America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

[Bill]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

However, any poster that did use it (CBO) as a reason to criticize the House plan needs to go back and delete their posts. I suspect we won't be hearing from any of them until tomorrow morning after the Limbaugh show airs so they can have their talking points ready to explain away this one.

You can use CBO estimates as a relative measuring stick. Their estimate for the House plan was an indication that it was going to cost more than Congress and the Admin were hoping, probably a lot more if it became reality. Their preliminary estimate for Baucus' Senate plan is relatively a lot better, even if overly optimistic as is likely the case. What has their House plan estimate to do with their Senate plan estimate?

 

[joecct]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

I tend to agree with eLynah (will RichS void my CCT alumni status?? ).

I, too, work in the federal government. Whenever we get an estimate, our inside joke is that the final cost is double the estimate + 10% more. Unfortunately, with all the change orders that get thrown on, it is too frequently true.

If I could dig up some documents around when Medicare was created, I bet NOBODY thought it would cost this much right now, even adjusted for inflation.

Government should facilitate, but it should never participate. Too bad too many in DC don't believe it.

 

[Bill]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

For your viewing/arguing pleasure ...

http://online.wsj.com/public/resources/documents/st_healthcareproposals_20090912.html

Interesting that the House plan has 94% US coverage and Baucus' plan has 95% US coverage. Using the 30 million US uninsured number that Obama used in his speech last week, and that number may be on the high side, we're probably already at around 90% coverage or close to it.

 

[ScoobyDoo]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Educating the young = good investment. Paying for expensive treatments that extend overall life expectancy by a few months = luxury. If you can afford it, fine - have a ball. If not, don't use the government to take money from me to pay for it.

If I paid to design and build an expensive new airplane, you wouldn't claim that everyone has a right to use it and set up a government program to try to ensure universal access to it. Why is it any different if a company designs and builds an expensive new medical device?

Oh, that's some good comedy there. Some of those new devices actually SAVE MONEY and lives you know. Take an MRI for example. Exploratory surgery is now virtually non-existent. Which do you think is more expensive?

But I'm glad you brought up investments. Since you want to cut medical care based on cost benefit then I think you should consider cutting education on cost benefit. Cause quite frankly in Minnesota we spend a hell of a lot more money on education then we do health care and a good sum of it is like shoveling money into a black hole.

 

[Kepler]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

At the end of it all, I just don't feel like we really are "entitled" to health care. 10,000 years ago, our ancestors were living in caves and loving it. 10,000 years from now, if there are any left, our descendants may be as well. We're no different from any other species on this lonely little rock - we're born, we live, we die, and we don't all get equal, long lifespans despite our best efforts. It's natural and just the way things are, and we're swimming upstream against Niagara Falls trying to change it.

I'm not sure how health care is distinguishable from anything else that is "natural," then. It's natural for the strong to dominate the weak -- natural for men to take what they want from women -- natural for a people with larger clubs to enslave those without.

Civilization is swimming upstream. Becoming more civilized is in large part about creating a non-natural place in which the angels of our better nature can flourish.

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

..At the end of it all, I just don't feel like we really are "entitled" to health care. 10,000 years ago, our ancestors were living in caves and loving it. 10,000 years from now, if there are any left, our descendants may be as well. We're no different from any other species on this lonely little rock - we're born, we live, we die, and we don't all get equal, long lifespans despite our best efforts. It's natural and just the way things are, and we're swimming upstream against Niagara Falls trying to change it.

This works only if no one accesses care. Like it or not we have a massive increase in the # of aging, folks in increasingly bad health who will not be crawling into a convienient little corner to die. They will be needing care and they will either get it earlier or more expensively much later before they croak messily in the ICU.

...I just can't wrap my head around how these proposed plans are spinning straw into gold. We're essentially intantaneously going to give 40M more people access to health care (massive increase in demand), force insurers to take on pre-existing conditions (which they've never had to), etc, and somehow magically health insurers don't go out of business, health care premiums don't go up, and the deficit comes down. It just defies common sense.

What I actually think will happen instead is that the increased demand for health care services will put such a burden on suppliers that everyone's quality of care will go down. Pent-up demand for services that people had just been living with will be unleashed all at once as people with pre-existing conditions get back into the system, draining the financial reserves of health insurace companies. They also get hit with extra taxes on their high end plans for a double-whammy on costs. To remain solvent, they'll have to raise premiums, causing employers to dump plans outright or increase the costs paid by the employees. The resulting premiums will be high enough that very few plans will be available that are cheaper than simply paying the penalty for not having insurance, so a lot more people than projected will choose to pay the penalty and still head for the emergency rooms for care, so the plan will fail to lead to coverage for anywhere near the advertised 97%. An awful lot of people will end up paying more out of pocket for worse health care than they get today with only a modest increase in the total number of people covered.

If this plan passes, this is one of those situations where I'd be really, really happy to be wrong.

No matter what critical mass is coming. Much more expensive to care for those folks the later they come out of the closet.

