How do people envision cutting medical cost?

[mheslep]

Privately delivered? Seriously?

Actually yes, in single payer the medical practitioners do not explicitly work for the government. However, since the government pays the bills for everyone in the system, the government can set prices and methods throughout the system. It therefore by and large acts and behaves as an employer.

 

[Nebula815]

The Canadian system I believe is one where government pays for, sets prices, etc...but the practitioners are private. The British system is one where the government owns and operates everything (hospitals are government-owned, doctors are government doctors, etc...). The military's VA system is also socialized medicine.

 

[Al68]

The Canadian system I believe is one where government pays for, sets prices, etc...but the practitioners are private.

This is obviously a very different definition of "private" than I would use. I would use the word "private" to mean free from government involvement.

I don't even think that would meet the criteria for "quasi-private".

 

[Skyhunter]

How am I confused, then?My statement is true. Non-system insurance policies would be outlawed. Have you read the bill? Voluntary? What definition of voluntary would that be?

Your confusion stems from a basic misconception.

There are already laws regulating the insurance and health industries.. If you read the bill, you realize that it is 2000 pages of amendments to existing law.

Like this:

(2) REDUCTION IN PERMITTED PREEXISTING
CONDITION LIMITATION PERIOD.—Section
9801(a)(2) of such Code is amended by striking ‘‘12
months’’ and inserting ‘‘3 months’’, and by striking
‘‘18 months’’ and inserting ‘‘9 months’’.

So, now you admit you think it's government's job to "establish the rules" for my personal health care? That certainly precludes the use of the word "private".

The government has already established the rules. And the system under those established rules is not working. Time for the government to change the rules.

Your argument is typical of the rhetoric coming from the republican party. That is one of the many lines of evidence that lead me to the conclusion that Republicans only want to obstruct for political gain, instead of governing. The 101 filibusters is another solid line of evidence.

Republican leadership brought us to the brink of disaster. Anything good for America while DEmocrats are in power, is politically bad for Republicans. Their strategy is clear, obstruct the Democrats from enacting any serious reforms until they get their power back. That is the primary difference I see in todays politicians. Democrats are willing to compromise. Republicans are not, and like Grover Norquist said: "Bi-partisanship is like date rape."

I'm not the one advocating any such thing.

I never said you were. I was asking why we should have a personal mandate without a public option.

In the Senate version, that is what would happen, and unlike driving a car... I may someday need healthcare. Why should I be forced to buy, but denied the choice of a public health plan?

The house bill version linked on the Speaker's web page is exactly the way I described. Participation isn't voluntary by any normal definition.

Since you are so familiar with the bill... why not give us the page and line numbers of the section that forces insurance and healthcare providers to participate.

But fortunately this assault on liberty isn't going to happen now, from the way it looks.

LOL

 

[Al68]

Your confusion stems from a basic misconception.

There are already laws regulating the insurance and health industries..

Yes, there are. The type of insurance policy I want is already illegal. Again, where is my confusion or misconception? You seem to be mistaking my opposition to increased government control with an ignorance of existing government control.

Do you think it's a "misconception" or "confusion" to oppose a law because it has similarities with previously enacted laws that I also opposed?

Your argument is typical of the rhetoric coming from the republican party. That is one of the many lines of evidence that lead me to the conclusion that Republicans only want to obstruct for political gain, instead of governing.

I don't really care what the motives of Republicans are at this point. They have historically failed to protect economic liberty in this country. But in this case, they have succeeded so far. Even if your hateful accusations about their motives for doing so are true.

And it's quite a coincidence that every time a politician actually takes my side against infringements on liberty, they are accused of having bad motives. Yeah, coincidence.

But ad hominem arguments are logical fallacies and irrelevant to the issue anyway.

I was asking why we should have a personal mandate without a public option.

We shouldn't.

Why should I be forced to buy, but denied the choice of a public health plan?

You shouldn't.

Since you are so familiar with the bill... why not give us the page and line numbers of the section that forces insurance and healthcare providers to participate.

LOL. By "participation isn't voluntary", I was referring to individuals, not insurance companies. That's section 501. That's what I thought you were referring to in the above two questions as if I were advocating such a thing.

What I said about insurance companies was that they would be "forbidden to sell private policies outside of the system". That's section 202.

