***OFFICIAL*** Obama's Healthcare summit discussion thread

[woolfe9999]

Because they have been promised an exception to the Cadillac tax for plans achieved through collective bargaining. If your company is successful enough to fund such a plan voluntarily, you're screwed and you pay for it. If on the other hand a union extorted the same exact plan on your behalf, you're golden.

We're still talking about something that isn't in the House bill, isn't in the Senate bill, and isn't in the President's proposal? This is relevant now, why? Because the dems discussed this for about 3 days in early January? Hollow talking points FTL.

- wolf

 

[werepossum]

Actual as an emergency physician, i can say that many people come to the er with non-emergency problems. We have implimented a fast track, and two urgent-cares. First we put mid-level providers in the fast track but the community was outraged that they may be forced to se a NP or PA. The urgent cares work great because it appears that the earliest appointments that anyone can get with their PMD's is about 3 or 4 days. Dispite this, many people still come into the ER with "colds" etc, either because they have no intention of paying, they have an HMO and can go nowhere else in an emergency, or their PMD told them to. You would think that people are cost sensitive but most are not.

Triage has become an important part of all emergency rooms for just this reason, people expect to be seen in order even when they are not seriously ill. We have decoupled health care from health care costs, originally in order to avoid salary caps in WW2. Free clinics would be an excellent alternative to minimize this, as most adults don't need to see a doctor. (Children I agree should also see a doctor in the ER because they don't know how they should feel and can't articulate the difference.)

 

[werepossum]

We're still talking about something that isn't in the House bill, isn't in the Senate bill, and isn't in the President's proposal? This is relevant now, why? Because the dems discussed this for about 3 days in early January? Hollow talking points FTL.

- wolf

Perhaps - but the unions seem to believe it. If the unions believe that the politicians they own will take care of them, then I tend to think that a deal has been made.

 

[Carmen813]

They need to do this discussion twice a week until they fix it. Eventually they will all tire of political theater and start actually doing work.

 

[mcmilljb]

Actual as an emergency physician, i can say that many people come to the er with non-emergency problems. We have implimented a fast track, and two urgent-cares. First we put mid-level providers in the fast track but the community was outraged that they may be forced to se a NP or PA. The urgent cares work great because it appears that the earliest appointments that anyone can get with their PMD's is about 3 or 4 days. Dispite this, many people still come into the ER with "colds" etc, either because they have no intention of paying, they have an HMO and can go nowhere else in an emergency, or their PMD told them to. You would think that people are cost sensitive but most are not.

I'm not arguing against the notion that people go to the ER with non-emergency problems. Sometimes it's just people do not know how serious the problem is. I'm arguing against the notion that people would some how think going to the ER would be cheaper if you have a high deductible instead of seeing a PCP. Yes a HMO could force you to go to the ER, and it is different if your PCP tells you to go. He was arguing people were going because of high deductibles. The deductible would still be in place whether you went to the ER or a PCP. That is just silly idea unless the people were going to try to skip paying their bills. I'm sure the rates going to your ER and Urgent Care are higher than a visit to a local PCP.

 

[woolfe9999]

Perhaps - but the unions seem to believe it. If the unions believe that the politicians they own will take care of them, then I tend to think that a deal has been made.

I think you're confused about the unions' position here. They objected to the high premium tax in the Senate bill because it would have affected too many union plans. The initial idea to address this concern was to (a) raise the ceiling that triggers the tax, and (b) start the tax in 2018 for the unions whereas it would start in 2016 for everyone else. This was the favorable treatment that everyone is talking about. The President's proposal does (a) and with respect to (b), it sets the start time at 2018 for everyone. Accordingly, the unions are still getting exactly what they wanted, but everyone else is being treated the same. So yes, the unions are happy because they get what they requested, but the current plan is going to give everyone else the same thing.

I would also add that what the unions really wanted was to ditch the high premium tax entirely, and instead go with the House's millionaire tax. That was their ideal solution. They didn't get this because the President favors the high premium tax as a cost control device.

- wolf

 

[StageLeft]

I had a swedish couple in the other day with their child who had a simple ear infection. They had to pay for the visit. Their american friend commented that it must be strange for them to have to pay. So I asked about it. They stated that about 60% of their salary go to taxes. I did'nt bother them further to discuss access but they did say that most sweds don't go to the doctor right away and only if it seems severe.
There is a cultural difference between us and Europe. They stated that their doctors wont treat most common illnesses right away and prefer to allow the bodies immune system the first crack at curing the disease.
In this country, I have to contend with people that come in within 24 hours of onset of symptoms. Many saying that they "just cant afford to be sick", as though the world would stop if they couldnt work.

Canada has this issue, some small percentage of the population use the hospitals and doctors like they're a drug and the person is an addict. Some have said a good way to dissuade these buffoons from constant trips to the doctor over a bout of sneezing is to have mild copays, but Canada is attached at the hip to nobody paying directly for healthcare so it never gets off the ground.