 

[joecct]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

This works only if no one accesses care. Like it or not we have a massive increase in the # of aging, folks in increasingly bad health who will not be crawling into a convienient little corner to die. They will be needing care and they will either get it earlier or more expensively much later before they croak messily in the ICU.
No matter what critical mass is coming. Much more expensive to care for those folks the later they come out of the closet.

Or, they are hastened into the afterlife.

God help us if that ever happens.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Interesting that the House plan has 94% US coverage and Baucus' plan has 95% US coverage. Using the 30 million US uninsured number that Obama used in his speech last week, and that number may be on the high side, we're probably already at around 90% coverage or close to it.

5% of the approx 300M people in the country means 15M without coverage after the bill takes effect. Excluding the 10M illegal immigrants that leaves 5M by my count.

I've heard right now 85% of the country has coverage, not 90%. Therefore insuring 30M legal residents currently without insurance = 10% increase, going from 85% currently to the goal of 95%.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

I tend to agree with eLynah (will RichS void my CCT alumni status?? ).

I, too, work in the federal government. Whenever we get an estimate, our inside joke is that the final cost is double the estimate + 10% more. Unfortunately, with all the change orders that get thrown on, it is too frequently true.

If I could dig up some documents around when Medicare was created, I bet NOBODY thought it would cost this much right now, even adjusted for inflation.

Government should facilitate, but it should never participate. Too bad too many in DC don't believe it.

So I'll put the question to you also. What independent entity would you believe health care cost estimates out of? Anybody? Rush Limbaugh?

 

[LynahFan]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

what exactly is innovation in the insurance industry?

For example, I'd love to be able to choose a plan that would pay for routine checkups and emergency care, but would not pay for treatments where the prognosis for recovery was nil and would never pay for life support. I'd love to be able to choose a plan that denied coverage to smokers and morbidly obese people. These are things that would actually bring my costs down.

This works only if no one accesses care. Like it or not we have a massive increase in the # of aging, folks in increasingly bad health who will not be crawling into a convienient little corner to die. They will be needing care and they will either get it earlier or more expensively much later before they croak messily in the ICU.
No matter what critical mass is coming. Much more expensive to care for those folks the later they come out of the closet.

I think this whole "get it earlier or it will be more expensive later" meme is a myth. People ARE going to die, so even if you catch condition A earlier and fix it, then they're going to die from B someday, and how do you know that B won't end up being more expensive? So then you'd have paid for early treatment for A + end of life care for B = HIGHER cost, not lower.

A dear family friend of ours just passed away in his early 60s. The nicest guy you could ever meet. He was a dermatologist and easily one of the healthiest people I knew - never smoked or drank, wore long sleeves and prescription sunscreen to the beach, and ate a ridiculously healthy diet. He was an avid cyclist, riding more than 100 miles every week. He had noticed that he was having trouble breathing on his bike rides, and was eventually diagnosed with a pretty advanced stage of a very aggressive lung cancer. He could have forced his insurance company to pay for expensive radiation and chemotherapy treatments, but it would have just prolonged the inevitible and vastly increased his pain. Instead, he chose to spend his remaining good days traveling, golfing, and spending time with his family and friends. I would make the same choice. I can understand that others might choose differently - and that's fine for them. I'd rather not be forced to pay for their choice though, because it IS a choice, and not a right.

 

[joecct]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

So I'll put the question to you also. What independent entity would you believe health care cost estimates out of? Anybody? Rush Limbaugh?

Glen Beck

Read the last sentance. I do not want Uncle Sam more involved in the process than they are now. No matter what bill is passed, the size of the government will increase, which IMO is a bad thing as you do not want more money into non profitable concerns.

Facilitate the process, but do not participate.

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

For example, I'd love to be able to choose a plan that would pay for routine checkups and emergency care, but would not pay for treatments where the prognosis for recovery was nil and would never pay for life support. I'd love to be able to choose a plan that denied coverage to smokers and morbidly obese people. These are things that would actually bring my costs down.


I think this whole "get it earlier or it will be more expensive later" meme is a myth. People ARE going to die, so even if you catch condition A earlier and fix it, then they're going to die from B someday, and how do you know that B won't end up being more expensive? So then you'd have paid for early treatment for A + end of life care for B = HIGHER cost, not lower.

A dear family friend of ours just passed away in his early 60s. The nicest guy you could ever meet. He was a dermatologist and easily one of the healthiest people I knew - never smoked or drank, wore long sleeves and prescription sunscreen to the beach, and ate a ridiculously healthy diet. He was an avid cyclist, riding more than 100 miles every week. He had noticed that he was having trouble breathing on his bike rides, and was eventually diagnosed with a pretty advanced stage of a very aggressive lung cancer. He could have forced his insurance company to pay for expensive radiation and chemotherapy treatments, but it would have just prolonged the inevitible and vastly increased his pain. Instead, he chose to spend his remaining good days traveling, golfing, and spending time with his family and friends. I would make the same choice. I can understand that others might choose differently - and that's fine for them. I'd rather not be forced to pay for their choice though, because it IS a choice, and not a right.

