News The US has the best health care in the world?

[turbo]

http://www.pnhp.org/facts/single_payer_resources.php

I have become a member of PHNP ( physicians for national health plan) after over a decade dealing with all the games the private insurances play. ( And, no national health insurance is not socialized medicine anymore than medicare ( national health insurance for the elderly) socialized our health system.

I personally deal with less beaurocracy from medicare and medicaid.

For anyone who thinks the private sector automatically means less cost and greater efficiency and better care, they don't know about the failure of medicare advantage plans ( privatized medicare ) and privitization of medicaid into HMOs. Google 'failure of medicare advantage plans". As a physician, I would have had to hire at least a dozen more administrative personell just to deal with the administrative paperwork from these plans. Thousands of patients in my community who opted into those private plans suddenly were without a single doctor who would take them.

Remember this, private plans ration to protect their corporate interests and profits. And believe me they do.
The government may ration but ethically, I can stomach rationing based on resources available vs. frank greed.

Thank you for weighing in with a doctor's viewpoint. My wife and I had a wide selection of doctors on her old insurance plan, but then her employer switched to BCBS. There are practices here that operate with a single doctor and one or two staff, and they can't afford all the administrative overhead that some HMOs place on them (denials, re-coding, resubmission, delays in payment...) My wife had to find a new doctor, after having had a wonderful country-doctor for years. I was able to keep mine because his multi-doc practice is affiliated with the local hospital.

I was the network administrator for a very large multi-location ophthalmic practice, and I was shocked to see the aging of the practice's receivables. Much of it would get paid eventually, but in the meantime, it limited the practice's line of credit from the commercial banks. When a patient's vision is at risk, they would get prompt treatment, then the insurance companies would play games with coding requirements, bouncing claims, etc. I wrote accounting programs for other businesses before taking that job, and I can assure you that manufacturers, large trucking companies, etc would have had their lines of credit pulled if their receivables were in such a sorry state.

My cousin was that practice's top coding specialist, and she currently works for a pediatric ophthalmologist who takes a lot of Medicaid referrals. She loves her job now - the coding standards for Medicaid are more transparent and the rules don't change without notice. That leaves more time for her to fight the private insurers for payment.

 

[DavidSnider]

I was the network administrator for a very large multi-location ophthalmic practice, and I was shocked to see the aging of the practice's receivables. Much of it would get paid eventually, but in the meantime, it limited the practice's line of credit from the commercial banks. When a patient's vision is at risk, they would get prompt treatment, then the insurance companies would play games with coding requirements, bouncing claims, etc. I wrote accounting programs for other businesses before taking that job, and I can assure you that manufacturers, large trucking companies, etc would have had their lines of credit pulled if their receivables were in such a sorry state.

I've just started writing software geared towards automating some of the administrative work in the health care industry. I am convinced that the overhead is largely due to administrative waste and not "value added services" as the insurance companies claim.

 

[adrenaline]

at least half of the physicians or more favor a single payor national health insurance
http://www.homepages.indiana.edu/011604/text/docs.shtml

Jama has a survey that shows a majority of physicians favor it, and here is one where a clear majority favored it http://www.pnhp.org/news/2004/february/most_physicians_endo.phpand

all in part due to the waste we see on the admininstrative end

 

[Evo]

at least half of the physicians or more favor a single payor national health insurance
http://www.homepages.indiana.edu/011604/text/docs.shtml

Jama has a survey that shows a majority of physicians favor it, and all in part due to the waste we see on the admininstrative end

My doctor is against it, he also said the majority of doctors (at least those he's affiliated with) are against it. I wonder if it depends on the doctor's practice.

 

[Ivan Seeking]

but no one takes such claims seriously, do they?

Yes. Sarah Palin and Rush Limbaugh have orchestrated this fiasco in an effort derail legitimate reform. I don't know if they are delusional or crooks, but they have a large enough audience to distract the media from legitimate discussions. News Fauxs like Fox eat this stuff up! I would wager that 20-30% of the country believes this idiocy.

The irony is that while these people persuade their audiences that they are fighting for America, fighting for freedom, fighting for this that and the other thing, they are in fact trying to steer the public herd right over a cliff. We desperately need health care reform in this country, but these people will do everything in their power to prevent it in order to "hand Obama his Waterloo", as one Republican put it. What they are really doing, whether they know it or not, is working to hand the American people their Waterloo.

