What Does a Bi-Partisan HC Reform Bill Look Like

[Carmen813]

The GOP has never been particularly interested in big healthcare reform. This isn't a slam against them, just an acknowledgement of reality. They have other issues that are generally more important to them.

So far in this thread I've seen a bunch of people say what they thought a conservative health care reform bill would look like, but I haven't seen anyone describe a bipartisan one. Can anyone do it?

I'll try:
state based exchanges and the removal of state boundaries
the ability to keep your insurance between jobs
no public option
eliminate pre-existing conditions, provide a tax break to insurance companies for each individual with a pre-existing condition covered (enough to make it a viable company policy)
removal of health insurance industry anti-trust exemption
money for making health records electronic

How do we pay for it? Eliminate waste in Medicare/Medicaid.

 

[woolfe9999]

No it's not.

E.g., Medicare/Medicaid uses the IRS for it's billing and collection admin functions; that's not factored into the overhead costs. The private sector (employers and their accountants) also pays quite a bit to calculate medicare/medicaid etc (payroll taxes?). Not the case with private insurers. Medicare/Medicaid also basically forces the service or goods provider to hire an outside firm to audit all bills and the service provider pays for this. Not the case with private insurance.

It's "apples to oranges" until properly adjusted.

Given the huge numbers we see estimated for medicare/medicaid fraud & waste they could probably use some more administration too.

Fern

That depends on whose analysis you read. In any event, Medicare admin costs are not my real point. My real point is one you avoided. Admin costs are way too high across the entire system because it is a multi-payor system that requires billions of pages of itemized medical bills, and that pads the cost at the provider end and at the insurer end, regardless of whether the insurer is a public or a private one.

- wolf

 

[woolfe9999]

I'll try:
state based exchanges and the removal of state boundaries
the ability to keep your insurance between jobs
no public option
eliminate pre-existing conditions, provide a tax break to insurance companies for each individual with a pre-existing condition covered (enough to make it a viable company policy)
removal of health insurance industry anti-trust exemption
money for making health records electronic

How do we pay for it? Eliminate waste in Medicare/Medicaid.

That isn't bad as a passing stab. My own is a little further left but possibly could grab a few repubs, or maybe not.

Exchanges
Portability of insurance
No denial for pre-existing with a tax subsidy
Recission reform
Remove anti-trust exemption
Provide subsidies but without mandates so people can buy the insurance with a subsidy but suffer no penalty if they opt not to do so
Prescriptions drugs can be purchased from foreign countries
No public option
Tort reform

- wolf

 

[Sacrilege]

1) Deregulate insurance markets and allow for sale of policies across state lines (instant competition)
2) Require insurance carriers to offer products to those with pre-existing conditions (no price controls)
3) Set up national rules for health savings accounts. Allow health savings accounts to be folded into retirement plan.
4) Tort reform aimed at eliminating the cost of "defensive medicine"

These may all be good points, but in order for them to be bi-partisan, we have to analyze how they will help:

The Unions
African Americans
Left Wing Socialist Activists

 

[halik]

Tort reform is considered a liberal/leftie/socialist idea in other countries where it operates. In single payor systems they basically do not allow med mal lawsuits. You're right, the idea of putting an arbitrary cap on one class of lawsuits is totally at odds with conservative and libertarian philosophy. It basically says let's restrict access to the courts for certain types of people, and let's not have a meritocracy in health care delivery because it costs us too much to penalize doctors who screw up. Very socialist.

- wolf

I don't really understand how mal reform is such a huge issue for people, but you can certainly make a libertarian/free market argument for why the system is screwy:

One way to look at mal lawsuit it it's a lottery for settlement. You have some probability P of winning a settlement X and the price to play is the litigation cost C. In a competitive market, the price or cost of filing C would adjust to match the demand and there would be a market equilibrium. Since the C is set low, I have an economic incentive to file law suits so long 0.3 * P * X > C.

Essentially the reason why the system is screwy is because the costs to file are minimal, so people in the business of litigation will file any frivolous lawsuit in the hopes of landing a large settlement. If the expected value (say 1% chance of willing 10M) * 30% is more than the cost i incur while litigating, as a lawyer I will file it regardless of merit.

Putting caps on X is one way to reducting the demand for lawsuits... alternatively you can rise the cost C.

 

[Hayabusa Rider]

That depends on whose analysis you read. In any event, Medicare admin costs are not my real point. My real point is one you avoided. Admin costs are way too high across the entire system because it is a multi-payor system that requires billions of pages of itemized medical bills, and that pads the cost at the provider end and at the insurer end, regardless of whether the insurer is a public or a private one.

