America's Affordable Health Choices Act of 2009 - The USCHO debates

[The Exiled One]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

I read it all! I hope you can agree that I'm considerate in my reponses thus far, hopefully this response won't alter that perception...

Here's one idea that our so-called health expert, who thinks he's above the partisan fray and some moral authority on the subject refuses to broach despite his wordy dissertations on how great ObamaCare will be.

Why not combine tort reform with the creation of a real competitive environment for health care?

Now, pardon the length of the following, but I've recently learned that, in order to be right about something, you have to write lots and lots of words.

No one is asking the fundamental question, or at least, no one is trying to understand the answer to the fundamental question. Why is health insurance considered expensive? The knee jerk reaction around here? "Well, the insurance companies, they only want PROFIT. What a horrible, horrible motivation. They should be doing this for free, obviously, but it's that disgustingly un-American PROFIT that is keeping illegals and other uninsured folks from having their own coverage.

To answer our question, we must work backwards. Why is it expensive? Well, how do they come to the cost? It's expensive because medical care is expensive these days. Why is that? It's expensive for three main reasons - first, because doctors need to recoup the skyrocketing costs of medical school, which are rising much faster than the standard of living. Second, because doctors are required to carry millions and millions of dollars worth of malpractice coverage, premiums for which have been similarly skyrocketing over the last decade. And third, naturally, is that EVIL PROFIT that doctors are looking for.

I'd like to add a fourth to that list... uninsured people using the emergency room as thier only source of healthcare. The cost of that care is not simply written off, it's passed on to the cash customers and insurance agencies in the form of higher prices.

The last one, we can't do anything about short of abolishing the 13th Amendment. Something could be done about the first one, but let's focus on the second one for now - why is medical malpractice insurance so expensive? Well, it's because insurance companies have been forced to dole out larger and larger settlements in court as ambulance chasing lawyers prowl about looking for the slightest excuse to sue for the largest pot of money they can convince a jury to hand out to a victim who may or may not be truly victimized. In addition, many states are requiring doctors to carry more and more protection just in order to practice. So not only do premiums continue to rise, the minimum coverage continues to rise as well, making it more and more expensive for doctors to keep themselves covered.

Premiums are so high now that many doctors are leaving the profession. Then we go back to what The Exiled One said - fewer doctors means more burden for the premiums. Prices go up as customers - doctors - become more scarce.

Just a reminder that there are two reasons somebody may file suit regarding their health care. The first is the one you mentioned above, involving mistakes or perceived mistakes from the health care provider. The second is when insurance companies deny coverage for something the patient feels should be covered. This is the one that gets complicated...

Let's say I get diagnosed with something that will cost $200,000 dollars to fix or I die. Even if it's clear that my insurance should cover it, the insurance company may deny it because it's so expensive. They may decide that it'll only take about $100,000 to keep the matter tied up in court until I die... thus saving them $100,000. So after I die, my family may or may not sue the insurance company for damages. If they do, what was my life worth? If tort reform limits the amount they can recover, then there is no incentive for the insurance company to alter their profitable, yet macabre, method of operation. Without tort reform, my family might win a huge settlement, but that money will be recouped by the insurance company in the form of raised premiums. It's quite a conundrum.

To summarize, tort reform regarding health care providers... sure. Tort reform regarding insurance agencies... a bit more complicated.

There's a corollary effect to this, as well.

Here's an excerpt from a brilliant piece in the Daily Mail by Stephen Glover, who critcizes both the American and British healthcare systems:

Once, in America and suffering from bad earache, I visited a local doctor. In [Britain] I would probably have been greeted with a weary smile, and, if lucky, offered an aspirin.

In the United States I was cosseted by a pretty nurse, and subjected to several exhaustive tests by an accommodating doctor, one of which involved me sitting in a sound-proof booth to have my hearing tested. At the end of it all I was presented with a bill for several hundred dollars - and the verdict that I had nothing to worry about.


"Several hundred dollars" - that is what the Obamatons will focus on in that passage. But what have we been doing kids? Work backward. "Several hundred dollars" follows "several exhaustive tests." Why did the hospital perform "several exhaustive tests" costing "several hundred dollars" for nothing more than a bad earache? It's because doctors are concerned about malpractice. Tests that usually would not be run become MANDATORY for doctors who must rule out EVERYTHING, even the least possible cause, lest they misdiagnose and... bingo! Malpractice lawsuit. More tests equal more costs. More costs equal - you guessed it, a higher bill. Higher bills equal higher premiums.