This is the paradox of American politics today: It is in the best interest of the Republican party to block health care reform, whether it best serves the public interest of not, because, if successful, Obama will almost certainly be reelected in 2012. The Democrats will have taken-on and handled one of the biggest problems that we face - something the Republicans have never even tried to do.

 

[adrenaline]

My doctor is against it, he also said the majority of doctors (at least those he's affiliated with) are against it. I wonder if it depends on the doctor's practice.

Probably, the specialties most against it are radiologists ( who never have to get precerts or priorauthorizations since the primary care docs do all the work) and anesthesiologists ( once again, the elective surgery has been begged for by the surgeon or primary care doc.) They don't have to hire extra personell to deal with precerts and denials, extra coders and billers etc. In addition, many doctors are republicans and they tend to listin to the misinformation propagated by hannity, rush, etc.

There is just as much misinformation among doctors about national health insurance being "socialized medicine". My retort is ...as a provider for medicare patients, are you in any way a salaried government employee or restricted in ordering necessary tests and treatments ? ( Medicare has far less restrictions than many of the HMOs). Granted, they pay me less but for every 100 dollars I collect from medicare I use probably 3 dollars for administrative work vs almost a third of the 100 dollars I collect from private insurers.

These doctors may not have much sense of the business end of their practice, as senior partner who does not believe all the business end should be handeled by accountants, I am acutely aware where every cent goes to.

 

[mheslep]

at least half of the physicians or more favor a single payor national health insurance
http://www.homepages.indiana.edu/011604/text/docs.shtml ...

The study is in a respected peer reviewed journal. I also read that, the lead author of this study purported to determine the opinion of physicians regarding single payer insurance Dr. Aaron E. Carroll, is on the the board the physicians group advocating single payer insurance - PNHP. It also appears he is a fairly single minded advocate for single-payer from his statements on the web.
http://pnhp.org/about/board_of_directors.php

The PNHP http://www.pnhp.org/news/2008/april/physician_opinion_ti.php" of the study also states:

The findings came from a random sample of 5,000 physicians from the AMA Masterfile. ...

About 500 questionnaires were undeliverable, 197 were returned by physicians no longer in practice, and 2,193 were completed (51% response rate) and returned to Drs. Carroll and Ackermann.

Thus they reported results come not from a random population, but from those that responded.

It also seems odd that PNHP would have only http://www.pnhpwesternwashington.org/about.htm" members in a country with 800,000 physicians, the majority of which per Carroll's study support single payer.

 

[turbo]

(Medicare has far less restrictions than many of the HMOs). Granted, they pay me less but for every 100 dollars I collect from medicare I use probably 3 dollars for administrative work vs almost a third of the 100 dollars I collect from private insurers.

The efficiencies gained from adding under-insured and uninsured people to a public option might make opting out of CIGNA, BCBS, and other plans look like a good deal for smaller practices. Slash administrative costs and reduce the aging of receivables to something attractive to your lenders, if you should need new equipment, etc. Maybe the big HMOs would have to curb some of their greed in order to keep docs participating in their plans. That certainly would not be a bad thing for the doctors. Private practices have been fattening insurance companies (involuntarily) with floating lines of credit in the form of denials and delays, and that's robbery. The banks were forced some time ago to clear our checks promptly instead of holding them for a week or two and investing the "float" - it's time that insurance companies were held to similar standards.

 

[Ivan Seeking]

Granted, they pay me less but for every 100 dollars I collect from medicare I use probably 3 dollars for administrative work vs almost a third of the 100 dollars I collect from private insurers.

As mentioned earlier, I have heard that 50-80% of the cost of running a doctors office can be attributed to paperwork and insurance regulations. Do you think these are somewhat inflated and that the real number is more like 30%, or could the numbers legitimately vary between 30-80%, when everything is considered and depending on the office?

Also, do you have any thoughts as to how the cost of medical care, from an operational point of view, can be reduced [beyond illness prevention]?

 

[mheslep]

...