- wolf

From what I see, part of the problem is that private and public insurances are trying to save money by putting more rules and regulations on providers. Sounds good, but because everything is so complicated it takes quite a bit of time and effort to get what should be relatively straightforward claims processed.

I dealt with a woman who is on Medicaid last week. Medicaids computer said that she wasn't covered, but her caseworker said she was. Well that's great, but we need valid numbers to bill. An hour later (I had to make the calls myself) I still knew nothing.

Apparently Medicaid changed her numbers, but didn't send out new cards to a lot of people. With private insurance one could call and get that taken care of. Not so with them. They refuse to give information to providers. So after yet another half hour, I find that she needs to go to the county medicaid office and they will write the number down on a piece of paper so she can give it to me. Not even her case worker can know it.

Well she goes down and they tell her that they won't give HER that info either, and she has to wait for a new card.

She should have that in a couple weeks.


She's the worst case in a couple months, but when it goes south, it typically takes days or more to get a resolution. In the meantime we're out I don't know how many man hours, the patient doesn't get treatment because we won't get paid, and the state just plays dumb.


So how much does that cost? A hell of a lot. The answer? More regulations.

We can't fucking win.

 

[woolfe9999]

I don't really understand how mal reform is such a huge issue for people, but you can certainly make a libertarian/free market argument for why the system is screwy:

One way to look at mal lawsuit it it's a lottery for settlement. You have some probability P of winning a settlement X and the price to play is the litigation cost C. In a competitive market, the price or cost of filing C would adjust to match the demand and there would be a market equilibrium. Since the C is set low, I have an economic incentive to file law suits so long 0.3 * P * X > C.

Essentially the reason why the system is screwy is because the costs to file are minimal, so people in the business of litigation will file any frivolous lawsuit in the hopes of landing a large settlement. If the expected value (say 1% chance of willing 10M) * 30% is more than the cost i incur while litigating, as a lawyer I will file it regardless of merit.

No, trust me, as a lawyer you will *never* file a med mal suit, or any kind of suit where you get paid on a contingency fee basis, regardless of merit. The lawyer's time has an opportunity cost. That same lawyer can bill each hour wasted on the lost frivolous suit at $300 to an hourly paying client, or use it on a contingency fee case with merit.

Ok, some lawyers do file meritless claims. The stupid ones.

Also, litigation costs are not low. Med mal cases require expert testimony, and they are among the most expensive cases to litigate in the entire system.

- wolf

 

[theeedude]

Selling insurance across state lines is a terrible idea. I can't believe people who preach states' rights want to attack states' right to regulate insurance. Can you imagine you have a problem with your insurance, and you have to take it up with some dude in US Virgin Islands under their law, instead of under your state's law.

 

[woolfe9999]

From what I see, part of the problem is that private and public insurances are trying to save money by putting more rules and regulations on providers. Sounds good, but because everything is so complicated it takes quite a bit of time and effort to get what should be relatively straightforward claims processed.

I dealt with a woman who is on Medicaid last week. Medicaids computer said that she wasn't covered, but her caseworker said she was. Well that's great, but we need valid numbers to bill. An hour later (I had to make the calls myself) I still knew nothing.

Apparently Medicaid changed her numbers, but didn't send out new cards to a lot of people. With private insurance one could call and get that taken care of. Not so with them. They refuse to give information to providers. So after yet another half hour, I find that she needs to go to the county medicaid office and they will write the number down on a piece of paper so she can give it to me. Not even her case worker can know it.

Well she goes down and they tell her that they won't give HER that info either, and she has to wait for a new card.

She should have that in a couple weeks.


She's the worst case in a couple months, but when it goes south, it typically takes days or more to get a resolution. In the meantime we're out I don't know how many man hours, the patient doesn't get treatment because we won't get paid, and the state just plays dumb.


So how much does that cost? A hell of a lot. The answer? More regulations.

We can't fucking win.

You want to get rid of all 50 state Medicaid programs, all eligibility requirements, and all medical billing as you know it, support a single payor system that everyone is in. Without that, you can at most only squeeze a little bit of admin savings by trying to make the existing system a little more efficient.

- wolf

 

[halik]

No, trust me, as a lawyer you will *never* file a med mal suit, or any kind of suit where you get paid on a contingency fee basis, regardless of merit. The lawyer's time has an opportunity cost. That same lawyer can bill each hour wasted on the lost frivolous suit at $300 to an hourly paying client, or use it on a contingency fee case with merit.

