News Republicans' Plan to Repeal Healthcare?

[adrenaline]

That's also gone. The only justifications now allowed for rate differential are age, family composition, geography, and tobacco. Period.

But not right away.
I read that the insurance exchange would prohibit the sale of policies that discriminate on the basis of gender, this ban would not apply to companies with more than 100 employees until 2017.
It almost sounds as if it is only for insurance offered on the insurance exchange? Or am I misreading it?

 

[mheslep]

But not right away.
I read that the insurance exchange would prohibit the sale of policies that discriminate on the basis of gender, this ban would not apply to companies with more than 100 employees until 2017.
It almost sounds as if it is only for insurance offered on the insurance exchange? Or am I misreading it?

hmm, dunno, I missed that caveat. It may be exchange insurance only.

 

[adrenaline]

Not so. The bill has many provisions that theoretically allow the government to reject any insurer rates it doesn't like, though that doesn't mean the government will do so. I expect the decision will be completely political, just as are current utility rates.http://dpc.senate.gov/healthreformbill/healthbill54.pdf

That is the problem, I don't trust the government to look out for me as a small business. What might be low insurance rate hike for a interventional radiologist with less overhead and less clerical personell is exponentially higher for primary care operating on razor thin profit margins.

 

[mheslep]

That is the problem, I don't trust the government to look out for me as a small business. What might be low insurance rate hike for a interventional radiologist is exponentially higher for primary care operating on razor thin profit margins.

Neither do I. But then why on Earth would you favor single payer which entirely cedes all financial health care authority to the government?

 

[turbo]

Neither do I. But then why on Earth would you favor single payer which entirely cedes all financial health care authority to the government?

Go back to post #50 and read an exchange of information from people who have been intimately involved in the business-aspects of private medical practices.

If you get your information from politicians, lobbyists, and talking-heads, you will be sadly misinformed. I have spent years in the business, as has adrenaline, and we know what economic forces have the most leverage on medical practices. Sadly, health-care reform was turned into a political football, with no rational discourse regarding the economic advantages of single-payer systems.

 

[adrenaline]

Neither do I. But then why on Earth would you favor single payer which entirely cedes all financial health care authority to the government?

probably because i have had less problems with medicare than most , but not all, private insurances.

And, I want to be back in the business of being a doctor, right now, running a business with a majority of employees in the non medical field, thinking up ways to keep our business solvent, yet needing so many personell to check insurances to figure out where I can run the labs ( quest vs labcorp vs inhouse labs), where to send for MRI, will their insurance pay for open MRI down the street, hiring extra MAs just to do precerts, prior auths etc. it takes the joy out of medicine. I am most at home just changing vent settings in the ICU or putting a chest tube in a collapsed lung, not listining to my office manager tell me how I have to code better, how to keep track of drug formulaies, listining to phone calls telling me I have to change a drug prescription because it used to be on the formulay but now it's not etc. At least with Medicare, I deal with one single set of rules and regulations. And honestly, I've never had to deal with a gum popping knucklehead begging them for an MRI in a person with a fever of 102 and loss of anal wink ( since I suspect spinal abscess) and telling me it will be another four hours before they can give me the approval.

It is all the above that a majority of us favor single payer.

Don't get me wrong, there are private insurances that are a joy to deal with but it is far and few between.

 

[turbo]

Don't get me wrong, there are private insurances that are a joy to deal with but it is far and few between.

Whatever insurance company covers Maine teachers was pretty darned good. One of my oldest, dearest friends was deeply in love with a teacher, and when he noticed her dropping parts of her daily routines (like laying out clothes for the next school day), he talked to her sister, and they got her checked out. Glioblastoma. Generally a death-sentence with a 6 month term or less. The insurance company paid for tests, re-tests, surgery, radiation, etc... Linda lasted over a year, and though she had her ups and downs, we got to visit with her at home, take her soups and stews, home-made breads, etc. Her insurance company didn't drop her, restrict treatment, etc.

 

[jbunniii]

I know I linked to this in another thread, but it fit here too. http://www.frumforum.com/waterloo".

That's a pretty amazing essay. It illustrates the mindset of a political strategist, who might be the only species on Earth who could write both of these things regarding the same bill:

"Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.

It’s hard to exaggerate the magnitude of the disaster."

and

"But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994."

