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

[Patman]

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

That is better.

Has anyone looked at the cost of what would happen if we stuck with the status quo? People keep mentioning the cost but I can't see how we can do nothing. The premiums are going up and the reimbursement (at least where we are) is going down. Where are all the $ going?

what are they going to do to keep prices down... who dies and why? its the same questions in the end. Very hard to compare things when the idea of health care doesn't keep the same definition.

Ah, but government is always smart, wise, and moral... we'll figure it all out shalln't we.

 

[Plante26]

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

Where are all the $ going?

Letting labor unions into health care probably didn't help things. At SMDC in Duluth, there are numerous nurses getting paid over $100k/year when OT is figured in. And the union that represents them? The Steelworkers union here in Northern Minnesota.

Granted, that doesn't help reimbursement rates, but a government plan isn't the answer considering that Medicare reimbursement rates are at the bottom of "insurers".

 

[leswp1]

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

what are they going to do to keep prices down... who dies and why? its the same questions in the end. Very hard to compare things when the idea of health care doesn't keep the same definition.

Ah, but government is always smart, wise, and moral... we'll figure it all out shalln't we.

Um- no. Looking at the % of care delivered and the amt of deaths this does not compute. There is a lot more chronic care than before.

Letting labor unions into health care probably didn't help things. At SMDC in Duluth, there are numerous nurses getting paid over $100k/year when OT is figured in. And the union that represents them? The Steelworkers union here in Northern Minnesota.

Granted, that doesn't help reimbursement rates, but a government plan isn't the answer considering that Medicare reimbursement rates are at the bottom of "insurers".

Well- speaking as an old floor nurse- those people are not sitting on their bottoms. They are the folks that keep people alive. The Docs just visit. They also are highly educated and usually working in an understaffed environments.

In our state, unions are the thing that keeps hospital environments safe when hospitals have tried to understaff using unsafe measures to make up for it. They have managed to challenge forced overtime (Nurses can be charged with abandonment if they refuse OT, even if they know they are no longer safe because of fatigued/ not thinking well) and staffing levels where the hospitals were understaffing with RNs and using ancillary staff to do things nurses usually do.

 

[Rover]

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

Some good points out here. 1) what is the cost of doing nothing, and 2) how laughable is the GOP bill which saves less money than the Dems and covers about 36M less people? Sometimes if have nothing to say, its better off not saying anything. GOP Minority Rep John Boehner, Boner, Bonehead, whatever his name is screwed the pooch on this one.

What I like about this, and what all Americans regardless of political persuasion should be proud of, is that their elected officials actually took a tough vote to solve a pressing problem. When's the last time that happened (I'd say the mid 90's). In the previous Congress, all we got was easy votes that constantly added to the federal deficit (special interest tax cuts, unfunded perscription drug benefit, etc).

Is this bill perfect? No. Did it leave some stuff out? I'm sure it did. Is it better than doing nothing? Undoubtably. The bottom line is, are we as voters going to reward people for putting their jobs on the line to fix a real problem, or will we sit back and complain instead of tackling tough problems. The easiest thing in the world to do is whine and cry about things. Its a lot harder to take action and I salute the Congress, the Dems +1 Republican in this case, for casting a historic vote in favor of health care reform.

 

[leswp1]

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

The bill isn't anything until it works thru both the house and the senate. I will be proud after they duke it out in conference.

Who was the idiot trying to shotput the bill at a press conference this AM? If he wanted to make a point with someone other than his faithful following he lost me behaving like a petulant child. I would really like to see someone make constructive criticism instead of just criticising. This is the thing that drives me nuts!

 

[LynahFan]

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

I would really like to see someone make constructive criticism instead of just criticising.

Okay. That conservative rag known as The New York Times airs some of the criticisms. From Democrats.

 

[French Rage]

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

Regardless of anyone's political stances, can we all agree the clip of the presiding member in the House telling members not to use kids as props was hilarious?

 

[leswp1]

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

Okay. That conservative rag known as The New York Times airs some of the criticisms. From Democrats.