There is just as much misinformation among doctors about national health insurance being "socialized medicine". My retort is ...as a provider for medicare patients, are you in any way a salaried government employee or restricted in ordering necessary tests and treatments ? ( Medicare has far less restrictions than many of the HMOs). Granted, they pay me less but for every 100 dollars I collect from medicare I use probably 3 dollars for administrative work vs almost a third of the 100 dollars I collect from private insurers...

How do we address losses attributed to Medicare fraud? That is, one can make the argument that Medicare saves administrative costs by not hiring the staff to properly administrate, and this is reflected in the http://www.usdoj.gov/opa/pr/2009/May/09-ag-491.html" in fraud losses every year. Extend such a system as is to the entire country and either the fraud breaks the treasury or the new system must also vastly ramp up administration costs.

 

[WhoWee]

http://www.pnhp.org/facts/single_payer_resources.php

I have become a member of PHNP ( physicians for national health plan) after over a decade dealing with all the games the private insurances play. ( And, no national health insurance is not socialized medicine anymore than medicare ( national health insurance for the elderly) socialized our health system.

I personally deal with less beaurocracy from medicare and medicaid.

For anyone who thinks the private sector automatically means less cost and greater efficiency and better care, they don't know about the failure of medicare advantage plans ( privatized medicare ) and privitization of medicaid into HMOs. https://www.cbo.gov/doc.cfm?index=8265&type=0 As a physician, I would have had to hire at least a dozen more administrative personell just to deal with the administrative paperwork from these plans. Thousands of patients in my community who opted into those private plans suddenly were without a single doctor who would take them. ( By the way, none of the medicare advantage plans pays for your first three days in the hospital or past 3 days in rehabilitation...as for the latter, if you are an elderly with a stroke, you only get three days of rehab...)

Remember this, private plans ration to protect their corporate interests and profits. And believe me they do.
The government may ration but ethically, I can stomach rationing based on resources available vs. frank greed.

I'm curious as to how much HIPPA has cost your practice and network - any estimate?

 

[adrenaline]

How do we address losses attributed to Medicare fraud? That is, one can make the argument that Medicare saves administrative costs by not hiring the staff to properly administrate, and this is reflected in the http://www.usdoj.gov/opa/pr/2009/May/09-ag-491.html" in fraud losses every year. Extend such a system as is to the entire country and either the fraud breaks the treasury or the new system must also vastly ramp up administration costs.

There is fraud with private insurance as well, separate issue but does not negate the benefit of single payer insurance.

Now let me also define what is medicare fraud... if I see a single mother who is uninsured and I treat her sinus infection for free, and I charge a medicare recipient 35 dollars to treat the same problem, that is fraud. In other words, medicare won't let me play robin hood doctor.

If I admit a patient for what I presumed is systolic congestive heart failure and she ends up with diastolic heart failure ( the latter pays less), that is fraud. In the meantime, I have admitted the patient while on call for another doctor at 2 am and coded it as systolic chf, the attending doctor gets an echo that shows it is diastolic heart failure ( two days later) so he codes it diastolic heart failure. Did I commit fraud? No, I coded it according to my clinical assessment for the night. In other words, medicare definition of fraud is very, very broad.

 

[WhoWee]

There is fraud with private insurance as well, separate issue but does not negate the benefit of single payer insurance.

Now let me also define what is medicare fraud... if I see a single mother who is uninsured and I treat her sinus infection for free, and I charge a medicare recipient 35 dollars to treat the same problem, that is fraud. In other words, medicare won't let me play robin hood doctor.

If I admit a patient for what I presumed is systolic congestive heart failure and she ends up with diastolic heart failure ( the latter pays less), that is fraud. In the meantime, I have admitted the patient while on call for another doctor at 2 am and coded it as systolic chf, the attending doctor gets an echo that shows it is diastolic heart failure ( two days later) so he codes it diastolic heart failure. Did I commit fraud? No, I coded it according to my clinical assessment for the night. In other words, medicare definition of fraud is very, very broad.

You're saying that Government regulations (regarding medicare) are the actual problem (in the context of 35% estimate of fraud in the system)?

