No Health Care Vote Before August Break

[TruePaige]

Originally posted by: colossus
I'll post these replies here since the other thread "died"

Originally posted by: WhipperSnapper

Originally posted by: JS80So you assume gov't would have lower admin costs than a private corporation that has board members, shareholders to be accountable to and executives who's compensation is tied to the profitability of the corporation?

I think it would be possible if we had a rational and efficient government that sincerely wanted to provide a service to the populace. A tremendous amount of money and resources can be saved by cutting out the middlemen. Are the Japanese really so much smarter than we are that their health system is less than 7% of their GDP whereas ours is just under 17% (while failing to insure tens of millions of people and providing inadequate care and coverage for millions more)?

I'm not going to request your CV showing me your experience in surveying health systems.

The number commonly touted around in the medical community is that 95% of all health care dollars are spent at the end of life. If you want to simply knock down the % utilization of GDP (reflected in pure dollar costs for care provided and not factoring lost wages and the like) simply disconnect grandpa from the vent.

I don't know how many times thhis year I spent trying to get people who were brain-dead off the vent by talking to families. While it may sound evil the fact is 3 days in the ICU geting constant brain perfusion scans and EEGs and basically sucking up an ICU nurse really runs up the bill. I haven't seen a single maggot (yeah that's what they amount to) in Congress address this issue. Why!?! They're not PAs, RNs, MDs or DOs. They don't know anything about medicine other than the numbers some secretarial aid crunched up.

There are lot of reforms that need to be made - like having a nation push for organ donation and ethics committees to decide to legally accelerate situations like brain-death. I almost tore my last bits of hair out trying to get a 92 woman to make her husband DNR after he was basically in a coma with 6 stage 4 ulcers. How that man survived for 10 months I don't know (I got stuck with him for 2 months). He easily cost Medicare over 5 million dollars. Even the chaplin could convince the woman for DNR and he said she was the toughest person he ever dealt with.

The solutions being offered by the "minds" in DC are pathetic. Most 3rd year medical students and LVNs could put together a better health care reform package and actually cut costs while improving on core quality. When Obama blatantly poo-poos anything the AMA says about tort reform (and I hate the AMA like I hate the AARP) then you know it's hopeless.

Funny they let baseball players testify about steriods on the hill for 3 days but can't find time to have open forum for medical professionals for 1 week. If the people reading this thread haven't written their reps they're part of the problem too. I for one have 13 letters written to Feinstein (1 was actually replied to).

Originally posted by: JS80

Originally posted by: Chaotic42

Originally posted by: Acanthus
Economics 101 solution: Make it easier to become a doctor or nurse. Increase the supply to decrease the demand, and therefore the price.

Is the problem a lack of interested, intelligent people or is it an artifical limit on the number of doctors. If it's the latter, it's an easy fix. If it's the former...

There is a lack of interest because you bust your ass undergrad take an impossibly hard exam to get into med schools that have an extremely limited open spots only to come out of med school in massive debt where you make $30-40k for another 4-8 years. Vs Wall St/hedge fund/private equity/mgmt consulting your first year you're making 100-150k and escalate to unlimited earnings potential.

But now that Wall St. is dead there will be a HUGE talent base that will no longer be entering finance we can incentivize from HS age students to go into medicine by loosening standards, increasing the number of med schools (which the AMA artificially keeps VERY LOW), and offer subsidized medical education while funding the building of new medical schools.

But good luck breaking the AMA lobby. They will fight you to the death just as they hold our health hostage.

You do know there is more than one medical lobby - although per media the second is dwarfed by the first. I'm referring to DOs and the AOA. I myself am a DO (mainly because I was unwilling to leave SoCal and not because of any philosophy). The number of DO schools more than doubled in the last 10 years and since most are private they put out large number of physicians.

DOs historically do primary care but in my class most people went into specialty which is where the money is. I myself matched for anesthesia (a somewhat difficult residency but financially overcompensated) but decided I would better serve people in primary care and made the stupid mistake of doing FP/IM (I could be blissfully ignoring paperwork and enjoying a GT3 right now instead of driving a Odyssey).

That brings me to my point about ethics. Sure I could have done the WS thing and given how driven I was in my 20s and how good I was at pulling 48 hour shifts w/p caffeine I could have probably been set for life by now. Don't think WS is holding $ back, the banks seem to still be on track for doling out the pork. If everybody who wanted to run to WS to make $ runs to Medicine to make $ - well you're going to be having a lot more shady physicians than we already have.

I chose medicine because I wanted the respect (yeah I'll admit it) and I wanted to genuinely help people. I'm a good listener, very patient and can solve problems quickly - none of those skill seem to be helping me today. Sure I read my CME articles and stay up to date - but I spend over 1/3 of my time filling forms and returning pages from something non-medical related.

As I said above I hate the AMA but if Obama refuses to listen to their pandering (he openly said it in a video clip) then I wonder who he'll (by he I mean Obama/Reid/Pelosi/Steele/et al) listen to.

Again I would like C-Span to show me 1 week where docs/nurses/PAs/therapist are up the hill testifying like every other group gets to do. Until I see that happen I'll laugh at the notion the government is compentently trying to fix anything.

BTW, the reason the AMA and AOA are so weak is because physicians are too lazy to get involved. They're so involved w/ running their practice and to some extent bogged with paperwork they don't choose to write the representative. A random poll done by myself showed that not one of 37 docs I saw in the doc lounge last year had written their congressional rep/senator. That's apathy. Guess Obama's HOPE didn't get to the docs.


TruePaige - above you made a good point that UHC can't cost 10x as much since it's 14% of the GDP. But what if in say 10 years the costs do continue to go up at a stable 7% per anum (we do have the boomers hitting the wall afterall). I fear the government's only option would be to print more $.


Ultimately there is a finite amount of $. The $ represents slavery in essence. I enslave myself to get those $s - they are precious to me :laugh:. If Obama is sincere in meaning deficit neutral - he means the net amount of work for caring for people should be the same. It would be pointless to keep the work the same and not improve outcomes - so I can only assume he wants better quality. I shell out close to $300 a month for Kaiser per year and have been doing so since age 22 or so (my dad paid for me when I was in med school). If you add 50 million people to the rolls they should be expected to utilize primary care. If they followed the docs advice (hell even I don't follow my own advice sometimes) and get healthy I would gladly shell out 10% more of my income. I don't see that happening any time soon.