But fortunately this assault on liberty isn't going to happen now, from the way it looks.

LOL

I'll take that to mean that you have no respect for the reason many of us oppose this kind of law. Or that you're shocked or can't believe that the reason could be something other than being "for the rich" or some other hateful delusion typical of Democrats.

Dismissing arguments in favor of individual liberty won't make them go away. Neither will hatefully misrepresenting them.

 

[Skyhunter]

I get it.

You are generally hostile to any government involvement in healthcare or any other industry. You are therefore susceptible to the "government takeover argument."

But to quote James Wilson: "Civil liberty is natural liberty itself, divested only of that part, which, placed in the government, produces more good and happiness to the community than if it had remained in the individual."

I don't support the individual mandate. In my opinion, healthcare should be single payer, and it should be payed for with a tax on the wealth produced by our nation. If someone is sick or injured, they should receive care without fear or worry about financial ruin. Providers are free to compete for patients, insurance companies can sell enhanced plans for those wanting vanity and elite care.

I would argue that healthcare should not be a for profit industry. Life and death decisions should not be made by insurance companies concerned over their bottom lines.

I don't know what kind of illegal policy you want to purchase. but if it is one from a company that would rather deny your claim than suffer a quarterly loss... Well, if not the government... Who you going to call?

 

[CRGreathouse]

I don't know what kind of illegal policy you want to purchase. but if it is one from a company that would rather deny your claim than suffer a quarterly loss... Well, if not the government... Who you going to call?

Why buy a policy at all? I wouldn't, if not for the current structure of tax law. Health *insurance* is a poor way to provide health *care*.

I'm not automatically opposed to catastrophic insurance -- though I'm not presently interested -- but the current system has much of the inefficiency of a public plan (thanks to regulation and paperwork), all the rent-seeking of an oligopoly, and even more distortion than the moral hazard would suggest (thanks to aforementioned tax policy).

 

[Al68]

I don't support the individual mandate. In my opinion, healthcare should be single payer, and it should be payed for with a tax on the wealth produced by our nation. If someone is sick or injured, they should receive care without fear or worry about financial ruin. Providers are free to compete for patients, insurance companies can sell enhanced plans for those wanting vanity and elite care.

I would argue that healthcare should not be a for profit industry.

I won't bother making a case against single-payer, since that's not on the table in the U.S., anyway. And it looks like we agree on what I consider to be the most oppressive part of this plan, the mandate to buy. And the plan's supporters pretty much say the rest of the plan is unworkable without the mandate.

For the rest, we just fundamentally disagree on the legitimate role of government in society.

I don't know what kind of illegal policy you want to purchase

The type of insurance policy I buy is high-deductible, major medical insurance-only. Basically, similar to car insurance, it only covers major unexpected medical expenses, and has a large deductible. No coverage for routine medical costs, etc.

This type of policy is relatively very cheap, even for a top-rated and trustworthy plan, since it is only insurance, not a comprehensive (Cadillac) health plan that amounts to paying a "middleman" to pay for routine physicals and other expected medical costs in addition to "insurance".

This type of policy would be outlawed under the house bill.

I'm not saying there's anything wrong with those comprehensive health plans. I'm just saying government shouldn't force me to buy one, or outlaw the alternatives.

but if it is one from a company that would rather deny your claim than suffer a quarterly loss... Well, if not the government... Who you going to call?

LOL. I don't buy the kind of insurance where those decisions are made after the fact. The policy is in writing and covers what the policy says it covers, period.

If you're referring to fraud or default by the insurance company, I don't know anyone who thinks fraud or contract default should be legalized, so I assume we agree on that one, too.

 

[mheslep]

[...] I wouldn't, if not for the current structure of tax law. Health *insurance* is a poor way to provide health *care*.

[...]
but the current system has much of the inefficiency of a public plan (thanks to regulation and paperwork), all the rent-seeking of an oligopoly, and even more distortion than the moral hazard would suggest (thanks to aforementioned tax policy).

Yes. Per Milton Friedman in this debate a few years ago, commenting on the pitfalls of the huge third party payer systems brought on by the current tax policy:
http://www.prospect.org/cs/articles?articleId=10764

MF: We have the worst of all of all worlds on that score. [third party system]

RK: I couldn't agree with you more. We have the worst mix of government and private, I could not agree with you more.

