HC passes Senate

[fskimospy]

You do realize that graph is a pile of shit, right? What are you trying to prove? Americans tend to live more unhealthy lifestyles compared to the rest of the world, which has absolutely nothing to do with the availability of health care.

Where in this abomination of health care legislation do we force Americans to eat healthy and exercise properly? Oh right, the government will just start taxing everything they deem unhealthy. More taxes on alcohol, cigarettes, sugar - tanning beds are included in this new legislation. The state of Maine is considering putting cancer warnings on cell phones, just a matter of time before the liberals in charge decide to raise taxes on cell phones.

So to fix health care costs we can either (1) ration care, (2) have the government legislate what is unhealthy and enforce high taxes accordingly, or (3) leave the choices up to the individual to take the risks and accept the consequences.

I'll take (3) thank you very much.

Australia leads a significantly less healthy lifestyle than America does and pays less than half what we do per capita. The 'Americans are too unhealthy' thing has been thrown out before and been dispensed with, it does not account for our disparity in spending, so no that graph is most certainly not shit.

 

[Patranus]

LOL - The Democrats have been chanting that the GOP is in the pockets of the health insurance companies and they are about to singlehandedly pass legislation that mandates every American buy their products - lining their pockets.

Does anyone believe anything that comes out of this administrations mouth anymore?

 

[cubby1223]

Australia leads a significantly less healthy lifestyle than America does and pays less than half what we do per capita. The 'Americans are too unhealthy' thing has been thrown out before and been dispensed with, it does not account for our disparity in spending, so no that graph is most certainly not shit.

hmmm...
http://www.nationmaster.com/graph/hea_obe-health-obesity

What I would like to see, what happens if someone made up the same graph but eliminates off the top 1% of the population with the greatest health care costs. Let's see what the costs are for the average person.

How much do we choose to spend to keep a few healthy, where other countries choose to ration out those treatments to save $$?

And to just point out expected life expectancy, there are far more factors that go into that too, many unrelated to the availability of health care, things that universal coverage doesn't have any impact on.

I stand by what I said, and that graph by itself is not even remotely close to the full story.

 

[Hayabusa Rider]

Australia leads a significantly less healthy lifestyle than America does and pays less than half what we do per capita. The 'Americans are too unhealthy' thing has been thrown out before and been dispensed with, it does not account for our disparity in spending, so no that graph is most certainly not shit.

So tell us the difference between the US and Australia and precisely how we get the 1/2 off sale? It's not in insurance company profits.

Caveat- No deux ex machina. You have a completely different political structure, tax system and demographics.

Please, show us how we can provide the same standard of care for less than it costs us to provide now without any profit at all.

If you can do it, you'd be the first.

 

[BoberFett]

So tell us the difference between the US and Australia and precisely how we get the 1/2 off sale? It's not in insurance company profits.

Caveat- No deux ex machina. You have a completely different political structure, tax system and demographics.

Please, show us how we can provide the same standard of care for less than it costs us to provide now without any profit at all.

If you can do it, you'd be the first.

What's amusing is that government already controls half of this country's health care spending and only provides coverage for a fraction of the population. So the same government that provides Medicare and Medicaid covering a small portion of us is somehow going to provide health care for everyone for the same price?

http://www.youtube.com/watch?v=CxUGR8vc8NE

 

[woolfe9999]

So tell us the difference between the US and Australia and precisely how we get the 1/2 off sale? It's not in insurance company profits.

Caveat- No deux ex machina. You have a completely different political structure, tax system and demographics.

Please, show us how we can provide the same standard of care for less than it costs us to provide now without any profit at all.

If you can do it, you'd be the first.

Well, you expressed this same skepticism in another thread, and I think I provided a reasonable answer there:

http://forums.anandtech.com/showthread.php?t=2031203&page=8

The short answer is that you can eliminate about 20% of healthcare costs by switching to single payor just by eliminating billing bureacracy from the sytem, without compromising care. There are other aspects of single payor than can also reduce costs, though I doubt you can get anywhere near 50% savings without reducing the quality of care.