If everbody is more or less covered evenly with UHC (kind of like Medicare is now) then everbody will have great primary care and horrible catastrophics/emergent care and the top levels of care will become unaccessable to all but the Rockafellers. Everybody would get their statin, their diabetes meds, their hypertensive meds, their pain control, flu shots, etc - but coronary stenting and the like simply won't be covered. I DON'T WANT ANYBODY OUTSIDE OF MEDICINE TO EVEN ARGUE AGAINST THAT - IT'S CLEARLY BEEN THE TRACK RECORD FOR NEUROLOGIC AND CORONARY CARE (look at reimbursements).

The other option would be to cover people only for inpatient needs and force a co-pay for outpatient visits. This could be fiscally sustainable since it's basically what we have now - but it doesn't really improve the health of those currently uninsured (unless they choose to pay for outpatient visits).

Look - no name calling. If people can avoid using name calling and stupid titles like Repub/Democrat/Neo-Con/Liberal then feel free to respond to this.

If you wouldn't mind could you please elaborate on this paragraph?

"If everbody is more or less covered evenly with UHC (kind of like Medicare is now) then everbody will have great primary care and horrible catastrophics/emergent care and the top levels of care will become unaccessable to all but the Rockafellers. Everybody would get their statin, their diabetes meds, their hypertensive meds, their pain control, flu shots, etc - but coronary stenting and the like simply won't be covered. I DON'T WANT ANYBODY OUTSIDE OF MEDICINE TO EVEN ARGUE AGAINST THAT - IT'S CLEARLY BEEN THE TRACK RECORD FOR NEUROLOGIC AND CORONARY CARE (look at reimbursements). "

Just want to hear a little more on that before I say anything.

 

[colossus]

Originally posted by: TruePaige
If you wouldn't mind could you please elaborate on this paragraph?

"If everbody is more or less covered evenly with UHC (kind of like Medicare is now) then everbody will have great primary care and horrible catastrophics/emergent care and the top levels of care will become unaccessable to all but the Rockafellers. Everybody would get their statin, their diabetes meds, their hypertensive meds, their pain control, flu shots, etc - but coronary stenting and the like simply won't be covered. I DON'T WANT ANYBODY OUTSIDE OF MEDICINE TO EVEN ARGUE AGAINST THAT - IT'S CLEARLY BEEN THE TRACK RECORD FOR NEUROLOGIC AND CORONARY CARE (look at reimbursements). "

Just want to hear a little more on that before I say anything.

Basically I'm saying you have a fixed amount of money the CMS (Medicare) is allocated each year. We all know the Medicare fund is somewhat raided by the house/Senate, but more or less the system is paying currently for the future retirees. Unfortunately the idiots who created this program doled out money at the inception to people who never put into the put - but that's another problem - can't go back in time. If UHC is passed and 50 million people are for all intents and purposes treated as if they had Medicare then the higher cost procedures would be phased out (quickly if not immediately). I'm not an expert in this area (or anything for that matter) but simply looking at the way Medicare reimburses physicians and hospitals indicates the general trend that medicine/procedures go where the money is rather than towards what is best for the patient. A specific example is heart attack - acute MI. Medicare used to pay boat loads for deploying a stent (this is why cardiologist could afford a new flavor of Porsche every year). Medicare, in their infinite insight, rather than setting practice guidelines and rules on who should get a stent (yeah that would not be politically correct to play God) decided to just reduce reimbursement. This way they "fixed" the money leak by not making it as lucrative for the cardiologist to deploy stents. As it stands the standard reimbursement for ICD-9 stent placement is about $250. However government wants to track who has heart disease and instead have people treated medically - so they are now saying a core quality indicator (basically a measure of how good a hospital is doing) is whether or not they do an echocardiogram of high cardiac risk patients. Supposedly someday they will release rankings lol.

The echocardiogram is a diagnostic tool and the stent deployment is treatment. They currently pay about $500 to do an echo. That's like paying $500 to have a technician see you need a new transmission and $250 to replace it. Silly - but that's Medicare. So now all cardiologists are hesitant to do stenting on 75+ year old people - it's not worth the risk of lawsuit/death for minimal compensation. Now physicians are being forced by hospitals to order echos and place people on meds.

Again, money in medicine sort of dictates what gets done (well I guess that is the point of this thread lol). In medicine - money chases procedures. The physicians who think - pathologists, primary care, internal medicine, etc usually don't make the $. The ones with the needle do (anesthesia, surgeon, radiologist, dermatologist).

I'm not saying this is right or this is wrong - that's just an observation I've pretty much heard from every doc over 40 years old. Perception is in ones mind - but if everybody says it they're either all confused or it's the observed truth.

Point of this being - if you take 50 million people and add them to what would effectively be Medicare then there is no way UHC could pay for anything more than a cholecystectomy or appendectomy. If you increase taxes yes there would be more revenue. It would be up to law-makers to decide what procedures get covered. If those maggots (I said no name calling but I don't think of the things in DC as sentient) won't ask for the help of the medical community now - what makes people belive they will later. Somehow hemodialysis became a pet for some lawmaker and that got passed. Had that money been spent on neural research or gene research we would be farther ahead in medicine than we are now (a belief shared by me and many other docs).

Even if you increase tax revenue 20% you still would not be able to provide coverage for procedures like organ transplants, tissue grafting, vascular repairs, coronary stenting, etc. Medicare was to go bankrupt in under 10 years even before thoughts of UHC were put into effect. Now if you banish the defense budget you could probably eek some better care out.

If you look at UHC in other countries this is basically what it is. Good general care. For higher level care you out-of-luck since there isn't enough volume to warrant doing business in those areas. For some Americans this is an upgrade - for others it's a downgrade.

I think it is pointless to even talk about UHC at this point in time since right now it can't be logistically implemented. Plain and simple the primary care infrastructure is not present in the US. It would take 10 years to train a crop of RNP/PA/and primary care docs, implement EMR (so the docs can cut paperwork to almost nothing), and adopt national standards for care.