 

[adrenaline]

Also, do you have any thoughts as to how the cost of medical care, from an operational point of view, can be reduced [beyond illness prevention]?

it is estimated we would save 700 billion a year if we did not have to practice defensive medicine.
http://www.sltrib.com/opinion/ci_12973517

we all do it. This is our line of thinking

1. What is the clinical diagnosis based on the symptoms and signs I have?
2. what tests do I reasonably order to rule in or out the disease?
3. And what tests do I need to order in case my a$$ gets sued?

Tort reform can mean something as simple as exonerating a physician if he or she practices evidence based medicine. That is not the case currently, a recent ruling where a 54 year old engineer agreed not to have his PSA done ( since it is one of the few cancer tests that has not really been shown to affect mortality) after being counseled extensively by a resident at a medical school and was aware of the risk involved in not testing. ( By the way the american cancer society and the united task force prevention service do not recommend routine psa screening). He ended dieing of prostate cancer and the family sued the medical school and won based on the fact that evidence based medicine was trumped by "standard of care". ( the latter by the way is not always the "best" care based on recent clinical evidence).

granted, there are doctors who over order tests for financial gain although the Stark laws have eliminated most of that, but the majority of us are just scared to death of being sued.

there is an adage in medicine " you don't get sued for the test you ordered, you get sued for the test you didn't order..."

 

[adrenaline]

You're saying that Government regulations (regarding medicare) are the actual problem (in the context of 35% estimate of fraud in the system)?

all I am saying is their definition of "fraud" is overencompassing and thus the numbers may be inflated. How much, I honestly don't know...

 

[adrenaline]

I'm curious as to how much HIPPA has cost your practice and network - any estimate?

I had to send my office manager to numerous classes that were not cheap, hired a consultant and software engineer to make our electronic medical records Hippa compliant, had to renovate our office ( put glass panels between nurses stations and patient rooms) and make our office hippa compliant, etc. probably 50-75 thous?

 

[turbo]

You're saying that Government regulations (regarding medicare) are the actual problem (in the context of 35% estimate of fraud in the system)?

That is an outrageously inflated number and I'd love to see where it came from. According to the Coalition Against Insurance Fraud:

he U.S. spends more than $2 trillion on healthcare annually. At least 3 percent of that spending — or $68 billion — is lost to fraud each year. (National Health Care Anti-Fraud Association, 2008)

Medicare and Medicaid made an estimated $23.7 billion in improper payments in 2007. These included $10.8 billion for Medicare and $12.9 billion for Medicaid. Medicare’s fee-for-service reduced its error rate from 4.4 percent to 3.9 percent. (U.S. Office of Management and Budget, 2008)

http://www.insurancefraud.org/stats.htm

I didn't see any 35% fraud numbers in there. If you want to stop Medicare fraud, stop the companies that lease or sell really expensive wheelchairs, scooters, etc to people who either don't need them and/or never receive them anyway. Doctors are not responsible for initiating that kind of fraud, for the most part.

 

[adrenaline]

The study is in a respected peer reviewed journal. I also read that, the lead author of this study purported to determine the opinion of physicians regarding single payer insurance Dr. Aaron E. Carroll, is on the the board the physicians group advocating single payer insurance - PNHP. It also appears he is a fairly single minded advocate for single-payer from his statements on the web.
http://pnhp.org/about/board_of_directors.php

The PNHP http://www.pnhp.org/news/2008/april/physician_opinion_ti.php" of the study also states:
Thus they reported results come not from a random population, but from those that responded.

It also seems odd that PNHP would have only http://www.pnhpwesternwashington.org/about.htm" members in a country with 800,000 physicians, the majority of which per Carroll's study support single payer.

good points as to membership I can tell you I don't pay my membership dues. Only 25% of doctors in the country are technically members of the AMA but tthe AMA claim to represent us...Most doctors in general don't agree with all the tenets of the AMA or PHNP so we choose not to belong to anything in particular. As a whole, doctors are lousy at organizing our group into a collective voice...

 

[Al68]

There is just as much misinformation among doctors about national health insurance being "socialized medicine".

The current proposal outlaws private contracts, imposes income tax penalties on those that don't join the "system", and uses force to confiscate wealth from some Americans to give to others. Calling it socialist is misinformation?

What other word could be used to describe government controlling the economic activity of citizens?