So the plan is more or less what their own party wanted in 1993-1994, but its passage is now a disaster? Why is it a disaster? Because their party chose to oppose it so militantly and it passed anyway? Well, whose fault is that?

And WHY did they choose to oppose it so militantly if they actually agreed with most of its tenets? Why didn't they negotiate and compromise like grown-ups do, particularly grown-ups who are in the minority party? They could have steered the bill to align it even more closely with their interests, and then they could declare a victory not only for their conservative principles but also their bipartisan ethos.

Instead they held their breath until they turned blue like big ol' babies. No wonder so many people consider our political system to be completely broken.

 

[Nebula815]

I suggest you look up the CBO report on the legislation that was passed, and they will put out another report on the amendments once they make their way through the Senate.

Like I said, the CBO is wrong; there is just no way they can accurately calculate something like this.

Do you have any links to support your claim that the CBO is wrong?

You don't need any official links for that one. It is basic common sense. They double-count Medicare, and furthermore, there is no example of any government healthcare program paying for itself that this nation has created. Even in Europe, many of the programs are heavily in debt, like France, they are having to ration within the UK, etc...

Just because the CBO says something will work doesn't mean it will, you might as well have meteorologists trying to predict the weather years from now.

The CBO has to rely on a lot of assumptions, regarding economic growth, that there won't be any big recessions further in the future, etc...

Like I've said before, it is the policy equivalent of engineering a brand-new jumbo jet, and then rather than build a few prototypes and test them, you just have a group of the best engineers analyze all the parts, the whole design, and "calculate" whether the plane will fly or not.

Well they can compute and calculate till the cows come home, you don't put the aircraft into production until you actually build a few versions and start flying them to see how all the parts function together.

But we are doing the policy equivalent of just this, engineer the jumbo jet then throw it into production. Sure, theoretically it will fly, reality is a whole different ballgame!

And thus far, the previous jets we have put into production have all crashed, or are headed towards crash.

 

[Nebula815]

And WHY did they choose to oppose it so militantly if they actually agreed with most of its tenets? Why didn't they negotiate and compromise like grown-ups do, particularly grown-ups who are in the minority party? They could have steered the bill to align it even more closely with their interests, and then they could declare a victory not only for their conservative principles but also their bipartisan ethos.

Instead they held their breath until they turned blue like big ol' babies. No wonder so many people consider our political system to be completely broken.

Because like I said before, that would be like asking Democrats to compromise on having abortion banned. Some things you cannot compromise on. Conservatives could not compromise on having the government take control over the health insurance industry.

The aspects they wanted the Democrats would never do. The Republicans wanted tort reform. No way. They wanted to remove the ban on purchasing health insurance across state lines. Again, no dice (and no debating it either!). And so forth.

 

[Char. Limit]

Because like I said before, that would be like asking Democrats to compromise on having abortion banned. Some things you cannot compromise on. Conservatives could not compromise on having the government take control over the health insurance industry.

The aspects they wanted the Democrats would never do. The Republicans wanted tort reform. No way. They wanted to remove the ban on purchasing health insurance across state lines. Again, no dice (and no debating it either!). And so forth.

You can't compromise on banning abortion... a ban is absolute, or it's no ban. So, indeed, it would be very hard to ask Democrats to compromise on something that if compromised on, no longer exists.

I do believe that tort reform and the public option should have been in, along with purchasing health insurance across state lines. I'm pro-responsibility, so I would not have favored my tax dollars (and I do pay tax dollars; just because I'm 17 doesn't mean I don't have a job) heading to abortion, no matter my views on abortion itself. Whether abortion is right or wrong, it shouldn't be tax-supported. After all, as I said earlier in this paragraph, I'm pro-responsibility. If you don't want the baby, don't have sex. I give exceptions in the case of rape or to save the life of the mother. Of course, the problem with this is that the already-high false rape accusation rate would skyrocket as women would find out that they were pregnant and then claim rape so they could get rid of the pregnancy. To sum up this overly blathering paragraph, tort reform, cross-state health insurance, and the public option should have been in, and tax-supported abortions should have been out.

 

[mheslep]

probably because i have had less problems with medicare than most , but not all, private insurances.
...

It is all the above that a majority of us favor single payer.

