human right and we're going to adopt Canada's system lock stock and barrel, and to hell with the health insurance industry, those people can apply for the government jobs. Instead they are trying to destroy the health insurance industry to get what they actually want, total government control. This is going to take our health care system down with it. And since we are more violent, drive more, smoke more, and are way fatter than Canadians, we're going to be dropping like flies.

That's exactly what the liberals are saying. The Dems, on the other hand, proposed a bill to prop up the insurance industry.

 

[Patranus]

I'd be more impressed with liberals if they came out and said universal single payer health care is a human right and we're going to adopt Canada's system lock stock and barrel, and to hell with the health insurance industry, those people can apply for the government jobs.

I'd be more impressed with liberals if they came out and stopped making up "rights" to justify instituting massive new government spending programs.

 

[0marTheZealot]

I'd be more impressed with liberals if they came out and stopped making up "rights" to justify instituting massive new government spending programs.

I can't wait until the company you work for (if you even work) lays you off, cites cost cutting and leaves you with no insurance. As an added bonus, if there truly is a God, you'll come down with diabetes or some other condition after you get laid off and essentially be uninsurable. You'll backtrack so fast on your positions, everyone's heads will spin.

 

[werepossum]

That's exactly what the liberals are saying. The Dems, on the other hand, proposed a bill to prop up the insurance industry.

There's some truth in that, although the Democrats in Congress (and the White House) today are unquestionably liberal compared to any previous occupants. But certainly there are other, more pure liberals, mostly those who don't have to worry about getting reelected. For my part though I think a right is an opportunity; it might cost money to preserve it or defend it, but not to provide it. (For instance, the government is not expected to buy you time on a radio station or a gun for your First or Second Amendment rights.) What the liberals (and Democrats) are pushing are not rights, but entitlements. They are not saying that you have the right to health care (meaning that no one is allowed to keep your from pursuing it), but rather that you are entitled to it. Entitlements don't require you to pursue or earn anything, but rather the government must actively remove wealth from one person and chase you down to transfer it to you.

 

[woolfe9999]

When speaking of "damages" one must be careful to differntiate between "actual" and "punitive".

If a doctor accidentially amputated the wrong leg, what is that leg worth? That's actual damages. I'm not advocating, nor are most tort reform proposals suggesting that be capped etc.

Now, after a finding that actual damages for a leg is $100K the jury will move to punative damages. What if the jury finds the loss of the one good leg so horrifying they award punative damages of $100M? So the $100M is to 'punish' the doctor for their error, does that make any sense? You commit a $100K error and get punished a thousand times over?

Also, we'll find in other similar cases juries may have awarded a much smaller 'punishment', does that make any sense? Should punishments be fairly similar for like offenses in order to be fair?

Right now the punitive part is just a (potential) big lottery for trial lawyers. IMO, that adds nothing of value (but does add cost) to the current HC system and needs to be changed.

Fern

This is not really accurate. Punitive damages are virtually never awarded, or even requested, in medical malpractice litigation. In order to get punitive damages, you have to prove malice on the part of the doctor, which is something akin to intentionally causing harm to the patient.

What you are probably thinking about is damages for pain and suffering. This is part of actual, compensatory damages and is not punishment. Tort reform schemes, such as we have here in California, severely limit such damages. In California, the cap is $250,000 per plaintiff, and that has not changed since the law was passed in the 1970's, not even to adjust for inflation. So under this law, if you are paralyzed for life by a doctor's negligence, your pain and suffering is worth a maximum of $250,000.

Other damages that are recoverable are medical costs (to repair the damage caused by the doctor), and wage loss. Those are not capped. However, medical bills are only recoverable to what is paid out of pocket by the patient. Amounts paid by insurers are not recoverable.

Essentially, under tort reform you can only recover a substantial amount if you can prove that you are unable to work for a long period of time due to the doctor's negligence, no matter how severe the injury, no matter how much pain and disability it causes.

Not saying anything for or against tort reform here, just supplying the facts based on existing state tort reform laws.

- wolf

 

[Darwin333]

Good Lord!

How will we ever have a decent debate on health care (and other issues) with this kind of inanity?

They don't oppose poor people having health care. (For one thing they already do, it's called Medicaid). They oppose being forced to pay for other peoples' HC.

Fern

I provided evidence of what you are incorrect about. You provide nothing.

Please explain why Walmart is able to deliver goods for the price they do then. My evidence is the biggest retailer in the history of the world. Millions of people do business with them daily so I would hardly call that nothing.

Its not simply volume, although its a big part, so what else is it besides low production costs?

 

[woolfe9999]

When speaking of "damages" one must be careful to differntiate between "actual" and "punitive".

If a doctor accidentially amputated the wrong leg, what is that leg worth? That's actual damages. I'm not advocating, nor are most tort reform proposals suggesting that be capped etc.

Now, after a finding that actual damages for a leg is $100K the jury will move to punative damages. What if the jury finds the loss of the one good leg so horrifying they award punative damages of $100M? So the $100M is to 'punish' the doctor for their error, does that make any sense? You commit a $100K error and get punished a thousand times over?