- wolf

 

[fskimospy]

hmmm...
http://www.nationmaster.com/graph/hea_obe-health-obesity

What I would like to see, what happens if someone made up the same graph but eliminates off the top 1% of the population with the greatest health care costs. Let's see what the costs are for the average person.

How much do we choose to spend to keep a few healthy, where other countries choose to ration out those treatments to save $$?

And to just point out expected life expectancy, there are far more factors that go into that too, many unrelated to the availability of health care, things that universal coverage doesn't have any impact on.

I stand by what I said, and that graph by itself is not even remotely close to the full story.

Hmmm indeed.

http://www.timesonline.co.uk/tol/life_and_style/health/article4171160.ece

 

[fskimospy]

So tell us the difference between the US and Australia and precisely how we get the 1/2 off sale? It's not in insurance company profits.

Caveat- No deux ex machina. You have a completely different political structure, tax system and demographics.

Please, show us how we can provide the same standard of care for less than it costs us to provide now without any profit at all.

If you can do it, you'd be the first.

As already stated the first thing you do is switch to single payer, that's a gimme. It's a tried and true system that shows massive efficiency gains across the world. Once you switch to single payer I would alter the compensation system from reimbursement per procedure to a salary based one. That's just a start. (by the way no, I'm not writing a report on the subject)

Single payer is a solution so blindingly obvious that our children will laugh at us for not making it sooner. Someday we will get there, but it will take time.

 

[Hayabusa Rider]

Well, you expressed this same skepticism in another thread, and I think I provided a reasonable answer there:

http://forums.anandtech.com/showthread.php?t=2031203&page=8

The short answer is that you can eliminate about 20% of healthcare costs by switching to single payor just by eliminating billing bureacracy from the sytem, without compromising care. There are other aspects of single payor than can also reduce costs, though I doubt you can get anywhere near 50% savings without reducing the quality of care.

- wolf

Considering that we have as much or more paperwork headaches when dealing with medicaid and medicare, where does this 20% come from? We spend more time resolving government roadblocks than any private insurance plan, not that they are any good. Time is money and we are constantly struggling to get back to work rather than doing the work of the insurance companies, government and private.

What would be great is if instead of "solving" problems by inflicting more onerous and confusing regulations they would get out of the way and do their jobs so we don't have to do theirs, that would be a good way to save money and let people concentrate on doing what they were trained for. Note this isn't just government, but the private insurance companies. Want to drive a practitioner crazy? Say two words "prior authorization" and stand back

It really would have been nice if someone considered health care issues from the patient/provider standpoint, but it's all been about who controls the dollars. That's not health care reform.

 

[Hayabusa Rider]

Oh, and I'd love to see standardized billing practices. That would be terrific, but it's like someone decided to make health care reform like an Italian dinner. Just add all the ingredients for the main course, salad, bread and dessert to the same pot and stir. Yummy.

 

[BoberFett]

Single payer (in other words, government payer) will cut costs? My wife works in medical billing, and according to her they spend more time on a per patient basis dealing with government bureaucracy than they do dealing with private insurers. So do you really want to stand by the 20% figure?

Edit: Heh, Hayabusa beat me to it. Granted, I agree there would be some efficiencies found. Right now some of the work done (as I understand it) is determining which exact prorgram a particular patient is covered by. If there were only one program there'd be less of that. But that 20% figure was clearly pulled straight out of someone's ass.

 

[fskimospy]

Single payer (in other words, government payer) will cut costs? My wife works in medical billing, and according to her they spend more time on a per patient basis dealing with government bureaucracy than they do dealing with private insurers. So do you really want to stand by the 20% figure?

Even when all differences in billing are accounted for and all hidden costs that private insurers deal with that Medicare does off budget are accounted for, Medicare is still much more efficient. Studies to show this have been linked here in the past, in threads I'm pretty sure you have participated in.

