Thank you Chief Justice Roberts, you are a wise man.

[Brad L]

Holy crap, BGL.... you pretty much called it on the issues. Bravo.

To me, the biggest point you have made, which has gone largely unaddressed in much of the discussion is the disgusting fact that the insurance companies have a "de facto" monopoly on health care. They get to set prices through bargaining power, deny coverage with impunity, and get away with being a "death panel" of the worst sort.

In the US, try for laughs getting an estimate of health care costs before you "purchase" health care. In my experience, you can't, at least not that the health care providers will honor. Ask for the cost of a procedure/drug/treatment beforehand and you will get demurrals, denials and a really difficult time in getting a quote. I did this with my wife's pregnancy. Finally, got quoted a bottom line figure, paid it, and then got additional bills after the fact (about 300% above what I negotiated). After the fact negotiation? A joke. I got a ton of different answers, different prices quoted based on where we were in the process (a percentage discount offered if paid in one lump sum, advisement to ignore the bills until referred out to collection- which supposedly will give better terms than the hospital will provide, even thought the collections is within the hospital, repeated referral to social services, which we don't qualify for, and no one can tell us what the basis for the bill is...oh, and multiple people within the same hospital give different "bills" due. Offers to pay an amount got different responses from different departments. Remember, this was after having negotiated a flat fee of $16,000 which I paid upfront. "Magically" the earlier agreement was not honored (little explanation as to why, but was told the price of services was higher than the original quoted fee; sure, if push comes to shove, I will be able to raise the original agreement as a defense...but outside of court, I am at the whim of the medical bill collectors). However, the same folks are happy to explain that if I am destitute, they will forgive and write off the entire bill. But, if I can pay, they are intent on chasing me for multiples above what they originally agreed to as a flat fee.
...

I was thinking just the opposite but didn't want to respond to his posts. We did not need to jump into socialist medicine to solve the problems that existed with medical insurance. Prices were artificially high because of needed regulation and the fact that Congress would not allow for competition between states. If prices truly go up and quality goes down like history and statistics predict, will you still approve?

You seem to be complaining that your care provider could not offer you prices on certain services before the fact. The great thing about our previous system is that we had choice, we could choose which doctor we wanted to go to and the prices would obviously vary. You could simply go to another doctor. When you can't go to another provider what will you do then?

 

[Brad L]

It's so fascinating that people think health care is an attack of the constitution and peoples freedom. Also it's fascinating that some US people treat this old peace of paper like the holy grail. As my personal opinion a constitution is something which could/should envolve during the time.

Is that an honest comment? Who really thinks healthcare is an attack on freedom? I think the debate is how healthcare is implemented and what freedoms or choices the individual loses because of that specific implementation. There are also long term implications relating to economics and scientific advances.

 

[MagnusB]

There was a Norwegian student this year who got bitten by a rattle snake in the US, the hospital billed $143.000 to administer the antidote and a days stay at the hospital. He had insurance, but my guess is the hospital took advantage of him being a insured foreigner.

 

[jadmperry]

I was thinking just the opposite but didn't want to respond to his posts. We did not need to jump into socialist medicine to solve the problems that existed with medical insurance. Prices were artificially high because of needed regulation and the fact that Congress would not allow for competition between states. If prices truly go up and quality goes down like history and statistics predict, will you still approve?

You seem to be complaining that your care provider could not offer you prices on certain services before the fact. The great thing about our previous system is that we had choice, we could choose which doctor we wanted to go to and the prices would obviously vary. You could simply go to another doctor. When you can't go to another provider what will you do then?

You miss the point completely. Under the so-called free market paradigm, I negotiated a high, but (by definition- because I agreed to it) fair price I agreed to for health care (though, it was ridiculously hard to do so in the first place). The care provider did state a price, which I agreed to and paid before hand. However, for whatever bogus reasons they have supplied, they have reneged on the price. Why would I go to a different doctor when I had a bargain that I paid for? And why could I not go to another doctor under the same regime (which existed before ObamaCare/ACA came into being) and get the same result? My point was that the insurance companies have an effective monopoly on pricing for health care and they are the only ones with leverage to change prices.