MF: We ought to have much more private or much more government.

RK: Well, to the extent that government is involved at all it ought to be doing a better job than its doing now. I am entirely in agreement.

MF: But there is no formula for doing it. Every area where the government gets involved, whether its education, whether its medicine. If government were to take over the industry of running retail grocery stores, that would be a major problem. The post office is a problem. And if Medicare and Medicaid had never been passed, it may well be, probably would be, that expenditure on health would have gone up, maybe to seven, eight, nine percent of GDP, because as we get to be a richer country, it's a product that people want to have more of. And there is nothing wrong with that. In fact there's nothing wrong with medical spending being 20 percent of national income.

 

[rewebster]

I personally think its about money. The republicans know their base hates even the hint of any additional taxes, and the R's yell that loudly; but, that's only part of it.

Normally some bills have some D's and some R's voting differently; but I think one of the MAIN reasons why the R's vote so solidly together: They get more money from those institutions IF and only IF they all (the R's) vote the same.

The money from the lobbyists has to be split among ALL the R's--and the longer they keep the bill from being passed WHILE still keeping alive to a certain extent (re-set/re-start the bill), the more money that the lobbyists will pay money to the R's to stop the bill. The people who want and need the bill passed are the poor; they don't have money to hire lobbyists.

 

[edpell]

Hi folks. The original question is how will we lower the cost of medical care in the US. Does anyone support a lifetime limit to the dollar amount of medical care we give to one person? Say $100,000 per lifetime? Or some other number?

 

[mheslep]

...This is true but many of the elements in http://rules-republicans.house.gov/Media/PDF/RepublicanAlternative3962_9.pdf appear in some form in the Democratic proposals ...

[...] encouraging the interstate sale of insurance policies, high-risk pools,

This one in particular - interstate sale of private insurance policies by any insurance company to any individual regardless of borders - is not in the Democratic bills (Senate or House). The http://www.opencongress.org/bill/111-h3962/text" empowers the individual, allowing "each individual to use the refundable tax credit toward the purchase of health insurance in any State", end of story.

[...] However, with these Republicans, winning policy concessions doesn't necessarily translate into voting for legislation. But don't be fooled into thinking the Democratic bills aren't heavy with conservative or Republican ideas.

I'll try not to be fooled by anyone, and I'm still looking for the conservative ideas in the Democratic bills.

Of course there is: accompany those things with a revenue source that more than pays for the coverage expansions. Both the House and Senate bills do this, which is why they reduce the deficit.

My reading of the CBO scoring (Senate bill) is the opposite: for a given year of actual benefits and spending (when indeed it starts), the revenues in the same year fall short.

There's no federal law that does this. State laws are what prevent interstate insurance sales.

Correct, but the federal government has the authority via the commerce clause to trump the state laws in this regard. Republicans favor the idea, Democratic legislators rejected it.

 

[mheslep]

...Politically this would be exceptionally difficult to do, even if it is a good idea.

Agreed. But there have been attempts at more pallatable solutions. McCain in the '08 campaign proposed moving the tax break dollar for dollar away from the employer-employee to the individual, a start at least to eliminate the madness of being forced to get high price health care only through an employer. The 08 Obama campaign, especially Biden, demagogued the idea heavily, so now for Congress to even mention the idea the political barrier was much higher.

The Senate bill's excise tax effectively caps this tax exemption at a fairly high level and even that's been very unpopular among the public.

http://www.nypost.com/p/news/national/unions_get_pecial_treatment_in_health_AB053CwqPIJlIxXAm37DOM" , then you get a pass on the Cadillac plan tax.

 

[mheslep]

The House bill contains financial assistance to states that enter into such compacts. If they choose to, fantastic. Each state entering such a compact will get to decide whether the regulatory floor in the compact is desirable for its residents. The Republican alternative--the Shadegg proposal--doesn't allow states to have a say in the insurance policies sold within their borders. That is, the Republicans call for states to cede sovereignty to other states. It's one thing to impose a federal floor on states but to pull the floor our from underneath states and allow the lowest common denominator to dominate the regulatory environment is irresponsible and potentially dangerous.