One thing I will say for UHC is there are standards. It's pretty easy for a doc to decide what to do if he only has 2 options instead of 20. The government will have to set guidelines on who deserves health care. 95% of the dollars are spent at that last grab on life. If Congress had any courage at all they would put religious leaders, medical personel, and number crunchers in a room and come up with some standards. Right now in one state you need a javelin in the head to get a CT - 10 miles down the road in another state that may be more litigious and simple headache gets a CT (even if the patient has 12 of them in the last year - yes it happens).

It also comes down to compromises - if people are willing to sacrifice their privacy - the system can be more efficient. Put a tag on every human. Why waste time getting verbal history and doing useless tests when it can all be pulled up in 5 seconds. I'm sure the ACLU would love that. But with this you could have medical students and nurses treating easier triage cases and drastically cut wait times. When implemented with EMR it would probably save a tree every second (pulling that out of my ass - that stat, not a tree). Then again, I'm sure Thomas Jefferson would roll over in his grave if he heard that.

 

[SammyJr]

Originally posted by: Fern

Originally posted by: SammyJr
-snip-
The biggest problem we have here is the Republicans

That's BS.

The Repubs haven't got anything to do with the current stalemate. It's the Dems fighting among themselves. As noted above, and reported everywhere in the MSM the Dems have basically broken into 3 camps: (Far) Left, so-called moderate and 'conservative' Blue Dog Dems.

Even the Obama channel, er I mean MSNBC says so. In fact most the left leaning talking heads are surprised Obama is ripping the Repubs for the stalemate when everybody knows the problem in his own party. Rahm Emanuel called the Blue Dogs in for a meeting to pressure them, but doesn't look like it worked etc.

Missed my point. Part of the problem is that the Republicans don't provide any constructive input at all. All they do is oppose. Period. Maybe if they provided constructive input and were actually willing to work with Democrats towards the goals of full coverage and lower costs, then things might get done. The Blue Dogs lean conservative. Maybe some rational Republican input would provide a different perspective, although I freely admit that a rational Republican is a unicorn these days.

The other part of the problem is Republican FUD. They scream at the top of their lungs and spend millions of dollars bitching about the health care plans. This makes an impression on people, including the Blue Dogs, which reduces support for the programs. Fine, but that leads back to the above. Where are the Republican plans, besides the status quo plus even more tax cuts? They pitch FUD and have nothing to offer at all.

 

[SammyJr]

Originally posted by: FerrelGeek

Originally posted by: senseamp

Originally posted by: blanghorst

Originally posted by: senseamp

Originally posted by: blanghorst

Originally posted by: senseamp
OK, since it's now going to be voted after the break, hopefully the people who want Congress to slow down will shut up.

Oh, are they working to revise the bill over their break? Of course not. We don't want them to slow down -- we want them to slow down AND fix the bill. Keeping the bill the same and just delaying the vote accomplishes nothing.

Well, if they weren't going to change it, they'd just vote on it before recess.
They are slowing down to change the bill, so critics who say "slow down" need to STFU now.

They didn't have the votes is my understanding, due mainly to the Blue Dog democrats. Maybe I misunderstood, but if that is still the case, my fear is that the true reason for the delay may be nothing more than a stall tactic to sell the current plan to them. This is NOT what we need.

I think it's exactly what we need.

Oh yes, let's rush to pass a poorly conceived piece of garbage just to make you stop pouting and stomping your little size 6 foot. You've done nothing in this thread but hold yourself up as the poster boy that people like Rush like to lampoon. Way ta go!

Anything worth doing is worth doing well. If we're realy going to reform healthcare, let's do it in a way that won't screw up the 80%+ of Americans that have it. But all you care about is checking the box.

OK. What's your plan? You sound like a Republican. You scream at the top of your lungs how horrible this plan is. What's your alternative?

 

[SammyJr]

Originally posted by: owensdj
Congress needs to take the time to get this right before the vote on anything. They should look at the UHC systems put in place in other countries to see what works and what doesn't, especially Taiwan's system. Taiwan looked at almost every country's system and tried to take the best ideas from each one. They only spend 6% of their GNP on health care, but cover everybody.

Why would you expect our Congress, let alone the Republicans and DINOs, to be that rational?

 

[TheSkinsFan]

Originally posted by: senseamp

Originally posted by: TheSkinsFan

Originally posted by: senseamp

Originally posted by: TheSkinsFan

Originally posted by: sactoking
It was somewhere in the bill- it was linked here on ATP&N. There was some discussion about how it would be interpreted or enforced. I never hear what the resolution was. I hate the fusetalk search, so maybe someone can help dig this thread up if they have some free time.

It's on page 16 of the bill. There, you can read all about "Grandfathered Health Insurance Coverage," and the subsequent vague foundation for the eventual elimination of any/all private insurance.

After all, if you're only allowed to choose from the Government's approved list of providers -- the mysterious and all-powerful "Federal Health Insurance Exchange" -- what happens when the Government's new healthcare "Commissioner" decides to take every private provider off said list?

woops.

And that's just one of the many ambiguous sections in this fun-filled House version of the bill...

What if SEC decides that all stocks are off the NYSE? I guess we should abolish SEC.

Comparing the New York Stock Exchange to the newly proposed Federal Health Insurance Exchange is pure amateur hour -- beyond the word "exchange" in their titles, they would have absolutely nothing in common.

I mean, really?

Stay in school kids.

One lists shares, the other lists health insurance options. Both are federally regulated exchanges.

You do know that the NYSE is a publicly traded competitive corporation, and not a Federal entity, right? Which means, like I said, that it would have absolutely nothing in common with the proposed Health Insurance Exchange.

Stay.in.school.

 

[fskimospy]

Originally posted by: SammyJr

Originally posted by: Fern

Originally posted by: SammyJr
-snip-
The biggest problem we have here is the Republicans

That's BS.

The Repubs haven't got anything to do with the current stalemate. It's the Dems fighting among themselves. As noted above, and reported everywhere in the MSM the Dems have basically broken into 3 camps: (Far) Left, so-called moderate and 'conservative' Blue Dog Dems.