...and here's the part that conservatives will focus on. This assumes facts not in evidence. I'm not saying the argument can't be factually supported, but in this case it certainly wasn't... therefore the rest of his statement is rendered irrelevant.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Because right now, there is no "public dole" to dump me into.

So what? This is about the employers, not the govt. What you're saying is if this is passed finding insurance will be the employee's problem. Why not make it that way anyway, right now, and save a ton of money as an employer? Again, there's no law saying they have to insure you, and there are currently non-employer based insurance options. What gives?

Obama has also stated publicly that he is in favor of a single payer system, the public option, and the elimination of private health insurance. We've seen the video of that in the past couple of weeks.

That "video" is from 2003. In the NH town hall meeting, he said that was unworkable. If you're going to hold that against him, how about the Republicans who voted in favor of end of life consultations, the very same thing they're now calling death panels?

Red Cloud,

I didn't say you had no ideas. I said your ideas are stupid and have no practical application in the real world. Get it right, will ya?

For example, a lot of knuckledraggers want to say "buying insurance across state lines will lower costs". I call BS and challenge you to explain how this will help. See I don't know if you actually graduated from RPI, or just went to the hockey games, but it seems anybody with half a brain would recognize that:

1) Having every provider having to have agreements and negotiations with 1,300 different insurers (source: MinnFan) is a logistical nightmare. Talk about driving up costs. The money spent on paperwork/recordkeeping/contracts etc would skyrocket, adding expenses to non-medical care. Really good idea there....

2) In some places it costs more for health care than others, much like in some places it cost more to insure your car. Call up a car insurer in North Dakota and ask them to cover your car in New York City for North Dakota rates and they'll laugh in your face. Why would health care be any different? Cost is going to be dictated by where you live and what the providers where you live charge, thus adding to the unworkability of your senseless proposal.



I await your response...

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

5 Freedoms you'll lose under the proposed reform

#4

Obviously, there isn't going to be language in the legislation that directly forces you to be on the gov't plan. You have to use a little common sense and see where things lead.

 

[PCM]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

So what? This is about the employers, not the govt.

I was talking about Obama making promises to people that he can't possibly keep by saying that all those who had health insurance they liked could keep it. It's not true.

 

[walrus]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

? Cost is going to be dictated by where you live and what the providers where you live charge, thus adding to the unworkability of your senseless proposal.

...

Or what the state you live in mandates be covered. Don't some states require that health insurance policies cover hair transplants?

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

For example, a lot of knuckledraggers want to say "buying insurance across state lines will lower costs". I call BS and challenge you to explain how this will help. See I don't know if you actually graduated from RPI, or just went to the hockey games, but it seems anybody with half a brain would recognize that:

1) Having every provider having to have agreements and negotiations with 1,300 different insurers (source: MinnFan) is a logistical nightmare. Talk about driving up costs. The money spent on paperwork/recordkeeping/contracts etc would skyrocket, adding expenses to non-medical care. Really good idea there....

2) In some places it costs more for health care than others, much like in some places it cost more to insure your car. Call up a car insurer in North Dakota and ask them to cover your car in New York City for North Dakota rates and they'll laugh in your face. Why would health care be any different? Cost is going to be dictated by where you live and what the providers where you live charge, thus adding to the unworkability of your senseless proposal.

I await your response...

How would it by any more difficult than what hospitals do now? When I go in to a doctor's office they have to check my insurance and see what I'm covered for. It would be the exact same process if my insurance is from out of state.

The main reason that healthcare costs more in some states is the reason you should be able to go across state lines: mandates. If you buy from a state with fewer mandates then you are simply covered for less. So if you wind up suffering from port wine stain (covered in MN) then you would have to pay for the treatment.

If I have auto insurance in one state and I get in an accident in another does it mean that my car won't get fixed? No, it means that my car will only be covered for what is dictated in my insurance.

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

1. Why do doctors get to recoup their education costs faster than the average American does? I don't see other professions getting huge bumps in pay relative to their education costs.

Source?

Most of the doctors I know took 20-30 years to pay off their loans, making monthly payments greater than their mortgage.

 

[Slap Shot]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Source?

Most of the doctors I know took 20-30 years to pay off their loans, making monthly payments greater than their mortgage.

Source?

 

[Bill]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

That "video" is from 2003. In the NH town hall meeting, he said that was unworkable. If you're going to hold that against him, how about the Republicans who voted in favor of end of life consultations, the very same thing they're now calling death panels?