Good for that guy. Sounds like he had as beautiful a death as one can arronge in that situation.

If that is how everyone went then- great. Unfortunately we have the messy heart attack that gets ICU care followed by tons of intervention before someone can wake up and say no, I would prefer to die thank you- or the stroke where even with no intervention you could end up living but needing care to get thru the most basic activities of the day, diabetes where you get the chance of heart attack, stroke or possibly watching limbs rot off if you really want to resist care. There isn't always a quiet/ semi peaceful decline

It is simplistic to believe that if people are left alone they quietly fade away. Instead they usually quietly get into a position where they are in big trouble and when they finally seek help it is because they can't stand the sx they are having. We don't allow euthanasia so Joe can't say- this costs too much, I am ready to die. Not only does this effect Joe, it usually financially and emotionally stresses Joe's family too because someone needs to wipe Joe's butt and feed him if he can't do it himself. Someone needs to afford the medications so he can be comfortable even if he choses palliative care only.

I, too, would like not to pay for their choices if that is truly a choice but I get to be the one who sees them in extremis and suffering without the ability to pay for the stuff that would not let them suffer. Or more frustrating- I get to see sub-par care d/t financial inability to pay that leads to hospitalization and expensive sequelae. That is not choice. That is healthcare rationing. In my practice alone (only PT, in a small town) I have seen tens of thousands of dollars wasted because the patient was not able to afford the beginning basic care. Maybe other places are different but I would love to see a study that worked out the cost of under-treatment vs no treatment or optimal treatment.

It seems I rarely hear this point of view from people who do not have financial stability but usually people who have coverage. They get to sit there and talk about choice because they have coverage and wouldn't know what it was to have to lose everything (and their families do the same) and die messily because they can't access care.

 

[Bill]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

5% of the approx 300M people in the country means 15M without coverage after the bill takes effect. Excluding the 10M illegal immigrants that leaves 5M by my count.

I've heard right now 85% of the country has coverage, not 90%. Therefore insuring 30M legal residents currently without insurance = 10% increase, going from 85% currently to the goal of 95%.

The population is getting close to 307 and a half million. If 10 million of them are illegal aliens, that puts current coverage at about 90% if we use Obama's 30 million figure.

 

[LynahFan]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

leswp1 - you keep using the word "need," but I don't think that word means what you think it means. A lot of the things you describe in terms of inevitibility (e.g. it ends up costing this much) really are the result of choices.

I think hospitals should be able to turn away patients based on ability to pay. I think health care rationing is a good thing and I would want to belong to a health plan that does it judiciously. I think health insurers should be able to offer plans that will only cover palliative care for certain diseases - in fact, I wish they could offer a salad bar of individually priced choices: I'd like full care for heart disease for $60 per month, but only palliative care for pancreatic cancer for $1 per month, etc.

The study I'd love to see is how much it would truly cost to provide "optimal" care for every person for every condition. Statistically, we know there will be so many heart attacks and so many cases of lung cancer each year, etc. Figure out the average cost of the optimal treatment course for each of those, and tally them up. That would represent the maximum of how much health care "should" be costing us each year. If that's less than we're paying now - great, then we should definitely try to increase the efficiency of the system. If it's *more* than we're paying now, then we'd be able to make a rational choice about whether we really want to forcibly extract each person's share from them or just leave things as they are.

Finally, discussion of optimal care is great, but in the end it still relies on the patients' choices to go get that optimal treatment. If we require people to buy health insurance, then we should also require them to use it. Hospitals should be allowed to say, "well, it sucks that you have advanced colon cancer, but you're an overweight 75-year old smoker with a two-bacon-cheeseburgers-a-day habit who's never bothered to have a colonoscopy, so I'm sorry, but we just can't help you. Have some painkillers and a nice day."

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

45% of doctors would consider quitting if current version of healthcare reform is passed

 

[Kepler]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Oh, I wanna play!

63% of doctors favor inclusion of public option

Clearly they just want those 45% to quit so they can drive up their rates.

New England Journal of Medicine vs Investor's Business Daily. Who to believe about a medical issue, hmmm...?

 

[LynahFan]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Asking doctors about health care reform is a bit like asking bank tellers about monetary policy.

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

New England Journal of Medicine vs Investor's Business Daily. Who to believe about a medical issue, hmmm...?

Have you ever read the New England Journal of Medicine? Its just left of the New York Times Editorial page.

From my anecdotal evidence of talking to many different doctors, I haven't found one that favors the public option and the majority are vary scared of what this reform package will do to patient care.

 

[ScottM]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Oh, I wanna play!

63% of doctors favor inclusion of public option

Clearly they just want those 45% to quit so they can drive up their rates.

New England Journal of Medicine vs Investor's Business Daily. Who to believe about a medical issue, hmmm...?

Actually, I'm sure any MD who favors the public option, whatever that may be, is presuming they would not be subject to the same reimbursement rates they now receive under Medicare.

 

[mookie1995]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

LBJ once said that "all men worry about heart attack and all women worry about cancer of the ***"

just sayin'