 

[BoberFett]

Wrong. Anything I've ever seen that "proved" government programs are more efficient is measuring as a percent of total spending, not on per treatment or even per patient basis. Fact is, administrative overhead is only a tiny fraction of what will be needed to cut to get us to this magical "half" that UHC proponents claim every other country on the planet pays.

 

[fskimospy]

Wrong. Anything I've ever seen that "proved" government programs are more efficient is measuring as a percent of total spending, not on per treatment or even per patient basis. Fact is, administrative overhead is only a tiny fraction of what will be needed to cut to get us to this magical "half" that UHC proponents claim every other country on the planet pays.

Why would you try to compare medicare to private insurance on a per patient basis? That would be beyond stupid.

 

[woolfe9999]

Single payer (in other words, government payer) will cut costs? My wife works in medical billing, and according to her they spend more time on a per patient basis dealing with government bureaucracy than they do dealing with private insurers. So do you really want to stand by the 20% figure?

Edit: Heh, Hayabusa beat me to it. Granted, I agree there would be some efficiencies found. Right now some of the work done (as I understand it) is determining which exact prorgram a particular patient is covered by. If there were only one program there'd be less of that. But that 20% figure was clearly pulled straight out of someone's ass.

Yes I would stand behind the 20% figure. It's a fact that billing bureacracy is about 20% of our healthcare costs. The problem is that Medicare cannot solve that because Medicare operates within the framework of itemized billing, just like the private insurance industry does. The matter gets confused because single payor advocates keep saying that Medicare is a model for single payor. However, in a proper single payor system, hospitals and doctors do not generate itemized bills and the paying entity doesn't pour over a billion pages of such bills. Hospitals do not employ 50-100 people for this purpose, nor does the paying entity. Rather, the paying entity pays the providors on a monthly basis, based on the provider's costs plus a fixed profit margin. This cuts out an enormous amount of red tape from the system. In sum, if you really want to "get out of the way," then you need the simplest system of health insurance possible, and properly implemented single payor is it.

OTOH, I acknowledge that skyrocketing costs mainly come on the provider end, separate and apart from the bureacracy. It is because we have an unhealthy lifestyle, which in turn produces a lot of chronic diseases (accounting for 80% of our total costs), and the state of medical technology is such that we can now treat these diseases over the long term but usually cannot cure them. That is a recipe for healthcare costs elevating beyond inflation for some time to come. It is a problem that can only be solved by improving public health, and in the longer term, by technology that will allow us to cure, rather than just endlessly treat, these conditions. Single payor can help quite a bit with costs in the short to mid term future, but in the long term it is all about the technology.

- wolf

 

[BoberFett]

Why would you try to compare medicare to private insurance on a per patient basis? That would be beyond stupid.

Why not? Because it ruins your argument? Your problem, not mine.

 

[Lemon law]

The fact is and remains that our existing employer based health care system was collapsing
as it was being cannibalized by inflation based cost increases that were unsustainable. The mere fact that such an employer based system did a decent job 50 years ago cannot disguise the fact its unsustainable now.

Its now easy to say the new system we will transition to has some downsides, but at the end of the day, the only way to honestly compare what we had to what we will have in the future was to honestly debate and the upsides and downsides of both alternatives.

But in the whole dishonesty of debate on the real health care issue, we, the American people were robbed of that honest debate. And as a corollary of Gresham's law, counterfeit debate drives out honest debate.

 

[woolfe9999]

I agree that we have not had an honest debate about healthcare in this country. The entire debate has been polluted by ideology. There is no way to solve a crisis like this unless everyone looks at the issue in the manner of a non-partisan policy wonk. There are precious few such people around. In the end, our system will get real reform when it is teetering on the edge collapse, and not before.

- wolf

 

[Darwin333]

I agree that we have not had an honest debate about healthcare in this country. The entire debate has been polluted by ideology. There is no way to solve a crisis like this unless everyone looks at the issue in the manner of a non-partisan policy wonk. There are precious few such people around. In the end, our system will get real reform when it is teetering on the edge collapse, and not before.

- wolf

I completely agree.