 

[adrenaline]

I didn't see any 35% fraud numbers in there. If you want to stop Medicare fraud, stop the companies that lease or sell really expensive wheelchairs, scooters, etc to people who either don't need them and/or never receive them anyway. Doctors are not responsible for initiating that kind of fraud, for the most part.

I think people assume if there were improper payments that fraud was involved when many times it is a matter of coding ( as I showed in my example.).

It's interesting that when I went to electronic medical records I found that I had undercoded by over 100 thousand a year. Naturally, this caught the attention of medicare since my charges were so much higher, they could not find any overpayment (thank you electronic medical records) and still found underpayments. It's amazing, they will collect from us if we over charge but they donn't reimburse us when they found we undercharge...I'll bet that is not in any of these studies.

 

[adrenaline]

The current proposal outlaws private contracts, imposes income tax penalties on those that don't join the "system", and uses force to confiscate wealth from some Americans to give to others. Calling it socialist is misinformation?

What other word could be used to describe government controlling the economic activity of citizens?

outlaws private contracts? here is a fact check, for the record, britain ( the standard of socialized medicine) has a very health private insurance market ( half the population uses the private sector.)


http://factcheck.org/2009/08/private-insurance-not-outlawed/

In fact, the bill envisions a wide variety of private policies being offered to the public through a new national health insurance exchange resembling the Federal Employee Health Benefits plan, which makes 269 different private plans in total available to federal workers, including members of Congress.

What page 16 actually says is that those who like their current policies are "grandfathered" and can keep them, even if the policies don’t meet new standards.

The false idea that H.R. 3200 would prohibit insurance companies from accepting new policyholders stems from the conservative Investors’ Business Daily, which made the claim in a July editorial:

Investor’s Business Daily, July 15: It didn’t take long to run into an "uh-oh" moment when reading the House’s "health care for all Americans" bill. Right there on Page 16 is a provision making individual private medical insurance illegal. … The provision would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.

So we can all keep our coverage, just as promised – with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

Here, however, is the paragraph immediately preceding IBD’s quote:

H.R. 3200: Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term “grandfathered health insurance coverage” means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met.

In other words, the quote IBD references is part of the definition of “grandfathered” health insurance coverage. That quote doesn’t say that insurers can’t take on new enrollees; it says that if they do, that won’t be considered grandfathered coverage. In other words, any new individual policies would have to meet minimum standards and be offered through the new health insurance exchange.

The proposed health care model would indeed encourage individuals not already covered by employer-provided health policies to buy coverage through the nationwide insurance exchange. The choices would include a range of private plans meeting the new standards, as well as a new federal plan, as the House bill is currently written. People with individually purchased insurance who wish (or need) to change their grandfathered plans will have to purchase insurance through the exchange. If an individual would rather keep his plan, he can do so for as long as the insurance company keeps offering it. At any rate, nobody will be forced into the federal health insurance option – they’ll have their pick of private ones.

In fact, some say the biggest change will be that individual insurance gets better. "In a lot of ways it would improve options for people buying coverage on the individual market right now," said Sara Collins, vice president of the Commonwealth Fund, a nonpartisan organization that supports “a high performing health care system." The exchange plans would not be underwritten, and would be required to provide a minimum level of service to everybody. There would also be subsidies available for individuals and small employers to offset the cost of purchasing insurance through...

I opposed the obama health plan because it was not a single payer insurance, even the physicians for national health plan opposed it.http://www.pnhp.org/news/2009/july/why_obamas_public_o.php

Why Obama's Public Option Is Defective, and Why We Need Single-Payer

the phnp support a flat tax to fund this on everyone. so they are not socialist.

As for a miniscule tax on someone who is irresponsible enough to do without health insurance ( even when the government gives it to you) , it's called responsibility, since the uninsured drive up the cost for everyone else around them, including the insured.http://www.usatoday.com/money/indus...-uninsured-costs_x.htm?csp=24&RM_Exclude=Juno

as for the surtax on those of us who make more than $350,000... cry me a river...I'm not going to hurt one bit by the small surtax but then I didn't buy into the huge Mcmansions and luxury car "necessities"' that afflicts most of my collegues. ( In fact my house will be paid off in five years and all my cars are paid for ( old jeep, civic hybrid and silverado truck.)