Ok, some lawyers do file meritless claims. The stupid ones.

Also, litigation costs are not low. Med mal cases require expert testimony, and they are among the most expensive cases to litigate in the entire system.

- wolf

There are many firms out that just do injury / mesothelioma / medical malpractice suits... and all advertise on late night tv. All these guys that went to non-ABA accredited schools have to pay their loans somehow...

If you can't charge $300/hour, whats your next best alternative? Try a bunch of frivolous suits and hope someone settles.

 

[Hayabusa Rider]

You want to get rid of all 50 state Medicaid programs, all eligibility requirements, and all medical billing as you know it, support a single payor system that everyone is in. Without that, you can at most only squeeze a little bit of admin savings by trying to make the existing system a little more efficient.

- wolf

How it generally works is that if one can be trusted with a little, then it's reasonable to trust with more. If someone says "we can't handle a little, but give us a lot and we'll be good", they are going to find it a hard sell, yet those who write legislation don't even know the programs they have already running are a logistical nightmare from a delivery standpoint.

Sure in theory I get it, but I don't work with that. I work with how it is. Politicians who say it will be better, yet not understanding what we providers know does not inspire confidence in us.

 

[werepossum]

You want to get rid of all 50 state Medicaid programs, all eligibility requirements, and all medical billing as you know it, support a single payor system that everyone is in. Without that, you can at most only squeeze a little bit of admin savings by trying to make the existing system a little more efficient.

- wolf

You can't possibly get rid of all medical billing, even with a single payer system. The money has to come from somewhere, even if it's all from one pile. And the money is not infinite, so it must be rationed. Therefore each dollar must be accounted for, just as it is now (except with the added proviso that none of the clerks may be fired for anything less than willfully setting the building on fire AND raping a baby.) There would still be lists of what is covered and what is not covered, and there would still be arguments over whether a particular patient falls into 'yay' or 'nay'. There would still have to be a system to keep track of both providers and patients, so that Provider 'A' and Provider 'B' don't both charge to remove Johnny's appendix and that Provider 'C' isn't billing for treating three hundred non-existent patients a day with his one doctor and two nurses. None of that changes, and it likely gets worse because now it's the hugest monstrosity in the world - and it's government.

The only way a single payer system reduces costs is by reducing benefits faster than costs increase. Thus you have doctors saying "I think you sprained your ankle, but it'll take six weeks to get an MRI so I'll just have to assume you did, and if it turns out that you actually torn a ligament, well, after a few weeks of pain come back in and we'll see about scheduling that MRI." Socialized medicine works by reducing the level of care knowing that this will still cover most injuries (and the rest can suck it since there's no alternative.) Although if it's like Canada, your dog can still get an MRI the same day.

 

[charrison]

Selling insurance across state lines is a terrible idea. I can't believe people who preach states' rights want to attack states' right to regulate insurance. Can you imagine you have a problem with your insurance, and you have to take it up with some dude in US Virgin Islands under their law, instead of under your state's law.

About the only insurance you cant buy across state lines is health insurance. People buy insurance and damn near everything else over state lines with little problem for the most part.

 

[palehorse]

rose-colored glasses are rose-colored.

 

[woolfe9999]

The only way a single payer system reduces costs is by reducing benefits faster than costs increase. Thus you have doctors saying "I think you sprained your ankle, but it'll take six weeks to get an MRI so I'll just have to assume you did, and if it turns out that you actually torn a ligament, well, after a few weeks of pain come back in and we'll see about scheduling that MRI." Socialized medicine works by reducing the level of care knowing that this will still cover most injuries (and the rest can suck it since there's no alternative.) Although if it's like Canada, your dog can still get an MRI the same day.

What you just said here is that we cannot reduce healthcare costs without reducing the end quality of care. By necessary implication, that argument rests on the following assumptions: 1) there is no waste in our system, 2) that we get the same bang for our healthcare buck as other systems (i.e. we pay more for portionally better care).

Neither of those assumptions are even close to correct.

We spend about 50% more per capita on healthcare in this country than they do in Canada and most of Europe, and that is after adjusting for our higher gdp/per capita. Do we get 50% better care, or better care at all? Our lifespan here is about 5 years shorter.

Before you try to put that all down to lifestye and behavioral differences, bear in mind that while obesity is considerably higher in the U.S., only 23% of Americans smoke whereas 35% of Europeans do. If there is anything worse than obesity on lifespan, it is smoking.