Even the Obama channel, er I mean MSNBC says so. In fact most the left leaning talking heads are surprised Obama is ripping the Repubs for the stalemate when everybody knows the problem in his own party. Rahm Emanuel called the Blue Dogs in for a meeting to pressure them, but doesn't look like it worked etc.

Missed my point. Part of the problem is that the Republicans don't provide any constructive input at all. All they do is oppose. Period. Maybe if they provided constructive input and were actually willing to work with Democrats towards the goals of full coverage and lower costs, then things might get done. The Blue Dogs lean conservative. Maybe some rational Republican input would provide a different perspective, although I freely admit that a rational Republican is a unicorn these days.

The other part of the problem is Republican FUD. They scream at the top of their lungs and spend millions of dollars bitching about the health care plans. This makes an impression on people, including the Blue Dogs, which reduces support for the programs. Fine, but that leads back to the above. Where are the Republican plans, besides the status quo plus even more tax cuts? They pitch FUD and have nothing to offer at all.

I like how the 178 Republicans in the House and 40 Republicans in the Senate that are opposing the bill aren't the reason why it's 'stalemated' (even though it's not), it's the 30 or so conservative Democrats!

This is not good logic, Fern.

 

[dmcowen674]

Originally posted by: SammyJr

OK. What's your plan? You sound like a Republican. You scream at the top of your lungs how horrible this plan is. What's your alternative?

Your wasting your breath, they don't have and don't want an alternative.

If you were making the obscene money they are making would you give any of that up?

 

[TheSkinsFan]

Originally posted by: dmcowen674

Originally posted by: SammyJr

OK. What's your plan? You sound like a Republican. You scream at the top of your lungs how horrible this plan is. What's your alternative?

Your wasting your breath, they don't have and don't want an alternative.

If you were making the obscene money they are making would you give any of that up?

Why do you wrongfully keep insisting that wealth has a party?

Oh yeah, it's you... nevermind. :roll:

 

[Darwin333]

Originally posted by: SammyJr

Originally posted by: FerrelGeek

Originally posted by: senseamp

Originally posted by: blanghorst

Originally posted by: senseamp

Originally posted by: blanghorst

Originally posted by: senseamp
OK, since it's now going to be voted after the break, hopefully the people who want Congress to slow down will shut up.

Oh, are they working to revise the bill over their break? Of course not. We don't want them to slow down -- we want them to slow down AND fix the bill. Keeping the bill the same and just delaying the vote accomplishes nothing.

Well, if they weren't going to change it, they'd just vote on it before recess.
They are slowing down to change the bill, so critics who say "slow down" need to STFU now.

They didn't have the votes is my understanding, due mainly to the Blue Dog democrats. Maybe I misunderstood, but if that is still the case, my fear is that the true reason for the delay may be nothing more than a stall tactic to sell the current plan to them. This is NOT what we need.

I think it's exactly what we need.

Oh yes, let's rush to pass a poorly conceived piece of garbage just to make you stop pouting and stomping your little size 6 foot. You've done nothing in this thread but hold yourself up as the poster boy that people like Rush like to lampoon. Way ta go!

Anything worth doing is worth doing well. If we're realy going to reform healthcare, let's do it in a way that won't screw up the 80%+ of Americans that have it. But all you care about is checking the box.

OK. What's your plan? You sound like a Republican. You scream at the top of your lungs how horrible this plan is. What's your alternative?

This guys plan makes a lot of sense.

 

[TheSkinsFan]

Originally posted by: Darwin333
This guys plan makes a lot of sense.

Brilliant!! and worth re-posting here in its entirety for the exceptionally lazy to have a chance at enlightenment as well.

Health Reform: Who Are They Trying To Fool?
by Karl Denninger

Health care "reform" is the current hot-button, with the Obama administration now talking about a "public" health-insurance system to "keep the system honest."

Uh huh.

Look folks, you want to know why we have the health cost problems we have? I'll lay it out for you - in a way you can't refute or argue with:

1. There are no published prices. In no other line of work is it legal to do this. Nowhere. You can't sell someone a hot dog and tell them after they eat it what it just cost them. You can't hire a lawyer and have him tell you "I'll tell you what this will cost when we're done." You can't hire an electrician and have him tell you "I'll make up a bill when I'm done." In every line of work except health care, this is illegal. There are even laws for "major" consumer work (e.g. contracting, auto repair, etc) where they must give you a binding written estimate before beginning work!
2. Robinson-Patman makes it illegal to discriminate against like kind purchasers of goods in pricing decisions when the effect of doing so is to lessen competition. While it does not apply to services, it darn well should. Whether you are paying privately, you have private insurance or you're a Medicare patient if you need to have a breast reconstructed due to cancer the complexity of the procedure does not change. Yet it is a fact that the privately-billed amounts for uninsured ("rack rate") patients are often ten times or more that billed to insurers or Medicare. Try charging a cash purchaser 10x more for a TV than someone who finances that TV on your in-house credit facility and you would be shut down and thrown in jail.

#1 and #2 exist because of explicit efforts by the "health care" industry to exempt themselves from the laws that every other merchant of every other good and service in the United States must adhere to.

To put this bluntly the medical industry has intentionally put forward a system by which it can screw you with impunity, obtaining exemptions from the laws that cover every other area of commerce, thereby effectively forcing you to buy overpriced services you do not want to purchase lest an unexpected life event literally wipe you out.

This is an extortion racket and absolutely none of the proposals being put forward have done a thing to address any of it.

If we want to fix the health care pricing problem we can do so. It isn't very difficult. Here's the prescription:

1. All health care providers must publish a price list for the procedures and services they offer and the patient must be presented, when possible, with that information before services are performed or goods (e.g. medication) supplied, consenting to the charge in each case. All normal anti-trust provisions with regards to collusion between providers apply. If a physician doesn't like "flat-rate" billing they're free to publish a per-hour fee much like an attorney.
2. No physician or group may discriminate based on the form of any external payment. If they want to internally finance procedure(s), that's fine - they can charge interest or discount for that, or whatever. But for anyone who pays via any other means (including the government) money is money - the price may not change based on the source of payment.
3. No event caused by your presence in a medical facility or the actions of an employee there can come with cost to you. It is absolutely common for people to be billed for treatment of MRSA infections acquired in the hospital! That is equivalent to a mechanic that through incompetence or even malice cuts a wiring harness in your car while it is on the rack having the oil changed and then tries to charge you to fix what he broke!