As we https://www.physicsforums.com/showpost.php?p=2316756&postcount=507", I doubt that a majority of US physicians favor single payer. As far as I can tell, universal single payer is fairly rare approach to universal health care throughout the world. There's Canada, who else?

 

[mheslep]

Like I said, the CBO is wrong; there is just no way they can accurately calculate something like this.

If the latter is true, then it would be more correct to say the CBO estimates are not credible in this case, not that they are wrong.

 

[adrenaline]

As we https://www.physicsforums.com/showpost.php?p=2316756&postcount=507", I doubt that a majority of US physicians favor single payer. As far as I can tell, universal single payer is fairly rare approach to universal health care throughout the world. There's Canada, who else?

Taiwan, where i came from it works fabulously, they were just like us until enacting national health insurance. My relatives in high paying professions like derm, urology there are doing just as well, they had to go electronic medical records, but are finding themselves hiring less staff,dealing with less beurocracy, etc.

 

[adrenaline]

as I am in academia and have to deal with real life free market overhead costs

Majority (57%) of Academic Medicine Physicians Favor Single-Payer
PRINT PAGE
EN ESPAÑOL

March, 1999

Study in New England Journal of Medicine Finds Medical School Deans, Faculty, Residents and Students Favor Single-Payer 3 to 1 Over Managed Care

Managed care is bad for your health, according to the first comprehensive survey of physicians involved in research and teaching published in this week's New England Journal of Medicine. But the nation's best and brightest physicians don't want to return to the old fee-for-service system, either.

So what does this prestigious group think would make a good health system? According to the study, "all groups [Deans, department chairs, residency training directors, physician faculty at medical schools, resident physicians, and medical students] expressed a preference for a single-payer health care system over both managed-care and fee-for-service systems. Overall, 57.1 percent thought that a single-payer system with universal coverage was the best health care system... A total of 21.7 percent favored managed care, and 18.7 percent preferred a fee-for-service system."

"I'm not surprised at all by these findings," said Dr. Douglas Robins, Chair of the D.C. chapter of Physicians for a National Health Program. "A survey of all physicians members of the D.C. medical society found that 69 percent support single payer. The academic medicine physicians are just the tip of the iceberg."

In an accompanying editorial in the Journal, Dr. Robert Michels strongly disagreed with the view that the purpose of medical education should be to "prepare students to fit into the new world of health care, to work in it effectively and presumably happily." Dr. Michels noted that "the unhappiness of academic physicians...reflects the recognition that managed care threatens medicine's core values," and that "medical education is working well...by underlining the urgent need to change managed care [emphasis added]." He also noted that physicians support single payer national health insurance even though physicians know that "a single-payer system would be unlikely to increase the financial rewards of medical practice."

"We know physicians support single-payer national health insurance because of the increasing numbers of medical associations and prominent physicians that are endorsing it," said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard.

They include: The D.C. branch of the American Medical Association (AMA), the American Medical Women's Association (AMWA), the National Medical Association (NMA), the Gay and Lesbian Medical Association (GLMA), the American Medical Student Association (AMSA), the American Public Health Association (APHA), the Islamic Medical Association (IMA), the American Association of Community Psychiatrists (AACP), the American Family Therapy Association, and others. The Maryland and Massachusetts branches of the AMA are studying single payer, and the American College of Surgeons' Dr. David Murray testified before Congress in 1994 that single payer would "probably provide the best assurance that patients would be able to seek care from any doctor of their choice."

Yes, overpaid specialists like interventional radiology, dermatology, nurse anesthestists that make more than me and don't have to continue stabilizing patients in the ICU when they crash, favor the status quo.

 

[adrenaline]

another poll showing a majority of us favor single payer

http://www.reuters.com/article/idUSN31432035


and another
http://www.workdayminnesota.org/index.php?article_1_115

and another( many studies in one chart)

http://www.wpasinglepayer.org/PollResults.html

and another

http://www.news.harvard.edu/gazette/2004/02.12/09-singlepayer.html


it goes on and on

 

[turbo]

I haven't polled the ophthalmologists that I worked for as their IT manager, but I am dead-certain that they would prefer single-payer insurance, as well. The practice had over 30 docs spread over 3 large permanent, and 4 smaller part-time locations. We were constantly sending our coders for training to keep up with the vague and ever-changing demands of the insurance companies. Keeping qualified, experienced people in administrative positions was critical to keeping the practice solvent. The practice was growing, and associate doctors that were working out well were offered partnerships. As you might imagine, the fiscal health of the practice, including the aging of receivables, solidity of lines of credit, etc were high in the minds of doctors considering buying into partnerships, so the senior partners needed access to accurate timely information regarding those.