Thank you. I would like to see more concrete things but this is better than nothing. A comment on bundling for certain dx. This looks good in theory but in practice is an extremely risky thing for primary care providers. In the early 90s we had that here in Mass (not sure about other places) and it was a disaster. The idea is you get a specific amt for each person and that doesn't change no matter what happens. If you see them 1 or 20 times you still get the same $. The healthy people were fine but it only takes a few people to get really sick (or be massively non-compliant) and smaller practices can be in real trouble when they crash and burn. What happened here was the complex patients were getting jettisoned and then no one would take them. It also encouraged some less than ethical practices/Drs to skimp on things they normally would order/prescribe. It was a nightmare.

Mass is trying to do this right now with global fees as next on the agenda. THe non-compliant people and the complex will once again be on the chopping block (there are ways you can 'fire' patients for breach of patient Dr relationship that are legal even if they are not ethical) except now there are a dearth of primary offices and they will be flooding the ERs.

Personal experience with that- L'il got RSV (causes wheezing) when he was about 6 months old. Normally he would have gotten a nebulizer treatment in the office and then be sent home with an order for a nebulizer if it worked. We were on Tufts and were capitated. The Dr would have had to eat the cost of the neb so instead he bypassed the neb and put the L'il on steroids & prescribed inhalers (using a mask- practically impossible with a 6 month old and not appropriate for acute care in this case). Luckily for us I got him in to my practice- he got a neb and had instant decrease of his wheezing. Did not need steroids, which although helpful should not be first line treatment in a kid that age. We saw a lot of kids that came over to our practice from that pedi office. All were getting sub-par treatment that even the uneducated parents could figure out- it just took awhile. They moved on because the Dr would tell them they weren't doing the right thing,the kids should be getting better, they didn't need to be seen again. No one died but the pedi basically forced out all the kids that were high utilizers. He made a bundle.

I agree fee for service has its abuses. Bundling is pretty scary. Either way you are dealing with a patient who is human and therefore an unpredictable entity. You could do everything right for them and lose your shirt if they go down the tubes. Not sure how you can protect both parties.

Regardless of anyone's political stances, can we all agree the clip of the presiding member in the House telling members not to use kids as props was hilarious?

yes.

 

[Kepler]

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

Regardless of anyone's political stances, can we all agree the clip of the presiding member in the House telling members not to use kids as props was hilarious?

I heard about it, but linky?

 

[DrDemento]

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

Thank you. I would like to see more concrete things but this is better than nothing. A comment on bundling for certain dx. This looks good in theory but in practice is an extremely risky thing for primary care providers. In the early 90s we had that here in Mass (not sure about other places) and it was a disaster. The idea is you get a specific amt for each person and that doesn't change no matter what happens. If you see them 1 or 20 times you still get the same $. The healthy people were fine but it only takes a few people to get really sick (or be massively non-compliant) and smaller practices can be in real trouble when they crash and burn. What happened here was the complex patients were getting jettisoned and then no one would take them. It also encouraged some less than ethical practices/Drs to skimp on things they normally would order/prescribe. It was a nightmare.

Mass is trying to do this right now with global fees as next on the agenda. THe non-compliant people and the complex will once again be on the chopping block (there are ways you can 'fire' patients for breach of patient Dr relationship that are legal even if they are not ethical) except now there are a dearth of primary offices and they will be flooding the ERs.

Personal experience with that- L'il got RSV (causes wheezing) when he was about 6 months old. Normally he would have gotten a nebulizer treatment in the office and then be sent home with an order for a nebulizer if it worked. We were on Tufts and were capitated. The Dr would have had to eat the cost of the neb so instead he bypassed the neb and put the L'il on steroids & prescribed inhalers (using a mask- practically impossible with a 6 month old and not appropriate for acute care in this case). Luckily for us I got him in to my practice- he got a neb and had instant decrease of his wheezing. Did not need steroids, which although helpful should not be first line treatment in a kid that age. We saw a lot of kids that came over to our practice from that pedi office. All were getting sub-par treatment that even the uneducated parents could figure out- it just took awhile. They moved on because the Dr would tell them they weren't doing the right thing,the kids should be getting better, they didn't need to be seen again. No one died but the pedi basically forced out all the kids that were high utilizers. He made a bundle.