The Democratic bills encourage states to decide the level of interstate insurance sales they're comfortable with and provides funding for planning and implementation to states that enter into compacts. You don't believe that's a reasonable compromise?...

No. As we know and you pointed out earlier, the reason the US doesn't have interstate health insurance now is because of the states themselves. Leaving it up to them means retaining the status quo, i.e. doing nothing. So I think that suggesting the D. bill will change anything regarding interstate sales is misleading.

Also while state sovereignty is important, it doesn't always trump everything else, especially not the individual. In this case I'd say that control is ceded to the individual, not other states. Auto insurance is sold across state lines; I don't see that as a attack on state rights.

Edit:

[...]The high risk pools in the Democratic bills are designed to be temporary and eventually people in those pools will be transitioned to the health insurance exchange. But these are ideas that vary in the details but have common roots.

Well we are talking past each other here. I see no intention to actually get behind pools in the D. bill when the plantgoing in is to get rid of them, but merely a political head fake to give the appearance of common ground, when in reality there is none.

 

[mheslep]

...
...for four years after the opening of the exchanges. I hope you didn't mean to imply a pass in perpetuity.

Agreed, it says four years now. We'll see if it stays that way. I doubt it.

 

[WhoWee]

It's funny how the Left has changed it's tune.

http://www.msnbc.msn.com/id/10609044/
"Three growing entitlement programs consumed nearly half of all federal spending in 2004, and budget analysts expect them to make up an even bigger share in the future.

Social Security, Medicare and Medicaid accounted for more than $1 trillion in the 2004 budget year, according to the Consolidated Federal Funds Report released Tuesday by the Census Bureau.

Overall federal spending was $2.2 trillion, an increase of 5 percent from 2003."


http://www.msnbc.msn.com/id/34415087/ns/politics-health_care_reform/
"Liberals had sought the Medicare expansion as a last-minute substitute for a full-blown, government-run insurance program that moderates insisted be removed from the legislation."

http://firstread.msnbc.msn.com/archive/2010/02/01/2191106.aspx
"The proposed FY2011 budget puts overall spending at $3.83 trillion dollars during the fiscal year, and projects a deficit of $1.27 trillion, or 8.3% of the Gross Domestic Product.

With the unemployment rate stuck at 10%, the administration has been under pressure to defend its spending decisions. Republican critics say efforts to pull the economy out of recession have done little to produce jobs and have added too much to the deficit. Obama has consistently argued the spending was necessary to prevent total economic collapse and has sought to remind people that he inherited an already huge $1.3 trillion deficit, was prepared to take steps to reduce it, and wants help from both parties."

Just saying

 

[Astronuc]

Start saving if one hasn't already.

The High Cost of Growing Older
http://finance.yahoo.com/focus-retirement/article/109070/the-high-cost-of-growing-older

No doubt, healthcare will be one of your biggest expenses in retirement. Qualifying for Medicare coverage at age 65 will quell some cost and coverage worries. But although Medicare is far more affordable than private health insurance coverage for seniors, the government health insurance program still leaves retirees with significant out-of-pocket costs.

Consider this: A typical 65-year-old married couple without chronic conditions will need $197,000 to pay for out-of-pocket medical costs throughout retirement, according to new calculations by the Center for Retirement Research at Boston College. That figure includes insurance premiums, services not covered by Medicare, and home healthcare expenses, but it excludes nursing-home care. Retirees also have a 5 percent chance that healthcare costs that are not covered by insurance will exceed $311,000, according to the study, which was underwritten by Prudential. "Regular ongoing out-of-pocket costs can really cumulate over the years," says Anthony Webb, associate director of research at the Center for Retirement Research at Boston College and coauthor of the study. "There is no substitute to having a lot of money stashed away."

Other researchers have come up with similarly large numbers. Fidelity Investments estimates that a couple, both age 65 in 2009, will need approximately $240,000 to cover medical expenses throughout retirement. And the Employee Benefit Research Institute determined that a 65-year-old couple in 2009 will need $210,000 to have a 50 percent chance of affording their retiree health expenses and $338,000 to have a 90 percent chance of being able to pay all their medical bills.

These eye-popping numbers are generally a tally of small expenses that add up throughout retirement. Here are the latest estimates of the health expenses most Americans will face.

. . . .

Don't get sick, or at least not seriously ill. It helps to be a millionaire or better.