If he doesn't actually retract what he said in those videos and specifically say that he has changed his mind on those issues, then that just makes it look more like he's not telling the truth now (NH). Sure those earlier clips were cherry picked, but it's pretty clear from his statements in them what his views on single payer, public option and private health insurance are. If he wants people to believe him now, he should retract the statements in the videos.

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Source?

You're the one who made the claim. I simply want to see if you have anything to back it up and refute my anecdotal evidence.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

How would it by any more difficult than what hospitals do now? When I go in to a doctor's office they have to check my insurance and see what I'm covered for. It would be the exact same process if my insurance is from out of state.

The main reason that healthcare costs more in some states is the reason you should be able to go across state lines: mandates. If you buy from a state with fewer mandates then you are simply covered for less. So if you wind up suffering from port wine stain (covered in MN) then you would have to pay for the treatment.

If I have auto insurance in one state and I get in an accident in another does it mean that my car won't get fixed? No, it means that my car will only be covered for what is dictated in my insurance.

Because your doctor's office is only dealing with certain insurers, which is why you have to ask who takes what insurance before you go in. Otherwise you get slapped with an "out of network" charge. That keeps the process a lot simpler than to figure out the policies of 1300 different companies. That's a nightmare and will skyrocket non-medical costs.

To your point about mandates by state, why would those go away under your proposal? In fact, as I've been saying, it makes everything even more cumbersome as now the insurers would have to tailor policies to meet up with state law. That adds costs to them, which they'll pass to you. Unless you'd like the feds to override state law and dictate what is and isn't covered.

Your last point has nothing to do with the subject. Its parallel to medical insurance is that if you're hurt outside of your network (like in another state) can you get treated? Of course, but it has nothing to do with what you pay for your policy. Up to this point, I still fail to see why getting insurance from somewhere else is going to lower healthcare costs. Costs will be dictating by state law and what it costs to get treatment where you are, not what insurance costs in the geographic location that the insurer is located in.

 

[ScoobyDoo]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Source?

Most of the doctors I know took 20-30 years to pay off their loans, making monthly payments greater than their mortgage.

I didn't make the claim. Red Cloud said that education costs were part of the rising costs of health care. I asked him why they should recoup their costs any faster than anybody else does. No one else gets an increase in salary to pay off their rising education costs that I am aware of.

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

To your point about mandates by state, why would those go away under your proposal? In fact, as I've been saying, it makes everything even more cumbersome as now the insurers would have to tailor policies to meet up with state law. That adds costs to them, which they'll pass to you. Unless you'd like the feds to override state law and dictate what is and isn't covered.

Thats the whole point of shopping in different states. You would no longer have to have those same mandates on your care. You would be able to have the mandates from a different state in the state you currently live.

 

[Bill]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

I would like someone to find me where in the bill it pushes for Socialized Medicine. I want to see it...don't give me platitudes about how this will lead to that which will roll down the slippery slope...give me some evidence. I dont support the bill or Socialized Medicine so it wont be hard to convince me...come on give me the goods!

One of the basic tenets of Socialism is government ownership of the means of production (in this case health care). That's exactly what the draft bill(s) were pushing with a public option/single payer system. If you don't think that's the case, you're being obtuse. We still have to see what the reconciled bill will say.

 

[Red Cloud]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

I read it all! I hope you can agree that I'm considerate in my reponses thus far, hopefully this response won't alter that perception...

You've been fairly even-handed, yes.

I'd like to add a fourth to that list... uninsured people using the emergency room as thier only source of healthcare. The cost of that care is not simply written off, it's passed on to the cash customers and insurance agencies in the form of higher prices.

Yes. Good add.

Just a reminder that there are two reasons somebody may file suit regarding their health care. The first is the one you mentioned above, involving mistakes or perceived mistakes from the health care provider. The second is when insurance companies deny coverage for something the patient feels should be covered. This is the one that gets complicated...

(snip)

To summarize, tort reform regarding health care providers... sure. Tort reform regarding insurance agencies... a bit more complicated.

I can agree here - though some tort reform would work much better than no tort reform.

...and here's the part that conservatives will focus on. This assumes facts not in evidence. I'm not saying the argument can't be factually supported, but in this case it certainly wasn't... therefore the rest of his statement is rendered irrelevant.