Also, we'll find in other similar cases juries may have awarded a much smaller 'punishment', does that make any sense? Should punishments be fairly similar for like offenses in order to be fair?

Right now the punitive part is just a (potential) big lottery for trial lawyers. IMO, that adds nothing of value (but does add cost) to the current HC system and needs to be changed.

Fern

This is not really accurate. Punitive damages are virtually never awarded, or even requested, in medical malpractice litigation. In order to get punitive damages, you have to prove malice on the part of the doctor, which is something akin to intentionally causing harm to the patient.

What you are probably thinking about is damages for pain and suffering. This is part of actual, compensatory damages and is not punishment. Tort reform schemes, such as we have here in California, severely limit such damages. In California, the cap is $250,000 per plaintiff, and that has not changed since the law was passed in the 1970's, not even to adjust for inflation. So under this law, if you are paralyzed for life by a doctor's negligence, your pain and suffering is worth a maximum of $250,000.

Other damages that are recoverable are medical costs (to repair the damage caused by the doctor), and wage loss. Those are not capped. However, medical bills are only recoverable to what is paid out of pocket by the patient. Amounts paid by insurers are not recoverable.

Essentially, under tort reform you can only recover a substantial amount if you can prove that you are unable to work for a long period of time due to the doctor's negligence, no matter how severe the injury, no matter how much pain and disability it causes.

Not saying anything for or against tort reform here, just supplying the facts based on existing state tort reform laws.

- wolf

 

[Patranus]

I can't wait until the company you work for (if you even work) lays you off, cites cost cutting and leaves you with no insurance. As an added bonus, if there truly is a God, you'll come down with diabetes or some other condition after you get laid off and essentially be uninsurable. You'll backtrack so fast on your positions, everyone's heads will spin.

COBRA premiums are less than $550per month and COBRA lasts 3 years. This doesn't account for the 66% discount Obama gave us in the "stimulus" package.

Yet another reason you save money instead to buying things one doesn't need or cannot afford.

 

[werepossum]

This is not really accurate. Punitive damages are virtually never awarded, or even requested, in medical malpractice litigation. In order to get punitive damages, you have to prove malice on the part of the doctor, which is something akin to intentionally causing harm to the patient.

What you are probably thinking about is damages for pain and suffering. This is part of actual, compensatory damages and is not punishment. Tort reform schemes, such as we have here in California, severely limit such damages. In California, the cap is $250,000 per plaintiff, and that has not changed since the law was passed in the 1970's, not even to adjust for inflation. So under this law, if you are paralyzed for life by a doctor's negligence, your pain and suffering is worth a maximum of $250,000.

Other damages that are recoverable are medical costs (to repair the damage caused by the doctor), and wage loss. Those are not capped. However, medical bills are only recoverable to what is paid out of pocket by the patient. Amounts paid by insurers are not recoverable.

Essentially, under tort reform you can only recover a substantial amount if you can prove that you are unable to work for a long period of time due to the doctor's negligence, no matter how severe the injury, no matter how much pain and disability it causes.

Not saying anything for or against tort reform here, just supplying the facts based on existing state tort reform laws.

- wolf

For what it's worth, in the only two successful medical malpractice suites I've been close to (not a party to, thankfully) substantial punitive damages were awarded. Plaintiff's attorneys argued that a big punitive judgment would encourage doctors to take more care to avoid such damages in the future. It's quite an odd departure from the norm, where the lawyer argues that there is a "habit and pattern" of behavior that must be punished with a big judgment. In both cases no other behavior came to light, which led to the lawyer arguing that such behavior, although not documented to be habitual, must be discouraged with a big judgment.

One thing about tort reform that often escapes notice is that bad doctors today have the option of settlement, with the obligatory nondisclosure agreement. Thus habitually bad doctors (alcoholics, for example) pay huge insurance premiums, but that still makes being a doctor more profitable than not being a doctor. By concealing malfeasance, it becomes more likely to recur. I would much prefer a system where all claims of malpractice or malfeasance must be reported to a government oversight for adjudication, so that bad doctors or nurses were prohibited from practicing (at least until the problem is remedied, with continuing oversight) rather than punishing them (and good doctors and nurses) with high insurance premiums. And I would restrict cases to be heard by judges or panels of judges, not twelve idiots with nothing better to do than jury duty.

 

[ebaycj]

I just checked and they seem to make 55-70k, but that is really good money for that job. Awesome paid vacation time, too.

Doctors in other countries are paid well. Not as well as the US but still Canada has never had a problem filling all its medical schools with applicants. I believe a fairly standard bill rate for a doctor in Canada in private practice is around $125/hour to the government but on top of that they have to cover their office, secretary, etc. so it's not a huge amount of money.

As far as the UPS drivers, that also doesn't include overtime, which they usually get a lot of (I have a couple buddies who drive UPS, and another friend's dad who works in corporate). And yes, the bennies are absolutely top-notch.

As far as doctors in other countries, yep, they're not starving. Not even close.