If you have every worked in ophthalmology, you'd know that a great many of the people referred to your practice have serious complications arising from diabetes, and other conditions that usually only crop up late in life. Because of that, we had a lot of poor people on Medicaid, and a lot of elderly people on Medicare. Payments from those programs were on-time and were rarely held back due to trivial details, unlike the private insurers. The practice would never consider refusing a new patient because they had government-managed insurance. Those docs are highly-paid specialists. Some did refractive surgeries, some did retinal surgeries and repairs, some did plastic surgery (reconstructive, following accidents usually) you get the drill. Still, they were very hands-on when we had meetings about the business side of the practice, and I never heard a single one of them suggest that there was a down-side to accepting and keeping patients who were on public plans. They understood the tremendous imbalance in overhead that resulted from dealing with public vs private plans. There were sometimes discussions about the possibility of dropping participation with some of the nastiest private plans, but never Medicare or Medicaid.

 

[mheslep]

as I am in academia and have to deal with real life free market overhead costs

I thought we all agreed there is very little 'free market' health care in the US.

...Yes, overpaid specialists like interventional radiology, dermatology, nurse anesthestists that make more than me and don't have to continue stabilizing patients in the ICU when they crash, favor the status quo.

I think discussion might go better if we look at the source and not summaries from the PNHP web site. http://www.pnhp.org/news/1999/march/majority_57_of_ac.php
That 1999 summary didn't post a NEJM title, I'm looking ...

 

[adrenaline]

I thought we all agreed there is very little 'free market' health care in the US.

i meant that my overhead goes up every year, my staff expects increases in salaries, and bonuses etc as if we can adjust our prices based on free market principles. Most employees just don't realize that I can't bill higher for a cold just because i need to find the 20 % in rent incurred this year etc.

 

[Char. Limit]

There's no free market, there's just a "free" market, when it comes to insurance...

After all, if insurance were a free market, companies would have incentive to stay competitive. But they don't compete...

 

[noblegas]

another poll showing a majority of us favor single payer

http://www.reuters.com/article/idUSN31432035


and another
http://www.workdayminnesota.org/index.php?article_1_115

and another( many studies in one chart)

http://www.wpasinglepayer.org/PollResults.html

and another

http://www.news.harvard.edu/gazette/2004/02.12/09-singlepayer.html


it goes on and on

Even if polls show that most americans want a healthcare system that resembles a single payer system , so what? That doesn't mean that the federal government should nationalize healthcare in order to grant the wishes of the majority of americans nor does it mean that americans are automatically entitled to healthcare because most want universal healthcare. Universal healtcare is immoral because you will be stealing the earnings of every US citizen without their consent to pay for a service that some don't want to use. 50 years ago ,Most americans did not support racial integration, does that mean since most americans did not support racial segregation that blacks should be stripped away of all of their rights that whites were fully allow to legally carry out? Polls use to show that most americans did not want to legalize gay marriage, but because most americans are uncomfortable seeing to gays in Holy Matrimony ,does that mean gays should not be allowed to get married? It is wrong to force americans to pay for a service that they are not naturally entitled to just like we are not automatically entitled to cars and free food, we should not be entitled to a "free" healthcare services.

 

[mheslep]

another poll showing a majority of us favor single payer

http://www.reuters.com/article/idUSN31432035

The authors are the same Carrol and Ackerman as in the 2004 study which https://www.physicsforums.com/showpost.php?p=2316756&postcount=507" , again Carrol is the PNHP leader/advocate.

and another
http://www.workdayminnesota.org/index.php?article_1_115

I see the author Dr Hart is a leader of the http://www.pnhp.org/states/minnesota" . Membership does not pertain, but I discount polls run by advocacy organization leaders.

and another( many studies in one chart)

http://www.wpasinglepayer.org/PollResults.html

Yes, cites the Hart and Carrol studies mentioned above, and public at large (not physicians) news organization polls along the lines of "Do you favor national health care or the existing system which sucks" strawmen. The links provided for further information are mainly back to PNHP website summaries. Sorry if I missed something more apropos but this is getting tiresome.