While you are correct that other kinds of admin costs will arise in single payor, admin is 33% of our healthcare costs here in the U.S., and 16% in Canada. And that is 33% of a higher base cost to begin with because our system is bloated and wasteful in other ways.

No, we don't get the same bang for our buck here, and yes, there is vast waste in our system not present to the same degree in other systems. That means that we can reduce costs without compromizing care. How that is accomplished is open for debate, but to claim that it can't be done when it has been done in other countries is not a tenable position.

- wolf

 

[woolfe9999]

Anyone on the right have an idea for a bi-partisan, compromise bill, that incorporates elements that both parties can agree to? Just trying to figure out what this "bi-partisan" bill that the dems were supposed to have pursued would have looked like.

- wolf

 

[Robor]

You forgot

10. Widespread increase in premiums/health care costs for the foreseeable future

Under our current system my health care premiums have been going up every year. Every year there is a negotiation and either the provider is changed or the rates, deductibles, and co-pays are adjusted (never in our favor).

 

[Hayabusa Rider]

Under our current system my health care premiums have been going up every year. Every year there is a negotiation and either the provider is changed or the rates, deductibles, and co-pays are adjusted (never in our favor).

And in any conceivable system your rates will go up every year.


You are no doubt too young to remember Nixon's wage and price controls. It failed miserably and Carter got screwed royally when the price corrections hit.

There will be more people requiring more treatment for chronic conditions, and no one can stop that. Consequently you rates WILL go up under ANY scheme, and significantly so. You'll find that the majority of that won't be due to Aetna's profits.

 

[JSt0rm]

there wont be a bi-partisan health care bill. The republicans refuse to follow Europe into the future.

 

[dmcowen674]

What Does a Bi-Partisan HC Reform Bill Look Like

It doesn't

No such thing as "Bi-Partisan"

 

[nick1985]

It doesn't

No such thing as "Bi-Partisan"

Dave I do think you just might be crazier than a rat in a tin shithouse.

 

[woolfe9999]

And in any conceivable system your rates will go up every year.


You are no doubt too young to remember Nixon's wage and price controls. It failed miserably and Carter got screwed royally when the price corrections hit.

There will be more people requiring more treatment for chronic conditions, and no one can stop that. Consequently you rates WILL go up under ANY scheme, and significantly so. You'll find that the majority of that won't be due to Aetna's profits.

You're right about that. It is because we are at the stage in technology curve where lots of chronic conditions are treatable, but few are curable. However, this doesn't mean there isn't waste in our system than can be eliminated. If we can lower the cost baseline significantly right now, it will give us decades more of high growth before it breaks us. This in turn gives us more time for technology to (hopefully) lower costs by providing cures for chronic conditions.

Oh, and btw, doing things like killing funding for stem cell research obviously aren't going to help...

- wolf

 

[Robor]

And in any conceivable system your rates will go up every year.


You are no doubt too young to remember Nixon's wage and price controls. It failed miserably and Carter got screwed royally when the price corrections hit.

There will be more people requiring more treatment for chronic conditions, and no one can stop that. Consequently you rates WILL go up under ANY scheme, and significantly so. You'll find that the majority of that won't be due to Aetna's profits.

I understand that - it's the rate at which they are going up right now. These chronic conditions did exist 5, 10, 15, 20 years ago.

 

[Robor]

You're right about that. It is because we are at the stage in technology curve where lots of chronic conditions are treatable, but few are curable. However, this doesn't mean there isn't waste in our system than can be eliminated. If we can lower the cost baseline significantly right now, it will give us decades more of high growth before it breaks us. This in turn gives us more time for technology to (hopefully) lower costs by providing cures for chronic conditions.

Oh, and btw, doing things like killing funding for stem cell research obviously aren't going to help...

- wolf

Federal funds for stem cell research vetoed TWICE by the GWB.

 

[GuitarDaddy]

As with any problem, the first step to solving it is recognition. As a country we have become so divided and so selfish that we can barely come to agreement that there is a problem with healthcare, and our views on how dire the problem is range from 0 to nuclear disaster levels.

I'm not sure if a bipartisan comprimise is even possible at this point, true comprimise thats squarely in the middle of left and right ideologies would have both sides crying like babies and would get no support from either party. Looks like we won't have the stomach to address the problem until people are dying in the streets in mass and the privaleged are afraid to leave there homes for fear of retribution or disease.