I am not a doc but anecdotally I feel people overuse the system. It's unbelievable to me how often people go to doctors and hospitals with their kids. My parents are doctors so naturally the only time I was ever at a hospital or doctor was when I was born and...well, never again. It was very hard to get a day off school with them, but we were healthy kids. A lot of parents appear to drug their kids up on any symptom. Many must be quite resistant to antibiotics, too. Makes you wonder how the hell the human race lived 100 years ago before we didn't have a pharmacy on every corner. I realize overall people were not healthy then, but for some it's swung too far.

I'm sure the rates going to your ER and Urgent Care are higher than a visit to a local PCP.

Perhaps but I'm not so sure. Our urgent care close to our house I think is similar cost to PCP. It really ought to be higher, it makes sense that it is. Our copay for a doctor is $20 and $30 for a specialist. A reasonable copay would be at least $100.

 

[mattpegher]

I'm not arguing against the notion that people go to the ER with non-emergency problems. Sometimes it's just people do not know how serious the problem is. I'm arguing against the notion that people would some how think going to the ER would be cheaper if you have a high deductible instead of seeing a PCP. Yes a HMO could force you to go to the ER, and it is different if your PCP tells you to go. He was arguing people were going because of high deductibles. The deductible would still be in place whether you went to the ER or a PCP. That is just silly idea unless the people were going to try to skip paying their bills. I'm sure the rates going to your ER and Urgent Care are higher than a visit to a local PCP.

True, most people who have to pay something will go where there copay is cheapest. The interesting thing is that our urgent cares charge about the same as pcp's (esp our contracted rates with the insurances) because currently most of our payors esp medicare do not pay Urgent care billing (CPT) codes, so we so far aren't billiing them to any payor.

 

[mcmilljb]

True, most people who have to pay something will go where there copay is cheapest. The interesting thing is that our urgent cares charge about the same as pcp's (esp our contracted rates with the insurances) because currently most of our payors esp medicare do not pay Urgent care billing (CPT) codes, so we so far aren't billiing them to any payor.

Well awesome. If prices are close, you(the consumer) have a choice. You can go see the Urgent Care if you feel you need to go right now, or you can wait until you can see your PCP. If they can keep the costs close, that's a plus for the whole community.

 

[her209]

I find it funny how all the Republicans citie the objections of the senior citizens who have Medicare to the bill because of the cuts to Medicare when its the Republicans that want to kill or significantly reduce Medicare/Medicaid if they could.

 

[werepossum]

Canada has this issue, some small percentage of the population use the hospitals and doctors like they're a drug and the person is an addict. Some have said a good way to dissuade these buffoons from constant trips to the doctor over a bout of sneezing is to have mild copays, but Canada is attached at the hip to nobody paying directly for healthcare so it never gets off the ground.

I am not a doc but anecdotally I feel people overuse the system. It's unbelievable to me how often people go to doctors and hospitals with their kids. My parents are doctors so naturally the only time I was ever at a hospital or doctor was when I was born and...well, never again. It was very hard to get a day off school with them, but we were healthy kids. A lot of parents appear to drug their kids up on any symptom. Many must be quite resistant to antibiotics, too. Makes you wonder how the hell the human race lived 100 years ago before we didn't have a pharmacy on every corner. I realize overall people were not healthy then, but for some it's swung too far.Perhaps but I'm not so sure. Our urgent care close to our house I think is similar cost to PCP. It really ought to be higher, it makes sense that it is. Our copay for a doctor is $20 and $30 for a specialist. A reasonable copay would be at least $100.

When I was growing up (sixties) every visit to the doctor resulted in a prescription for antibiotics. That was the practice. I always took them all, but that had to really drive antibiotic resistance in bacteria.

Everything is paid for by the consumer/taxpayer, only some costs are hidden as corporate taxes or government payments for political purposes. Any visit for health care generates some paperwork, but it should be obvious that if some third party is paying, then additional paperwork is required to satisfy that third party that the bill is legitimate. This paperwork is one of the major overhead costs for insurance companies. Ideally most to all normal health care should be paid for by the consumer, on the spot. This minimizes the overhead costs which detract from the money actually spent on health care. The larger the percentage of day-to-day health care is paid by "someone else", whether an insurance company or we as taxpayers, the more health care money must be spent on paperwork rather than actual health care.

The other major overhead cost for insurance companies, managing the client pool, is pretty much a given whether it is a single payer system, a not-for-profit insurance system, or a for-profit insurance system. Due to the extremely high potential cost of modern health care, almost everyone needs at least catastrophic health care insurance OR government assistance; there has to be some form of risk pooling.

 

[werepossum]

I find it funny how all the Republicans citie the objections of the senior citizens who have Medicare to the bill because of the cuts to Medicare when its the Republicans that want to kill or significantly reduce Medicare/Medicaid if they could.