I agree fee for service has its abuses. Bundling is pretty scary. Either way you are dealing with a patient who is human and therefore an unpredictable entity. You could do everything right for them and lose your shirt if they go down the tubes. Not sure how you can protect both parties.

yes.

The personal anecdote you mentioned is exactly why bundling does not work. It fosters a factor of human nature in many physicians-they try to preserve their own income. If they get the same pay no matter how much they have to do, they will try to do less. It is virtually the same as physicians who lose money if they refer to specialists. If their pay is reduced they will try to keep the patient from seeing much needed specialists rather than take the pay cut. Care rationing of these types is a consequence of most types of healthcare cost reductions. I am not sure the general public understands this. Not all types of medical care are equal. Just as not all physicians are the same-some graduated at the top of their classes and some were at the bottom. I prefer to see the former if I can and hope that he has my best interests at heart and is not working from a cookbook recipe where he can only treat me the way the government has dictated. Just my 2 cents.

 

[Kepler]

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

Okay. That conservative rag known as The New York Times airs some of the criticisms. From Democrats.

En passant, this is why the NYT is not in the same league as the wingnut outlets. They will actually allow real criticism, even of the positions they ostensibly favor. (Unless it's Shoreham, which the Ochs and Salzburgers must have owned stock in or something).

 

[Rover]

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

The notion that I disagree with most strongly is the idea that because we don't know exactly what the savings will be, or because every issue isn't addressed, no bill should be passed. That's stark raving stupid IMHO. Like anything, the effects of the bill after implementation will have to be looked at and adjustments made if needed. In particular I like the idea of the independent board to make savings recommendations. Too many people have lost the willingness to accept compromise on both sides frankly, but I'll say again to all the pessimists out there (and there's quite a few) this is the first time in almost 15 years where Congress is putting their careers on the line to tackle a pressing problem instead of punting it away and borrowing money to cover up the problem. That should be commended.

 

[Plante26]

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

The notion that I disagree with most strongly is the idea that because we don't know exactly what the savings will be, or because every issue isn't addressed, no bill should be passed. That's stark raving stupid IMHO. Like anything, the effects of the bill after implementation will have to be looked at and adjustments made if needed. In particular I like the idea of the independent board to make savings recommendations. Too many people have lost the willingness to accept compromise on both sides frankly, but I'll say again to all the pessimists out there (and there's quite a few) this is the first time in almost 15 years where Congress is putting their careers on the line to tackle a pressing problem instead of punting it away and borrowing money to cover up the problem. That should be commended.

I'd say that exactly: No bill should be passed. Is getting it right the first time too much to ask of the people we elect to do things like this? Would your boss let you do your job however you wanted for a year and then go back and correct things you messed up? The current bill is obviously not a good way to go about health care reform--the majority of Americans are against it and numerous Dems crossed over in the House to vote against it. That tells you something about this bill in its current form.

 

[walrus]

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

I heard Mike Michaud, 2nd district congressman, Maine, on the radio this morning. What a lightweight he is. He kept saying over and over how he was ready to vote no as the bill hurts Maine. Apprently Maine gets crushed on Medicare and Medicaid because of this bill and seeing as Maine is the oldest state in the nation, Mikes constituents are going to be hurt by this bill. Yet he still voted yes, why? and he admits this on the radio, all the big unions called him and begged for a yes and then Obama calls and begs for a yes. Obama tells him they'll work it out and understands why he'd vote no. So Mike does what he's told and votes yes. A great Rep we have.

 

[Rover]

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

I'd say that exactly: No bill should be passed. Is getting it right the first time too much to ask of the people we elect to do things like this? Would your boss let you do your job however you wanted for a year and then go back and correct things you messed up? The current bill is obviously not a good way to go about health care reform--the majority of Americans are against it and numerous Dems crossed over in the House to vote against it. That tells you something about this bill in its current form.