I don't want to focus on that because Britain's health system isn't in question here, it's our own. But do bear in mind that the statement I quoted was from a Brit.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Thats the whole point of shopping in different states. You would no longer have to have those same mandates on your care. You would be able to have the mandates from a different state in the state you currently live.

Says who? The Feds? Mandates are if you're insuring people in that state. Shopping for insurance in a different state does you no good, if they plan on insuring you, they have to follow the law where you live. The only way you get around that is if the Feds override state laws governing what should be covered for their residents (or what should be covered for insurers covering people in their state). What's mandated for coverage in Alaska for a company that's based in Alaska has no bearing on what insurers have to cover in Minnesota if you live there. That's not going to change by getting insurance "out of state". Are you advocating the feds overriding state law?

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

More BS knocked down by factcheckers:
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From NBC's Domenico Montanaro
As we were putting clips together for First Read, RNC Chairman Michael Steele was on MSNBC's Morning Joe and did nothing to dissuade viewers from believing that so-called "death panels" are in the bills moving their way through Congress.

As Politico writes, "Asked if he thinks there is a 'death panel' provision in the bill -- a suggestion that has been proven untrue and that the White House has spent a week trying to knock down -- Steele said he does not know. 'It may or may not be. I don’t know. We don’t know what the bill is,' Steele said. 'But there’s clearly an attempt by at least the House members to put in place a structure that causes concern for the American people in respect to end of life decisions. I think that’s a legitimate point. You don’t have to call it death panels if you don’t want to. You can call it a panel. I call it rationing.'"

As we've written previously on First Read, including again in First Thoughts this morning -- citing non-partisan fact-checkers -- there are no such "death panels."

But, reached for a response on Steele's comments, RNC spokeswoman Gail Gitchco not only defended them, but added that "death panels have not been totally debunked."

The RNC, she said, draws a distinction between end-of-life counseling and "comparative effectiveness research," which the RNC claims "leads to government boards deciding what treatments would or wouldn't be funded." The RNC cites portions of an article in the Washington Post and two Wall Street Journal editorials. (Here and here.)

"First, death panels have not been totally debunked," Gitchco told First Read in an email. "Second, Steele didn’t call it a death panel. He clearly said that he calls it rationing. Third, everyone is focused on these death panels as 'end of life care.' But what Steele was referring to as rationing was the comparative effectiveness research. Fourth, his point about there not being a bill is spot on -- the Dems do not have a bill in the senate. So, bottom line is that I don’t think you have your post quite right."

But FactCheck.org and the Pulitzer-prize winning Politifact have also debunked this specific notion.

FactCheck:

As for the health care bills themselves, the House’s H.R. 3200 sets up a center to conduct and gather such research within the Agency for Healthcare Research and Quality, an entity the CBO called “the most prominent federal agency supporting various types of research on the comparative effectiveness of medical treatments." Like the stimulus legislation, the bill states that: "Nothing in this section shall be construed to permit the Commission or the Center to mandate coverage, reimbursement, or other policies for any public or private payer."

Politifact gave Sarah Palin a "Pants on Fire" for saying, in Politifact's words, "Seniors and the disabled 'will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care.'"

Palin also may have also jumped to conclusions about the Obama administration's efforts to promote comparative effectiveness research. Such research has nothing to do with evaluating patients for 'worthiness.' Rather, comparative effectiveness research finds out which treatments work better than others.

The health reform bill being considered in the House of Representatives says that a Comparative Effectiveness Research Center shall 'conduct, support, and synthesize research' that looks at 'outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.'

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[MattS]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Two points from the Fortune article:

4. Freedom to keep your existing plan

5. Freedom to choose your doctors

These are the two things that are most troubling to me with this so-called health care reform. I believe that something needs to be done to make health care affordable, but someone explain to me why I should be forced to give up my excellent health care?

 

[Handyman]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

I think a majority want reform, they just don't want the the system blown up.

What about all the paper pushers in hospitals, why are there more administration then there are medical care providers in a hospital?

Don't ask me man you are preaching to the choir...I think bureaucracies are choking the life out of a lot of things from hospitals to universities to big business.

 

[The Exiled One]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

I don't want to focus on that because Britain's health system isn't in question here, it's our own. But do bear in mind that the statement I quoted was from a Brit.

It seems like a simple scientific test would answer a lot of these questions regarding the differences between health care systems of different nations. I don't know if it's been done, being done, or has never been thought of before, but why can't a patient visit a few different countries (let's say: USA (private), Great Britain (socialzed), and Canada (single payer)) and see what happens?