Who was talking about socialist medicine? I was talking about supposed "free market" medicine. After much difficulty in negotiating a "fair" (but still expensive in my view) price, the health care provider and hospital simply charged more than they agreed to. What the heck would be socialist about paying out of pocket for negotiated services and then, just because its "health care" getting a ridiculously inflated bill? Is that capitalism in your view? In my mind, it is grand larceny. Because I am an individual consumer with no leverage, they can charge whatever they think? (No worries for my own circumstances...should we go to court on this, I will subpoena their fee schedule for services, what insurance companies actually pay for the same services, and any reduced fees they have negotiated for same services and then argue that they violated the contract we entered into and that they have violated state Unfair and Deceptice Practices Act...can't guarantee I will win, but I sure as hell can make it painful for them...plus, oddly, they have not really indicated that actually want me to pay...it seems more like they want me to apply for state benefits to get the state to pay inflated fees- that sure does not feel like capitalism to me).

Who says that prices would go up for me, a supposed free market participant? And what statistics show that both prices will go up and quality will go down? If you have objective support (or any support) for this proposition, I am interested in knowing. That could change my mind.

 

[shawn]

Non-profit is a term of art.

Plus the accounting scheme of the health insurance company misses the point with the essential problem of health insurance companies, they provide no health care services but consume 40% of every health care dollar and they consume it by denying people health care to fuel their "non-profit" salaries, bonuses, jets, real estate empires, massive bureaucracies working night and day to deny health care to sick people.

No, it's not. You're arguing about Wall Street fat cats, when *my* insurance company (and many others, according to Goog) are not-for-profit, meaning Wall Street is strictly out of the loop.

In 2008, BCBSNC took in $5.2B in premiums, paid out $4B in medical costs, consumed $1.2B in taxes and in salaries for its 4,600 people. They made a "profit" of $100M... which sounds like a lot, but only amounts to $30 per client per year, and works out to 2.1% profit margin. If you were a Wall St fat cat looking to make it big, this doesn't sound like a buy.

Since I've demonstrated that you're clearly making up things about the insurance companies in order to argue your point, perhaps you should reform your argument and explain why you think that government-administered healthcare is going to be more efficient (monetarily and otherwise) than a system administered by private companies, subject to the market and forced to compete against one another. The bottom line is that "adminstration" is going to consume some percentage of every healthcare dollar. At the very least, someone has to review the doctor/hospital bills and determine who's getting paid, and how much. The critical question is: how do we provide that service as efficiently as possible, so that most of our "healthcare money" gets spent where it counts - on care.

 

[shawn]

Keeping prices opaque is one way medical institutions seek to avoid competition and thereby keep prices up. And they get away with it in part because so few consumers pay directly for their own care—insurers, Medicare, and Medicaid are basically the whole game. But without transparency on prices—and the related data on measurable outcomes—efforts to give the consumer more control over health care have failed, and always will.

Right, which isn't a problem that's solved by single-payer or anything resembling it.

BTW, our second child is due in December. Total cost is $6k. We paid the first chunk of it yesterday.

 

[shawn]

It's so fascinating that people think health care is an attack of the constitution and peoples freedom. Also it's fascinating that some US people treat this old peace of paper like the holy grail. As my personal opinion a constitution is something which could/should envolve during the time.

And it can. There's an amendment process, clearly defined. You're welcome to submit your recommendations for revisions via the proper channels.

 

[shawn]

Feel free to continue the discussion on the "more efficient" European system in light of the above normalized statistics.

 

[captainslater]

I think it's not my business as I don't live there. It just came up in my mind while following the discussions around this "Obamacare".

 

[MagnusB]

View attachment 31043View attachment 31044


Feel free to continue the discussion on the "more efficient" European system in light of the above normalized statistics.

http://www.factcheck.org/2009/08/cancer-rates-and-unjustified-conclusions/

 

[jadmperry]

Right, which isn't a problem that's solved by single-payer or anything resembling it.

BTW, our second child is due in December. Total cost is $6k. We paid the first chunk of it yesterday.

Why do you say that single payer (or anything like it) is not the solution? This seems like a conclusory statement. What then, is the solution?

Where are you located? Like I said, they quoted me $16k (included 9 months of prenatal care, plus delivery), which I paid upfront. After the fact (with no complications or changes), they tripled the price quoted (among other things, they added "care for the newborn infant" as not included....three day total hospital stay).