 

[mheslep]

A typical 65-year-old married couple without chronic conditions will need $197,000 to pay for out-of-pocket medical costs throughout retirement,

With an average lifespan of 75 (and they might be using 80 in the future), that's ~$20k/ year for a couple, age 65-75 that includes hip / knee replacements, etc, etc. One hardly needs to be a millionaire to afford those kind of out of pocket costs. Frankly I can't imagine using a trained medical staff and facilities that cost much less than that.

 

[Astronuc]

With an average lifespan of 75 (and they might be using 80 in the future), that's ~$20k/ year for a couple, age 65-75 that includes hip / knee replacements, etc, etc. One hardly needs to be a millionaire to afford those kind of out of pocket costs. Frankly I can't imagine using a trained medical staff and facilities that cost much less than that.

Closer to 80 years (or high 70's). I was thinking that ~$1 million in investments so that one lives of the interest. Otherwise, one is looking at a sinking fund. Although one might expect to live 80 years, what happens if one is still alive and manages to live to 90 or 100. My mother in law is 89 this year, and her sister lived to about 93, but spent the last 3 years in a nursing home with Alzheimers/dementia.

A lot depends on where one lives. My parents looked at place on the E. Coast, and the planned retirement communities were pretty expensive. The question becomes one of when assisted living will be required.

It also depends on how much travel one might want to do. Of course, one could just stay local and wait to die.

 

[mheslep]

Closer to 80 years (or high 70's). I was thinking that ~$1 million in investments so that one lives of the interest. Otherwise, one is looking at a sinking fund.

<shrug> Can't take it with you.

A lot depends on where one lives. My parents looked at place on the E. Coast, and the planned retirement communities were pretty expensive. The question becomes one of when assisted living will be required.

Yes though living expenses are a separate issue, not included in the article.

 

[Count Iblis]

How do you think the U.S. will cut medical cost?

For the US, it is actually very simple. The government can give people money for successfully losing weight and staying at their new weight.

 

[edpell]

For the US, it is actually very simple. The government can give people money for successfully losing weight and staying at their new weight.

I have not carefully reviewed all the posts but I think this is the first positive constructive answer to the question! Thank you.

My grandmother is 101 years old and showing no signs of dying.

 

[ThomasEdison]

More medications should be over-the-counter and not require a doctor's approval or a visit to a pharmacy to get them.

 

[edpell]

More medications should be over-the-counter and not require a doctor's approval or visit to a medical center to get.

I agree.

In fact as a Libertarian I would have all medical services, drugs and devices be available in the free market. Not being a prefect Libertarian I would have regulation to the extent that no one may make fraudulent claims (i.e. lie about their training or lack of training).

 

[adrenaline]

Provide more primary care physicians,they provide lower cost medical care, many times with even better outcomes.

Eliminate defensive ordering of tests estimated at 300 billion a year. There are two things that go through every doc's mind.

1. what test do I need to order to confirm or rule out a diagnosis?
2. What test do I need to order so I don't get my a$$ sued.

It is number two that adds to cost

( Also, right now doctors cannot use evidence based medicine to defend their practices, they have to use standard of care ( many times the standard of care is no longer the best practice and actually more expensive).

single payer, saves 400 billion a year in clerical and administrative costs but that is as likely as hell freezing over

Third, change the lifestyle of americans, something as simple as making sure there are adequate bike lanes and side walks ( I bike in a very bike unfriendly city Atlanta) people may start to bike or walk more to work.
Change expectations that more expensive is better or that quick fixes are the answer to everything. . For example, we are finding out that verteboplasty is no better than placebo, much of the times, yet many americans still want a quick fix for their compression fracture pain and studies are out there that show non invasive, medical and diet management of heart disease is as good as aggressive more costly interventions( ,( depending on the type of heart disease of course!)

Change the fee for service, especially in the general medicine fields ( not surgeons) , right now an family practioner gets paid more to take care of an ingrown toenail in 10 minutes than he would to spend 45 minutes educating patients on diet, exercise, disease avoidance , how to manage exacerbations of disease, how to modify treatment plans in emergencies etc. ( of course, the latter is being relegated to nurse practioners right now already) or an internist spending 35 minutes of cognitive effort sorting out a complex disease diagnosis.