A better analogy is if you did your job for a year, but because you didn't do it perfectly and in your year end review your boss still had a couple of things for you to improve upon, he fired you on the spot and started over with a new hire.

Majority of Americans against it depends on the poll, and some nervous Dems voting against it isn't any more relevant than GOP'er Cao voting for it. A majority of the House passed the measure. Why not enact something that cuts the deficit and insures the uninsured?

 

[Kepler]

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

A better analogy is if you did your job for a year, but because you didn't do it perfectly and in your year end review your boss still had a couple of things for you to improve upon, he fired you on the spot and started over with a new hire.

An even better analogy would be the boss is about to hire you, but then thinks you might not do the job 100% the way he envisions it, so he decides not to hire anybody and the job never gets done at all.

 

[Plante26]

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

A better analogy is if you did your job for a year, but because you didn't do it perfectly and in your year end review your boss still had a couple of things for you to improve upon, he fired you on the spot and started over with a new hire.

Majority of Americans against it depends on the poll, and some nervous Dems voting against it isn't any more relevant than GOP'er Cao voting for it. A majority of the House passed the measure. Why not enact something that cuts the deficit and insures the uninsured?

Your analogy will most likely be the scenario for quite a few congresspeople in 2010.

Here's a couple of reasons that the bill shouldn't be passed: A public option will destroy the private insurance industry, which employs millions of people. Small business will dump millions of workers on to the public option--a scenario that Obama is in favor of, and has stated his desire to see come to fruition. And, since we've already established that everything the government touches gets more expensive, the estimated costs are most likely understated. This bill may cut the deficit and insure the uninsured, but what happens to the health care system itself? When something becomes free, the fraud and abuse follow shortly thereafter (see Medicare, Medicaid, Social Security-Disability, Stimulus Money). Much like an AYCE buffet, people will overuse the coverage. Health care will be stretched thinner, creating a shortage. The economic laws of supply and demand will kick in, driving the cost of health care higher.....which will ultimately cost the taxpayers more in the end.

I agree that the GOP plan isn't any better than the plan currently being pushed through Congress, but I still don't see any reason that they can't stop, back up and do things the right way the first time around. Because if the bill goes through, and pushes private insurers under, there's no going back and fixing those insurance companies. They're gone--for good. Along with the jobs. Irrevesible damage will be done to the health care and insurance systems.

And speaking of jobs, if this bill goes through, it will be mandatory to have health insurance, but optional to have a job? I'd still like to see some sort of legislation tacked on to this bill making it mandatory that every able-bodied citizen be employed in some manner--be it through low-level government CCC-type work, or minimum wage jobs in their communities--to qualify for free government insurance, welfare benefits and government/Section 8 housing. This would take care of the freeloaders in the system.....because let's face it: There are millions of people out there on the public dole because they just don't want to work. Of course, I'm not talking about people who are legitimately disabled, or people who are of retirement age. Unfortunately, I am certain that quite a few people would rather be homeless than go to work 40 hours a week.

 

[Rover]

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

Your analogy will most likely be the scenario for quite a few congresspeople in 2010.

Here's a couple of reasons that the bill shouldn't be passed: 1) A public option will destroy the private insurance industry, which employs millions of people. 2) Small business will dump millions of workers on to the public option--a scenario that Obama is in favor of, and has stated his desire to see come to fruition. 3) And, since we've already established that everything the government touches gets more expensive, the estimated costs are most likely understated. This bill may cut the deficit and insure the uninsured, but what happens to the health care system itself? 4) When something becomes free, the fraud and abuse follow shortly thereafter (see Medicare, Medicaid, Social Security-Disability, Stimulus Money). Much like an AYCE buffet, people will overuse the coverage. Health care will be stretched thinner, creating a shortage. The economic laws of supply and demand will kick in, driving the cost of health care higher.....which will ultimately cost the taxpayers more in the end.

I numbered some points for clarity's sake.