Now clearly #1 doesn't work so well when you're unconscious due to a heart attack or just wrecking your car. But setting your broken leg or performing a cardiac procedure is something that's done for people who aren't incapacitated too, so guess what - the price is already published and thus the charge known.

This prevents the common practice of hospitals gouging private payers, it exposes prices and brings competition to pricing, and allows the free market to work. It ends the preference for "insurance" on routine procedures.

Next up, if you want to sell "insurance" in a market you must sell it to all persons in that market, defined as an area of at least one US State. You may discriminate in your pricing only based on age and gender - nothing else. If you sell that "insurance" product to any person you must sell to all persons within that state at the same price, and you must publish all your plans and offering prices.

"Insurance" products that are not true insurance products may not discriminate on reimbursement dependent on where the service is performed. The practice of requiring "in network" doctors or even hospitals lest you get "rejected" must end. In addition pre-qualification for any bona-fide non-elective procedure must be absolutely barred as a matter of law.

Finally, all providers of "insurance" must sell a true insurance product. Common HMO/PPO plans are not insurance - they are pre-paid medical care. Insurance is the purchase of a contract to cover damage caused by an unexpected event. Everyone needs health care of some form. Those who want to sell "pre-paid health plans" may do so, but they must also offer true insurance (e.g. covering ONLY hospitalization and related events, etc.)

These changes instantly destroy the connection between health "insurance" and employment. If you leave your job you have the absolute right to keep your health plan by continuing to pay for it. If you don't like your health plan or move out of the state you can buy any plan offered to anyone in your state, at your choice, for the same price they pay.

All mandates to provide specific services and products under "insurance" are federally preempted. Women should be able to choose a health plan that does not include abortion (and/or pre-natal!) services, for example, if they would never use either. Some women (e.g. those who have chosen to have a tubal ligation!) can't use these services, yet they often wind up paying for them in their premiums. Men should be able to choose a plan that does not cover things like Viagra - or, if they choose, perhaps they do want "ED" coverage.

If the health lobby won't cut out the nonsense and work for this sort of change to the system then I am forced to advocate for full nationalization of the entire health system, effectively placing everyone under Medicare. This will lead to forced rationing due to cost but that's happening already, and such a forced system will put a stop to the discriminatory practices of insurers, physicians, hospitals and others in the medical field who commonly bill private parties ten times what health "insurance" plans or Medicare pay for the very same procedure, while playing "let's deny coverage any time we think we can get away with it."

It is my opinion that we should be treating those in the health-insurance lobby, including hospitals, physicians and health-insurance providers, as co-conspirators in a racketeering scheme that effectively trades on the fear of disease and imminent bankruptcy to bamboozle and screw the population, while waving around their "hippocratic oath" - something better described as the "hypocritic oath."

nice find.

 

[FerrelGeek]

Originally posted by: SammyJr

Originally posted by: FerrelGeek

Originally posted by: senseamp

Originally posted by: blanghorst

Originally posted by: senseamp

Originally posted by: blanghorst

Originally posted by: senseamp
OK, since it's now going to be voted after the break, hopefully the people who want Congress to slow down will shut up.

Oh, are they working to revise the bill over their break? Of course not. We don't want them to slow down -- we want them to slow down AND fix the bill. Keeping the bill the same and just delaying the vote accomplishes nothing.

Well, if they weren't going to change it, they'd just vote on it before recess.
They are slowing down to change the bill, so critics who say "slow down" need to STFU now.

They didn't have the votes is my understanding, due mainly to the Blue Dog democrats. Maybe I misunderstood, but if that is still the case, my fear is that the true reason for the delay may be nothing more than a stall tactic to sell the current plan to them. This is NOT what we need.

I think it's exactly what we need.

Oh yes, let's rush to pass a poorly conceived piece of garbage just to make you stop pouting and stomping your little size 6 foot. You've done nothing in this thread but hold yourself up as the poster boy that people like Rush like to lampoon. Way ta go!

Anything worth doing is worth doing well. If we're realy going to reform healthcare, let's do it in a way that won't screw up the 80%+ of Americans that have it. But all you care about is checking the box.

OK. What's your plan? You sound like a Republican. You scream at the top of your lungs how horrible this plan is. What's your alternative?

I'm not screaming, I'm merely disagreeing; last I knew, we still had that right in the US. People can disagree without blowing a gasket; you should try it sometime. Frankly, I don't see any point in offering anything as all I'd get from liberals.txt on this site would be their typical vitriol and bile for anything that doesn't involve a massive government solution and somebody else paying for them.

]But I'll leave you with the following so that you don't think that I'm a drooling shill for the status quo (though I'm sure you will anyway): I do believe that our system can stand some reforms. We need to address people with pre-existing condition. I like the idea of allowing people to be able to transfer their current plan to their new job. I like the idea of allowing plans to be portable across state lines. I could live with a public option that deals with only the ~10-15% of the country that isn't insured. I think we could manage some of these items without a massive .gov power-grab.

 

[TheSkinsFan]

Originally posted by: FerrelGeek
But I'll leave you with the following so that you don't think that I'm a drooling shill for the status quo (though I'm sure you will anyway): I do believe that our system can stand some reforms. We need to address people with pre-existing condition. I like the idea of allowing people to be able to transfer their current plan to their new job. I like the idea of allowing plans to be portable across state lines. I could live with a public option that deals with only the ~10-15% of the country that isn't insured. I think we could manage some of these items without a massive .gov power-grab.

:thumbsup:

 

[quest55720]

Originally posted by: TheSkinsFan

Originally posted by: FerrelGeek
But I'll leave you with the following so that you don't think that I'm a drooling shill for the status quo (though I'm sure you will anyway): I do believe that our system can stand some reforms. We need to address people with pre-existing condition. I like the idea of allowing people to be able to transfer their current plan to their new job. I like the idea of allowing plans to be portable across state lines. I could live with a public option that deals with only the ~10-15% of the country that isn't insured. I think we could manage some of these items without a massive .gov power-grab.