 

[daishi5]

Why would you try to compare medicare to private insurance on a per patient basis? That would be beyond stupid.

I have to question this, medicare insures one of the more expensive parts of the population. If you compare efficiency in terms of % of total amount spent, then their demographic would make them more efficient without any actual efficiency. In fact, I cannot think of any good reason to not compare them on a per patient basis.

 

[blackangst1]

Yes I would stand behind the 20% figure. It's a fact that billing bureacracy is about 20% of our healthcare costs. The problem is that Medicare cannot solve that because Medicare operates within the framework of itemized billing, just like the private insurance industry does. The matter gets confused because single payor advocates keep saying that Medicare is a model for single payor. However, in a proper single payor system, hospitals and doctors do not generate itemized bills and the paying entity doesn't pour over a billion pages of such bills. Hospitals do not employ 50-100 people for this purpose, nor does the paying entity. Rather, the paying entity pays the providors on a monthly basis, based on the provider's costs plus a fixed profit margin. This cuts out an enormous amount of red tape from the system. In sum, if you really want to "get out of the way," then you need the simplest system of health insurance possible, and properly implemented single payor is it.

OTOH, I acknowledge that skyrocketing costs mainly come on the provider end, separate and apart from the bureacracy. It is because we have an unhealthy lifestyle, which in turn produces a lot of chronic diseases (accounting for 80% of our total costs), and the state of medical technology is such that we can now treat these diseases over the long term but usually cannot cure them. That is a recipe for healthcare costs elevating beyond inflation for some time to come. It is a problem that can only be solved by improving public health, and in the longer term, by technology that will allow us to cure, rather than just endlessly treat, these conditions. Single payor can help quite a bit with costs in the short to mid term future, but in the long term it is all about the technology.

- wolf

You bring up a good point about lifestyle. One thing that aggrevates me about the current bill is it doesnt reward those who take care of themselves. For example, even though Im a type 1 diabetic, I get healthy measure discounts from my employers insurance. They have 11 different areas to qualify in, and I qualify for 7. There really needs to be *some* kind of incentive for those of us who DO take care of themselves.

 

[daishi5]

I agree that we have not had an honest debate about healthcare in this country. The entire debate has been polluted by ideology. There is no way to solve a crisis like this unless everyone looks at the issue in the manner of a non-partisan policy wonk. There are precious few such people around. In the end, our system will get real reform when it is teetering on the edge collapse, and not before.

- wolf

A lot of people don't want to look at what the true definition of "cost cutting" would be. If we truely cut 50% of our medical costs in this country, that is a lot of people out of a job. If we eliminate all the billing overhead we put a lot of people whose only real expertise is in billing out of a job. If we reduce all the unnecessary testing, lab technicians and the people who make the testing materials will be let go.

Also, you stated that in a single payor system

Rather, the paying entity pays the providors on a monthly basis, based on the provider's costs plus a fixed profit margin.

Wouldn't this encourage hospitals to inflate their costs, or at the minimum remove all incentive to cut costs and become more efficient? If my profit is a guaranteed 2% of my costs, I can increase my nominal profits just by spending extra money on stupid crap.

I have never heard this idea that a single payor system would remove all the billing overhead completely. It seems to be a critical piece in the governments efforts to prevent fraud.

 

[Hayabusa Rider]

Yes I would stand behind the 20% figure. It's a fact that billing bureacracy is about 20% of our healthcare costs. The problem is that Medicare cannot solve that because Medicare operates within the framework of itemized billing, just like the private insurance industry does.

That's one reason I'm entirely skeptical about the same people single payer.

For sake of argument, let's say that you worked for me, and had created two very large programs. They turn out to be incredibly difficult to manage, and let's say that the people who have to deal with it are out of pocket 20%.

You then come to me saying that you have a new program which dwarfs that which you have done, but the claim is that it will knock off 20% of the costs now incurred.

Frankly that's going to be a hard sell. I'm going to tell you to demonstrate that you can make what you already have work, then come back to me.