1) That's your opinion, not something based on actual facts. Why, you ask? Because Medicare, Medicaid, VA, etc are already public health care options, within certain limitations, and they've yet to destroy private insurance, and the millions of jobs that go with them. Its the difference between what you think may happen, and what's actually happening right now.

2) Why aren't they doing that anyway? Nobody's forcing small business to offer health insurance (again within certain parameters). They can simply dump people off, especially in this economy. Why hasn't that already happened?

3) Or it could result in more savings, especially given the mechanisms (independent board recommending savings) that are part of the plan. Recall when Clinton passed deficit reduction act in '93, not only did it get no GOP votes, but even independent estimates foresaw no surpluses as a result, far understating the 4 years of surplus that actually happened.

4) Fraud and abuse happen everywhere, with everything. Should we eliminate the defense budget for that reason too? I would like to see a stronger focus on cracking down on fraud in the system, because I believe big savings can be found there. However, its not a reason not to enact reform.

 

[LynahFan]

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

I numbered some points for clarity's sake.

1) That's your opinion, not something based on actual facts. Why, you ask? Because Medicare, Medicaid, VA, etc are already public health care options, within certain limitations, and they've yet to destroy private insurance, and the millions of jobs that go with them. Its the difference between what you think may happen, and what's actually happening right now.

Not for the majority of people in the country, they're not. This is like pointing out that UK's NHS isn't driving US private health insurers out of business. Well of course it's not - it doesn't serve the same market.

2) Why aren't they doing that anyway? Nobody's forcing small business to offer health insurance (again within certain parameters). They can simply dump people off, especially in this economy. Why hasn't that already happened?

Because somebody IS forcing small business to offer health insurance - the invisible hand of market forces. Small business owners know that if they dump their coverage, many of their workers will go elsewhere (especially the ones with good resumes!), so they choose to continue to offer coverage - even in this economy. We don't have to explain why it SHOULD be that way based on some economic theory - the fact is that it IS that way based on empirical data.

3) Or it could result in more savings, especially given the mechanisms (independent board recommending savings) that are part of the plan. Recall when Clinton passed deficit reduction act in '93, not only did it get no GOP votes, but even independent estimates foresaw no surpluses as a result, far understating the 4 years of surplus that actually happened.

An independent board recommending nebulous savings down the road doesn't give me a warm fuzzy. Pray tell, which part did the forecasters miss in '93 - their estimates of government spending (nope) or the skyrocketing revenues (yep)?

4) Fraud and abuse happen everywhere, with everything. Should we eliminate the defense budget for that reason too? I would like to see a stronger focus on cracking down on fraud in the system, because I believe big savings can be found there. However, its not a reason not to enact reform.

I actually agree with this. Completely.

 

[Rover]

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

1) Not for the majority of people in the country, they're not. This is like pointing out that UK's NHS isn't driving US private health insurers out of business. Well of course it's not - it doesn't serve the same market.


2) Because somebody IS forcing small business to offer health insurance - the invisible hand of market forces. Small business owners know that if they dump their coverage, many of their workers will go elsewhere (especially the ones with good resumes!), so they choose to continue to offer coverage - even in this economy. We don't have to explain why it SHOULD be that way based on some economic theory - the fact is that it IS that way based on empirical data.


3) An independent board recommending nebulous savings down the road doesn't give me a warm fuzzy. Pray tell, which part did the forecasters miss in '93 - their estimates of government spending (nope) or the skyrocketing revenues (yep)?

1) Some people are acting like public insurance doesn't exist at all. In fact it does already exist, for a good deal of the population. I fail to see why adding another limited option will cause the demise of the employer based system.

2) Exactly, and I'd expect this same phenomenon to occur even if a limited public option is enacted. The principle doesn't change.

3) A panel operating much like the base closings panel does work. Recommendations that can only be voted up or down in entirety, not subject to horse trading and other political influence is the way to go IMHO.

In the early 90's while revenue went up, the bottom line is the political leadership at that time resisted the urge to spend it all, be it on programs or tax cuts and instead started paying down the deficit. That kind of discipline will be needed again once the economy turns around.