 

[shawn]

http://www.factcheck.org/2009/08/cancer-rates-and-unjustified-conclusions/

They're playing games with the numbers to argue a non-existent point. The uninsured people are *included* in the survivability statistics (skewing it down), and the "uninsured" are covered largely by Medicare or Medicaid. Shorter factcheck: people whose healthcare is administered by a government agency live less long than people whose healthcare is administered by a private insurance company.

 

[craigiri]

Your arguments are not well-served by unnecessary partisanship or a misunderstanding of federalism. Under a Federalist argument, Massachusetts can write whatever sorts of healthcare laws they would like, so long as those laws don't conflict with Federal law. The Federal government, however, can only write what laws the enumerated powers in the Constitution allow it to write.

I've heard all those arguments - but they clash 100% with what the other 3/4 of the right here say (that they should not pay for others, etc. etc. ) - and, being a student of history, I seem to remember that the strong Federal Government won out at the Constitutional Convention. States have rights like setting their own sales tax. But when ONE ITEM is approaching 20% of our GDP and involved the general welfare and health and happiness of the people (and life and death and interstate commerce and drugs and procedures and standards) , it is arguably within the realm of the Federal Government.

 

[shawn]

Why do you say that single payer (or anything like it) is not the solution? This seems like a conclusory statement. What then, is the solution?

Where are you located? Like I said, they quoted me $16k (included 9 months of prenatal care, plus delivery), which I paid upfront. After the fact (with no complications or changes), they tripled the price quoted (among other things, they added "care for the newborn infant" as not included....three day total hospital stay).

Three days in the hospital sounds like a c-section...?

This is in Chapel Hill, NC. All prenatal care, birth and delivery, etc. emergency surgery obviously would cost more. Our out-of-pocket after insurance picks up their portion will be ~$2500ish.

My argument against single-payer only reflects that it doesn't put the patient in charge (or even make them aware) of the costs of their healthcare. Look at Medicaid, for example. That's a single-payer system that already exists in the US. Its costs are tremendous and only set to increase.

On the other hand, lets say we treat health "insurance" like we treat car insurance -- State Farm doesn't send Jiffy Lube a check every time I get an oil change. I pick up the costs of regular maintenance and only pay for "catastrophic" coverage. (aka insurance, in the Websterian sense). So now I go to the doctor once a year, I pay the $100 visit out of my own pocket. I've got an ache or pain, the doc says "we can run a bunch of tests, send you for an MRI, see if something comes up". I ask how much that costs, and we make a decision together about what the most prudent decision is. If my costs per year exceed my deductible, insurance kicks in.

I'm not saying it's perfect -- but an HSA *does* address the problem of putting the health care consumer (you) directly in charge of the costs of your healthcare. Any single-payer system (and most "insurance" systems currently at work in the US) obscure those costs.

 

[craigiri]

They're playing games with the numbers to argue a non-existent point. The uninsured people are *included* in the survivability statistics (skewing it down), and the "uninsured" are covered largely by Medicare or Medicaid. Shorter factcheck: people whose healthcare is administered by a government agency live less long than people whose healthcare is administered by a private insurance company.

Picking and choosing there...pretty good ones.

Texas, with 25% of the population uninsured..then, in your view, must be all old people?
And the fact that we have worse stats in infant mortality and die at an earlier age.....is that because we pay so much more (double what many others do)?

If you stand back and instead of trying to make the facts fit your conclusions, look at the actual situation...you may end up agreeing with the health experts (not that ones paid by right wing think tanks!) that "fee for service" just does not work. It incentivizes the wrong thing (disease, not health).

This is costing us all big time.
" a condition that could be treated in a doctor's office for $56.21 (including lab and x-ray) costs $193.92 in the emergency room. National studies back up that data, finding, for example, that the charge for treating an ear infection in the emergency room is $170 versus $55 in a family physician's office."

Our system has been broken for a long time. I have seen double digit premium increases almost every year (in different states!) since the late 1990's. Health care is not approaching 20% of our entire national output - and is simply unaffordable (8K per person per year).

If talking points could fix it we'd have the best health care in the world.