:thumbsup:

I am against any public option. We know it will become the only option after a few years. There is plenty of reform to try first before we go the road of having Pelosi in charge of our health care.

 

[Double Trouble]

Originally posted by: eskimospy

I like how the 178 Republicans in the House and 40 Republicans in the Senate that are opposing the bill aren't the reason why it's 'stalemated' (even though it's not), it's the 30 or so conservative Democrats!

This is not good logic, Fern.

Wait a second, no matter how you turn it, the dems have the votes to do whatever they want no matter what any republican says or does. Trying to blame the repubs for *anything* at this point makes no sense, the dems control every legislative and executive government body to the point of being able to completely ignore/override anything the repubs do. Sorry, that excuse won't fly.

 

[Gonad the Barbarian]

Originally posted by: TheSkinsFan

Originally posted by: Darwin333
This guys plan makes a lot of sense.

Brilliant!! and worth re-posting here in its entirety for the exceptionally lazy to have a chance at enlightenment as well.

Health Reform: Who Are They Trying To Fool?
by Karl Denninger

Health care "reform" is the current hot-button, with the Obama administration now talking about a "public" health-insurance system to "keep the system honest."

Uh huh.

Look folks, you want to know why we have the health cost problems we have? I'll lay it out for you - in a way you can't refute or argue with:

1. There are no published prices. In no other line of work is it legal to do this. Nowhere. You can't sell someone a hot dog and tell them after they eat it what it just cost them. You can't hire a lawyer and have him tell you "I'll tell you what this will cost when we're done." You can't hire an electrician and have him tell you "I'll make up a bill when I'm done." In every line of work except health care, this is illegal. There are even laws for "major" consumer work (e.g. contracting, auto repair, etc) where they must give you a binding written estimate before beginning work!
2. Robinson-Patman makes it illegal to discriminate against like kind purchasers of goods in pricing decisions when the effect of doing so is to lessen competition. While it does not apply to services, it darn well should. Whether you are paying privately, you have private insurance or you're a Medicare patient if you need to have a breast reconstructed due to cancer the complexity of the procedure does not change. Yet it is a fact that the privately-billed amounts for uninsured ("rack rate") patients are often ten times or more that billed to insurers or Medicare. Try charging a cash purchaser 10x more for a TV than someone who finances that TV on your in-house credit facility and you would be shut down and thrown in jail.

#1 and #2 exist because of explicit efforts by the "health care" industry to exempt themselves from the laws that every other merchant of every other good and service in the United States must adhere to.

To put this bluntly the medical industry has intentionally put forward a system by which it can screw you with impunity, obtaining exemptions from the laws that cover every other area of commerce, thereby effectively forcing you to buy overpriced services you do not want to purchase lest an unexpected life event literally wipe you out.

This is an extortion racket and absolutely none of the proposals being put forward have done a thing to address any of it.

If we want to fix the health care pricing problem we can do so. It isn't very difficult. Here's the prescription:

1. All health care providers must publish a price list for the procedures and services they offer and the patient must be presented, when possible, with that information before services are performed or goods (e.g. medication) supplied, consenting to the charge in each case. All normal anti-trust provisions with regards to collusion between providers apply. If a physician doesn't like "flat-rate" billing they're free to publish a per-hour fee much like an attorney.
2. No physician or group may discriminate based on the form of any external payment. If they want to internally finance procedure(s), that's fine - they can charge interest or discount for that, or whatever. But for anyone who pays via any other means (including the government) money is money - the price may not change based on the source of payment.
3. No event caused by your presence in a medical facility or the actions of an employee there can come with cost to you. It is absolutely common for people to be billed for treatment of MRSA infections acquired in the hospital! That is equivalent to a mechanic that through incompetence or even malice cuts a wiring harness in your car while it is on the rack having the oil changed and then tries to charge you to fix what he broke!

Now clearly #1 doesn't work so well when you're unconscious due to a heart attack or just wrecking your car. But setting your broken leg or performing a cardiac procedure is something that's done for people who aren't incapacitated too, so guess what - the price is already published and thus the charge known.

This prevents the common practice of hospitals gouging private payers, it exposes prices and brings competition to pricing, and allows the free market to work. It ends the preference for "insurance" on routine procedures.

Next up, if you want to sell "insurance" in a market you must sell it to all persons in that market, defined as an area of at least one US State. You may discriminate in your pricing only based on age and gender - nothing else. If you sell that "insurance" product to any person you must sell to all persons within that state at the same price, and you must publish all your plans and offering prices.

"Insurance" products that are not true insurance products may not discriminate on reimbursement dependent on where the service is performed. The practice of requiring "in network" doctors or even hospitals lest you get "rejected" must end. In addition pre-qualification for any bona-fide non-elective procedure must be absolutely barred as a matter of law.

Finally, all providers of "insurance" must sell a true insurance product. Common HMO/PPO plans are not insurance - they are pre-paid medical care. Insurance is the purchase of a contract to cover damage caused by an unexpected event. Everyone needs health care of some form. Those who want to sell "pre-paid health plans" may do so, but they must also offer true insurance (e.g. covering ONLY hospitalization and related events, etc.)

These changes instantly destroy the connection between health "insurance" and employment. If you leave your job you have the absolute right to keep your health plan by continuing to pay for it. If you don't like your health plan or move out of the state you can buy any plan offered to anyone in your state, at your choice, for the same price they pay.

All mandates to provide specific services and products under "insurance" are federally preempted. Women should be able to choose a health plan that does not include abortion (and/or pre-natal!) services, for example, if they would never use either. Some women (e.g. those who have chosen to have a tubal ligation!) can't use these services, yet they often wind up paying for them in their premiums. Men should be able to choose a plan that does not cover things like Viagra - or, if they choose, perhaps they do want "ED" coverage.