Idiot, Democrats saying that Republicans want to kill Medicare and kill off seniors does not make it so. This is merely a political ploy the Dems use at every election.

 

[Throckmorton]

Idiot, Democrats saying that Republicans want to kill Medicare and kill off seniors does not make it so. This is merely a political ploy the Dems use at every election.

Are you joking or serious? 😕

For as long as I can remember, Republicans have been talking about ending socialist redistributionist Medicare. A couple weeks ago Michelle Bachman mentioned that in a speech.

 

[her209]

Are you joking or serious? 😕

He's playing possum.

😀

 

[werepossum]

Are you joking or serious? 😕

For as long as I can remember, Republicans have been talking about ending Medicare. A couple weeks ago Michelle Bachman mentioned that in a speech.

Serious. There is no move among the Republican Party to kill off Medicare and everyone knows it. There is a small group among the GOP to privatize it, but even that is a tiny minority. (Although if it were privatized it wouldn't be allowed to run as a Ponzi scheme, it would have to meet funding standards the government enforces on others but rejects for itself.)

 

[ElFenix]

Are you joking or serious? 😕

For as long as I can remember, Republicans have been talking about ending socialist redistributionist Medicare. A couple weeks ago Michelle Bachman mentioned that in a speech.

GOP leadership apparently is backing away from bachmann and ryan


and the reps had the biggest expansion in medicare in years. so much for ending it. what comes out of their mouths and what they actually do are usually not the same.

 

[Fern]

Are you joking or serious? 😕

For as long as I can remember, Republicans have been talking about ending socialist redistributionist Medicare. A couple weeks ago Michelle Bachman mentioned that in a speech.

As a conservative I'm unaware of any (serious) attempt to end Medicare/Medicaid. Nor would I support such an effort. But it does need reform.

IMO, a good HC reform that effectively reduced costs, something we don't now have, would 'kill 2 birds with stone'. Not only would HC (cost) be reformed, but Medicare/caid too. With our present cost curve neither are sustainable.

Fern

 

[her209]

GOP leadership apparently is backing away from bachmann and ryan

and the reps had the biggest expansion in medicare in years. so much for ending it. what comes out of their mouths and what they actually do are usually not the same.

Sen. Mike Enzi spoke earlier. Rep. Paul Ryan is currently speaking.

The GOP's Mixed Medicare Message
http://news.yahoo.com/s/uc/20100218/cm_uc_crjcox/op_4512995

 

[sunzt]

Javiar (sp?) from CBO is pwning (R) Paul Ryan

 

[werepossum]

Sen. Mike Enzi spoke earlier. Rep. Paul Ryan is currently speaking.

The GOP's Mixed Medicare Message
http://news.yahoo.com/s/uc/20100218/cm_uc_crjcox/op_4512995

So just to be clear, warning seniors that the Democrat plan to take hundreds of billions of dollars OUT of Medicare to pay for other people's health care is wanting to kill Medicare, as is wanting to offer seniors another choice. I suppose the Dems' plan to rob Medicare is also evidence of their staunch protection of Medicare? Nice.

I remember reading how Jessie James used to love banks and payroll trains in a similar manner.

 

[cubby1223]

What balls McCain has not wearing a flag pin!!!

 

[woolfe9999]

So just to be clear, warning seniors that the Democrat plan to take hundreds of billions of dollars OUT of Medicare to pay for other people's health care is wanting to kill Medicare, as is wanting to offer seniors another choice. I suppose the Dems' plan to rob Medicare is also evidence of their staunch protection of Medicare? Nice.

I remember reading how Jessie James used to love banks and payroll trains in a similar manner.

Do you actually even know what they are specifically doing with Medicare in this bill? If you did, you wouldn't be calling it "robbery" of Medicare. That statement is completely out of touch with the reality of this bill.

- wolf

 

[her209]

So just to be clear, warning seniors that the Democrat plan to take hundreds of billions of wasted dollars OUT of Medicare to pay for other people's health care is wanting to kill Medicare, as is wanting to offer seniors another choice.

Fixed.

 

[Carmen813]

Since Republicans were asked about new ideas for expanding coverage and didn't provide one...I'll help out.

How about instead of expanding medicaid, you provide a voucher to purchase insurance on the exchange system (whatever exchange ends up existing)?

 

[werepossum]

Do you actually even know what they are specifically doing with Medicare in this bill? If you did, you wouldn't be calling it "robbery" of Medicare. That statement is completely out of touch with the reality of this bill.

- wolf

You guys are so amusing! The Dems are going to remove hundreds of billions from Medicare - but it will only be waste and fraud! But they can only remove the waste and fraud from the one system they totally control IF they are given control of the rest of our health care system! The only way that makes any sense is if your idea of logic is regurgitating Democrat talking points.

Harry Reid has this ocean front property in Nevada he wants you to buy too. He'll give you a great price too - but only if you give him power of attorney. Trust him, he's from the government and he's here to help you.