 

[craigiri]

It's so fascinating that people think health care is an attack of the constitution and peoples freedom. Also it's fascinating that some US people treat this old peace of paper like the holy grail. As my personal opinion a constitution is something which could/should envolve during the time.

They are responding to the right-wing echo chamber and to the multi-million dollar ad campaigns paid for by the very people and businesses that benefit from their ignorance.

It's all about Fear, Uncertainty and Doubt (FUD) and instilling it into a certain segment of the population. As you suggest, for people to work against their own interests seems fantastic! Yet it is very real. Programming. They know not what they do - rather they listen to 24/7 blabber and something sounds good so they repeat it.

 

[MagnusB]

They're playing games with the numbers to argue a non-existent point. The uninsured people are *included* in the survivability statistics (skewing it down), and the "uninsured" are covered largely by Medicare or Medicaid. Shorter factcheck: people whose healthcare is administered by a government agency live less long than people whose healthcare is administered by a private insurance company.

Have you ever worked with statistics? Are you even familiar with any methodology? You are presenting a data table, nothing more. You show nothing about the assumptions behind the data, if any data is discarded from the statistics, nothing about the methodology used. If anything, the study shows that if you detect cancer at an early stage, you are more likely to be alive after 5 years, which is something you choose to completely ignore, instead you are saying this is absolute evidence that USA has the best healthcare in the world.

 

[jadmperry]

They're playing games with the numbers to argue a non-existent point. The uninsured people are *included* in the survivability statistics (skewing it down), and the "uninsured" are covered largely by Medicare or Medicaid.

I read it the other way...they were including many folks in the US as having "cancer" when it was aggressive early "identification" of "pre-cancer" in the US included in the figures. The numbers are bogus if they are not using the same diagnostic criteria. You can't have a valid sample if you use different definitions for the studied populations.

Shorter factcheck: people whose healthcare is administered by a government agency live less long than people whose healthcare is administered by a private insurance company.

Source? Though I don't doubt this...the argument is a classic failure of confusing causation with coincidence. Who, in the US, uses government health care more: richer or poorer folks? And if (as is the case) poorer people use government healthcare more than richer people, than are there any additional factors of being rich(er) that impacts outcomes? Diet, exercise, even higher rates of education all correlate with longetivity. If you don't understand the causation/correlation distinction, here is a question: Do cemeteries kill people? If you look at it incorrectly, you would think they do, because 100% of the residents of cemeteries are dead people.

 

[craigiri]

You will naturally get more innovation in an environment that rewards it. If there are caps on what a doctor or researcher can earn, and limits on specific expensive procedures, then of course we are going to see less innovation.

This is absolutely not true.

Firstly, there are already caps PUT IN PLACE BY INSURANCE COMPANIES. Since there are a limited number of companies that can come up with the billions to be a health insurance company, the "market" is extremely limited and always will be.

Secondly, I know quite a few doctors and they have been BURIED under the mess of HMO's and insurance company paperwork and rules for decades. A lot of docs have found themselves unable to serve their patients correctly - I know a few who have quit. Not every doctor wants to be a businessman trying to earn as much as possible - in fact, most don't.

There is no limit to what a doctor who discovers a new drug or invents a piece of equipment can earn. Many (actually most) of the medical breakthroughs in the world come from European countries, which seems to speak against your point.

I will grant you one point! Medicare Fraud is a way LOTS of docs can make big money...and they do. But that's another subject.....

Massachusetts, with it's "socialized" medical care, leads the nation in Bio-tech and has a booming economy with health care being a large sector. We have the highest income in the country (or close). Look it up.

 

[BGL]

In the US, try for laughs getting an estimate of health care costs before you "purchase" health care. In my experience, you can't, at least not that the health care providers will honor.

Which is interesting because those of use on the other side of health care know EXACTLY what we will get paid by the insurance company for each procedure. Well almost exactly, sometimes despite our paying to hire office staff solely to deal with insurance company, getting prior approval for exactly what insurance will pay, the insurance company will deny payment. Then we hire more staff and outside contractors to deal with insurance company on the back end. Of course much of the "insurance" you pay for goes to paying people to deny approval and then deny or delay payment even after approval. These two huge staffing bureaucracies are about 10% of the US's 50% higher cost of health care insurance (not health care).