If the health lobby won't cut out the nonsense and work for this sort of change to the system then I am forced to advocate for full nationalization of the entire health system, effectively placing everyone under Medicare. This will lead to forced rationing due to cost but that's happening already, and such a forced system will put a stop to the discriminatory practices of insurers, physicians, hospitals and others in the medical field who commonly bill private parties ten times what health "insurance" plans or Medicare pay for the very same procedure, while playing "let's deny coverage any time we think we can get away with it."

It is my opinion that we should be treating those in the health-insurance lobby, including hospitals, physicians and health-insurance providers, as co-conspirators in a racketeering scheme that effectively trades on the fear of disease and imminent bankruptcy to bamboozle and screw the population, while waving around their "hippocratic oath" - something better described as the "hypocritic oath."

nice find.

That is a damn fine article. :thumbsup:

 

[BoberFett]

Originally posted by: eskimospy
I like how the 178 Republicans in the House and 40 Republicans in the Senate that are opposing the bill aren't the reason why it's 'stalemated' (even though it's not), it's the 30 or so conservative Democrats!

This is not good logic, Fern.

Really? So those 40 out of 100 Republican senators are preventing a vote of 51 of 49?

Are you retarded? Seriously? Are you mentally retarded? Medically speaking, are you retarded? I knew Democrats were stupid, but really? Do you really want to blame this on Republicans?

This forum has hit a new low. Thanks eskimospy for being the new low point of stupidity. You bring great value to this discussion.

 

[fskimospy]

Originally posted by: Skoorb
Obama = owned.

Maybe next time he can push for a bill that isn't a total piece of sh*t. We can hope, right?

Damn, I was hoping they'd finally be able to get something done this time around. Honestly, I think that waiting until after the break will just give a better chance for those who either want to kill the bill or those who are good intentioned but ignorant to amend the bill and make it even more convoluted than it already is.

Should something so damn important be unable to hold itself up for a month while they BBQ, though?

This piece of legislation sucked. Congressional budget committee said it wouldn't save any money. Go back to the drawing board and come up with something better.

Obama hasn't been owned in any way whatsoever. This legislation was step 1 in a 10 step process, and the CBO most certainly didn't say that it wouldn't save any money. It's amazing how much something can be twisted in such a short time.

If you actually are paying attention to how things are progressing you would see that it is extremely likely that this legislation will pass. Period. Shame on you Skoorb, I thought better of you.

 

[themusgrat]

Originally posted by: eskimospy
Shame on you Skoorb, I thought better of you.

I feel like we're all back in 2nd grade, when you used to do all the "i know you are, what am i?" jokes, you ignored anything you wanted to ignore, and when you think you get the upper hand you condescendingly look down on the poor sod who dared cross words with you, and tell him you expected better. I mean, really?

 

[blackangst1]

Originally posted by: TheSkinsFan

Originally posted by: Darwin333
This guys plan makes a lot of sense.

Brilliant!! and worth re-posting here in its entirety for the exceptionally lazy to have a chance at enlightenment as well.

Health Reform: Who Are They Trying To Fool?
by Karl Denninger

Health care "reform" is the current hot-button, with the Obama administration now talking about a "public" health-insurance system to "keep the system honest."

Uh huh.

Look folks, you want to know why we have the health cost problems we have? I'll lay it out for you - in a way you can't refute or argue with:

1. There are no published prices. In no other line of work is it legal to do this. Nowhere. You can't sell someone a hot dog and tell them after they eat it what it just cost them. You can't hire a lawyer and have him tell you "I'll tell you what this will cost when we're done." You can't hire an electrician and have him tell you "I'll make up a bill when I'm done." In every line of work except health care, this is illegal. There are even laws for "major" consumer work (e.g. contracting, auto repair, etc) where they must give you a binding written estimate before beginning work!
2. Robinson-Patman makes it illegal to discriminate against like kind purchasers of goods in pricing decisions when the effect of doing so is to lessen competition. While it does not apply to services, it darn well should. Whether you are paying privately, you have private insurance or you're a Medicare patient if you need to have a breast reconstructed due to cancer the complexity of the procedure does not change. Yet it is a fact that the privately-billed amounts for uninsured ("rack rate") patients are often ten times or more that billed to insurers or Medicare. Try charging a cash purchaser 10x more for a TV than someone who finances that TV on your in-house credit facility and you would be shut down and thrown in jail.

#1 and #2 exist because of explicit efforts by the "health care" industry to exempt themselves from the laws that every other merchant of every other good and service in the United States must adhere to.

To put this bluntly the medical industry has intentionally put forward a system by which it can screw you with impunity, obtaining exemptions from the laws that cover every other area of commerce, thereby effectively forcing you to buy overpriced services you do not want to purchase lest an unexpected life event literally wipe you out.

This is an extortion racket and absolutely none of the proposals being put forward have done a thing to address any of it.

If we want to fix the health care pricing problem we can do so. It isn't very difficult. Here's the prescription:

1. All health care providers must publish a price list for the procedures and services they offer and the patient must be presented, when possible, with that information before services are performed or goods (e.g. medication) supplied, consenting to the charge in each case. All normal anti-trust provisions with regards to collusion between providers apply. If a physician doesn't like "flat-rate" billing they're free to publish a per-hour fee much like an attorney.
2. No physician or group may discriminate based on the form of any external payment. If they want to internally finance procedure(s), that's fine - they can charge interest or discount for that, or whatever. But for anyone who pays via any other means (including the government) money is money - the price may not change based on the source of payment.
3. No event caused by your presence in a medical facility or the actions of an employee there can come with cost to you. It is absolutely common for people to be billed for treatment of MRSA infections acquired in the hospital! That is equivalent to a mechanic that through incompetence or even malice cuts a wiring harness in your car while it is on the rack having the oil changed and then tries to charge you to fix what he broke!

Now clearly #1 doesn't work so well when you're unconscious due to a heart attack or just wrecking your car. But setting your broken leg or performing a cardiac procedure is something that's done for people who aren't incapacitated too, so guess what - the price is already published and thus the charge known.

This prevents the common practice of hospitals gouging private payers, it exposes prices and brings competition to pricing, and allows the free market to work. It ends the preference for "insurance" on routine procedures.