Medicaid is killing states. In NY, our education budget is being cannibalized to pay for it. True, states have a good share of blame, but the whole concept was flawed from the beginning, and in 50 years the Dems have fought reform tooth and nail. Medicare D is another huge problem, and the only way it could be sold was to insert the "donut hole" and pretend that all was well.

In light of the above, what credibility do those who some would have take over the health care system have? I heal about "obstructionism", but I've not seen much of an explanation of what was being blocked, other than what seems to be a pig in a poke.

I don't consider trivial the ability of myself and others to provide quality care. If you can get the pols to demonstrate competence with something small, then I'll reconsider. I'm unmoved by "Republican obstructionists!" as much as I was by "terrorist supporters!"

 

[woolfe9999]

A lot of people don't want to look at what the true definition of "cost cutting" would be. If we truely cut 50% of our medical costs in this country, that is a lot of people out of a job. If we eliminate all the billing overhead we put a lot of people whose only real expertise is in billing out of a job. If we reduce all the unnecessary testing, lab technicians and the people who make the testing materials will be let go.

Also, you stated that in a single payor system

Wouldn't this encourage hospitals to inflate their costs, or at the minimum remove all incentive to cut costs and become more efficient? If my profit is a guaranteed 2% of my costs, I can increase my nominal profits just by spending extra money on stupid crap.

I have never heard this idea that a single payor system would remove all the billing overhead completely. It seems to be a critical piece in the governments efforts to prevent fraud.

On your first point, yes, we would eliminate several hundred thousand jobs in medical billing and in the insurance industry. The economy will survive. The fact is, our system of medical billing is inefficient and places a large layer of additional cost onto a system that already has a problem due to so many chronic illnesses now being treatable but not curable. When you look at a bloated system like that, you have to focus in on where the inefficiency can be eliminated. It isn't in the doctors or nurses saleries. It isn't in the cost of medical equipment or pharmaceuticals, as we need profit in those industries to encourage innovation. Rather, it is in the bloated and inefficient bureacracy.

If you are concerned about the loss of jobs in that sector, consider how many jobs are lost, or simply not created, because of the high cost of medical premiums to American companies. In fact, we lose out to foreign labor markets because our employers pay for medical premiums, and pay through the nose.

The second point you raise might be valid, but I do not doubt there are ways around it. It is a complicated problem you point out where any solutions would also be complicated. I suppose you could spot audit provider accounting practices. It would be too much bureacracy to audit all of it all the time, but a spot audit to identify unnecessary costs being racked up might be sufficient to deter these practices.

- wolf

 

[Hayabusa Rider]

I completely agree.

And I with both of you.

Here again is my suggestion which will be completely ignored by most.

Both parties appoint professionals recognized by their peers as being exceptional in their fields. Physicians, nurses, etc. Get some actuaries who have demonstrated a grasp of financial matters. Put leading consumer advocates versed in the complexities of the health care system. Get people who understand what's going on involved.

Let them have access to any and all data, and with specific mandates. Have them identify problem areas in health care delivery (that would include billing), regulatory issues (complex and conflicting rules), what methods could be employed to improve things, and NO political agenda. No scrapping or promoting any system in advance.

Gather data, review it, reach a consensus and then file a very public report. At this point Congress has a resource which it can use to make informed legislation based on the needs of it's citizens.

Now it can go off (and it almost certainly will) to make political hay, but there will be a public reference and a group of experts who can put things in context. Makes it easier to hold the law makers who would be doctors accountable.

If he Dems had really been interested in health care and had two good neurons unaffected by party considerations they could have done something like this. Why didn't this happen? Because they would have lost some control over the process. Suppose that a method was found to deal with this that didn't dovetail with their agenda? What if a government run single payer system wasn't the best option? No, party first.

But back to the fairy land where our representatives have our best interests at heart. The Reps would have objected and tried to subvert, but it would be a bitch to oppose genuine beneficial health care reform which has been responsibly worked out and painfully explained.

In the end, something good might have come of this.

Instead it's the Healthocons vs the Neocons. What a tragic waste.