 

[mheslep]

i meant that my overhead goes up every year, my staff expects increases in salaries, and bonuses etc as if we can adjust our prices based on free market principles. Most employees just don't realize that I can't bill higher for a cold just because i need to find the 20 % in rent incurred this year etc.

Ah. Well all the best with your practice Dr A.

 

[adrenaline]

That 1999 summary didn't post a NEJM title, I'm looking ...

Volume 340:928-936, March 25th, 1999 #12
I have not renewed my subscription to nejm, so i could not get the full text sorry
but you may have access to it

And this was not in any way related to people in phnp

 

[adrenaline]

Membership does not pertain, but I discount polls run by advocacy organization leaders.

fair enough

Yes, cites the Hart and Carrol studies mentioned above, and public at large (not physicians) news organization polls along the lines of "Do you favor national health care or the existing system which sucks" strawmen. The links provided for further information are mainly back to PNHP website summaries. Sorry if I missed something more apropos but this is getting tiresome.

i'm sorry i meant to post that was a public opinion sorry, my lack of sleep is making me sloppy again

what about the study in the archives of internal medicine, granted it was limited to one state, but it seemed a reasonable poll of representative physicians?

 

[TMFKAN64]

Universal healthcare is immoral because you will be stealing the earnings of every US citizen without their consent to pay for a service that some don't want to use.

So you think that K-12 education, the interstate highway system, the space program and the U.S. military are similarly immoral?

 

[adrenaline]

So you think that K-12 education, the interstate highway system, the space program and the U.S. military are similarly immoral?

Yes let's not forget that most americans pay for the uninsured anyway with higher charges by the hospital ( ten dollar asprins to recover the costs of the uninsured on non payers) and that all health insurance premiums are higher just for the purpose of covering the uninsured. I believe I read some estimate an extra 1000 dollars for families and less than that for individuals. Can't remember the exact numbers.
Thus, American families are already picking up the tab for universal health coverage. Remember, providers often pass along the cost of treating the uninsured to their insured patients.

Consider it a hidden tax for taking care of the uninsured.

 

[BobG]

Universal healthcare is immoral because you will be stealing the earnings of every US citizen without their consent to pay for a service that some don't want to use.

So you think that K-12 education, the interstate highway system, the space program and the U.S. military are similarly immoral?

There's certainly some that would say using taxpayer dollars for K-12 education is immoral because they'd prefer a school voucher system.

 

[Nebula815]

Yes let's not forget that most americans pay for the uninsured anyway with higher charges by the hospital ( ten dollar asprins to recover the costs of the uninsured on non payers) and that all health insurance premiums are higher just for the purpose of covering the uninsured. I believe I read some estimate an extra 1000 dollars for families and less than that for individuals. Can't remember the exact numbers.
Thus, American families are already picking up the tab for universal health coverage. Remember, providers often pass along the cost of treating the uninsured to their insured patients.

Consider it a hidden tax for taking care of the uninsured.

One can make the above argument to argue that it would be better if everyone purchase health insurance, but that doesn't justify forcing people to buy health insurance IMO.

 

[adrenaline]

One can make the above argument to argue that it would be better if everyone purchase health insurance, but that doesn't justify forcing people to buy health insurance IMO.

I did not agree with the individual mandate, ( originally designed by Mitt Romney it looked like ) trust me, I opposed this health care reform bill but it is the only way to prevent the insurance industry who are now forced to cover preexisting from going bankrupt. human behavior is such they will wait till they are sick or diagnosed with a bad disease before purchasing health insurance on the exchange, kind of like allowing a person to obtain car insurance right after an accident. Thus, by forcing all comers healthy and sick to purchase the insurance you prevent this financial ruin for the health insurance companies. Don't you think the insurance lobby thought this through and helped pushed this through?

someone just sent this quote to me, I'm sure it is on another discussion panel.

"
Some of my libertarian friends balk at what looks like an individual mandate,'' Romney wrote in The Wall Street Journal in 2006. ``But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian.'' -Mitt Romney
"