Next up, if you want to sell "insurance" in a market you must sell it to all persons in that market, defined as an area of at least one US State. You may discriminate in your pricing only based on age and gender - nothing else. If you sell that "insurance" product to any person you must sell to all persons within that state at the same price, and you must publish all your plans and offering prices.

"Insurance" products that are not true insurance products may not discriminate on reimbursement dependent on where the service is performed. The practice of requiring "in network" doctors or even hospitals lest you get "rejected" must end. In addition pre-qualification for any bona-fide non-elective procedure must be absolutely barred as a matter of law.

Finally, all providers of "insurance" must sell a true insurance product. Common HMO/PPO plans are not insurance - they are pre-paid medical care. Insurance is the purchase of a contract to cover damage caused by an unexpected event. Everyone needs health care of some form. Those who want to sell "pre-paid health plans" may do so, but they must also offer true insurance (e.g. covering ONLY hospitalization and related events, etc.)

These changes instantly destroy the connection between health "insurance" and employment. If you leave your job you have the absolute right to keep your health plan by continuing to pay for it. If you don't like your health plan or move out of the state you can buy any plan offered to anyone in your state, at your choice, for the same price they pay.

All mandates to provide specific services and products under "insurance" are federally preempted. Women should be able to choose a health plan that does not include abortion (and/or pre-natal!) services, for example, if they would never use either. Some women (e.g. those who have chosen to have a tubal ligation!) can't use these services, yet they often wind up paying for them in their premiums. Men should be able to choose a plan that does not cover things like Viagra - or, if they choose, perhaps they do want "ED" coverage.

If the health lobby won't cut out the nonsense and work for this sort of change to the system then I am forced to advocate for full nationalization of the entire health system, effectively placing everyone under Medicare. This will lead to forced rationing due to cost but that's happening already, and such a forced system will put a stop to the discriminatory practices of insurers, physicians, hospitals and others in the medical field who commonly bill private parties ten times what health "insurance" plans or Medicare pay for the very same procedure, while playing "let's deny coverage any time we think we can get away with it."

It is my opinion that we should be treating those in the health-insurance lobby, including hospitals, physicians and health-insurance providers, as co-conspirators in a racketeering scheme that effectively trades on the fear of disease and imminent bankruptcy to bamboozle and screw the population, while waving around their "hippocratic oath" - something better described as the "hypocritic oath."

nice find.

Pretty good read. I dont agree with point #2, but whatever. The only problem I see is...lets say hospitals have a list of expenses. Do you, as the patient, sign off on this before accepting treatment? Who the hell is going to read it? No one will. Secondly, the "list" will simply be too long. Costs for procedures are not static. Two people going in for the exact same thing will have different costs associated with their care, based on two individual treatments. Sure, some things are static. For example, every doc Ive ever seen in the last 20 years has a standard flat rate for "checkups". And being a diabetic, Ive seen alot of docs. They all have it if you ask. But for hospital costs...its an unreasonable request IMHO.

 

[blackangst1]

Originally posted by: FerrelGeek

Originally posted by: SammyJr

Originally posted by: FerrelGeek

Originally posted by: senseamp

Originally posted by: blanghorst

Originally posted by: senseamp

Originally posted by: blanghorst

Originally posted by: senseamp
OK, since it's now going to be voted after the break, hopefully the people who want Congress to slow down will shut up.

Oh, are they working to revise the bill over their break? Of course not. We don't want them to slow down -- we want them to slow down AND fix the bill. Keeping the bill the same and just delaying the vote accomplishes nothing.

Well, if they weren't going to change it, they'd just vote on it before recess.
They are slowing down to change the bill, so critics who say "slow down" need to STFU now.

They didn't have the votes is my understanding, due mainly to the Blue Dog democrats. Maybe I misunderstood, but if that is still the case, my fear is that the true reason for the delay may be nothing more than a stall tactic to sell the current plan to them. This is NOT what we need.

I think it's exactly what we need.

Oh yes, let's rush to pass a poorly conceived piece of garbage just to make you stop pouting and stomping your little size 6 foot. You've done nothing in this thread but hold yourself up as the poster boy that people like Rush like to lampoon. Way ta go!

Anything worth doing is worth doing well. If we're realy going to reform healthcare, let's do it in a way that won't screw up the 80%+ of Americans that have it. But all you care about is checking the box.

OK. What's your plan? You sound like a Republican. You scream at the top of your lungs how horrible this plan is. What's your alternative?

I'm not screaming, I'm merely disagreeing; last I knew, we still had that right in the US. People can disagree without blowing a gasket; you should try it sometime. Frankly, I don't see any point in offering anything as all I'd get from liberals.txt on this site would be their typical vitriol and bile for anything that doesn't involve a massive government solution and somebody else paying for them.

]But I'll leave you with the following so that you don't think that I'm a drooling shill for the status quo (though I'm sure you will anyway): I do believe that our system can stand some reforms. We need to address people with pre-existing condition. I like the idea of allowing people to be able to transfer their current plan to their new job. I like the idea of allowing plans to be portable across state lines. I could live with a public option that deals with only the ~10-15% of the country that isn't insured. I think we could manage some of these items without a massive .gov power-grab.

The problem with the left (and the right to be frank) is that they think ANY plan is better than the one we have. THAT is the problem. But, as recent polls have shown, the American people and the senate want health industry change, but they just dont want what is being proposed.

 

[blackangst1]

Originally posted by: Double Trouble

Originally posted by: eskimospy

I like how the 178 Republicans in the House and 40 Republicans in the Senate that are opposing the bill aren't the reason why it's 'stalemated' (even though it's not), it's the 30 or so conservative Democrats!

This is not good logic, Fern.

Wait a second, no matter how you turn it, the dems have the votes to do whatever they want no matter what any republican says or does. Trying to blame the repubs for *anything* at this point makes no sense, the dems control every legislative and executive government body to the point of being able to completely ignore/override anything the repubs do. Sorry, that excuse won't fly.

QFT

 

[piasabird]

Lets have the vote right now and see what happens. Put up or shut up.

 

[blackangst1]

Originally posted by: piasabird
Lets have the vote right now and see what happens. Put up or shut up.

It wouldnt pass.