 

[DavidSnider]

The current proposal outlaws private contracts, imposes income tax penalties on those that don't join the "system", and uses force to confiscate wealth from some Americans to give to others. Calling it socialist is misinformation?

What other word could be used to describe government controlling the economic activity of citizens?

God forbid they confiscate the wealth we are borrowing from the Chinese.

 

[Al68]

The current proposal outlaws private contracts, imposes income tax penalties on those that don't join the "system", and uses force to confiscate wealth from some Americans to give to others. Calling it socialist is misinformation?

What other word could be used to describe government controlling the economic activity of citizens?

outlaws private contracts? here is a fact check, for the record, britain ( the standard of socialized medicine) has a very health private insurance market ( half the population uses the private sector.)

http://factcheck.org/2009/08/seven-falsehoods-about-health-care/
http://factcheck.org/2009/08/private-insurance-not-outlawed/

Your link verifies that private contracts would be outlawed. I never said all private insurance would be outlawed. But mine will be, along with any type of policy I would ever be interested in buying. I, and many others, will have to buy the kind of insurance that we don't need or want, or are morally opposed to, or pay the tax penalty and live without medical insurance.

I notice you didn't answer my question: What other word could be used to describe government controlling the economic activity of citizens?

 

[adrenaline]

By the way, if it wasn't for government funded health care medicare, the private plans would not have been so economically prosperous. Medicare "socialized " the eldery and disabled, ( thus diminishing the subset of the population that over utilizes health care) and privatized the young, working class. Once again, I support a single payer system, not obama's patchwork of competing public options. And don't forget, the cry of socialization also was also cried in vain when l. johnson signed medicare into law, people screamed american medicine would become socialized. It didn't happen with medicare.

I still don't see where the link confirms private contracts will be outlawed.


Look, I'm not going to get into debating socialism. If you want unfettered libertarian free market go to calcutta India or look at what lack of government oversite does for china's level of industrial pollution and food contamination , child labor usage etc. And it was precisley the laissez free economics that destroyed the banking industry and put us in the mess we are in. We need to find that balance and we are looking for it now.

The bigger question, why are we the only industrialized, free nation that does not offer basic health care to our all of our population ? Investment in our infrastructure, our health , is as important as any other infrastructure investment..no?

Let's not forget, the best avante garde basic medical research is done by NIH, government funded, ( socialized) without profit motive. Health insurance companies don't do medical research, drug companies are resorting to "me too" drugs or slight modifications of existing drugs ( ie: nexium from prilosec, lexapro from celexa) for the quick profit turn around.

 

[Al68]

As for a miniscule tax on someone who is irresponsible enough to do without health insurance ( even when the government gives it to you) , it's called responsibility, since the uninsured drive up the cost for everyone else around them, including the insured.http://www.usatoday.com/money/indus...-uninsured-costs_x.htm?csp=24&RM_Exclude=Juno

as for the surtax on those of us who make more than $350,000... cry me a river...I'm not going to hurt one bit by the small surtax but then I didn't buy into the huge Mcmansions and luxury car "necessities"' that afflicts most of my collegues. ( In fact my house will be paid off in five years and all my cars are paid for ( old jeep, civic hybrid and silverado truck.)

Who's crying for them? Strawman argument?

And I'm irresponsible because the new bill will outlaw my insurance? And yes, I know that temporarily there is a grandfather clause, and it doesn't apply to any new policies. The proposal outlaws all new policies that aren't part of the system.

 

[WhoWee]

By the way, if it wasn't for government funded health care medicare, the private plans would not have been so economically prosperous. Medicare "socialized " the eldery and disabled, ( thus diminishing the subset of the population that over utilizes health care) and privatized the young, working class. Once again, I support a single payer system, not obama's patchwork of competing public options. And don't forget, the cry of socialization also was also cried in vain when l. johnson signed medicare into law, people screamed american medicine would become socialized. It didn't happen with medicare.

Please explain the danger of "patchwork" as you described the plan.

I often hear it referred to as over-layed, and other descriptions - basically layers of regulations imposed instead of fixing the initial problem. As is often the case with Government efforts, they often transform one problem into a different problem (or worse).

 

[bleedblue1234]

People have this entire situation convoluted... here's a post I made on another forum...

The problem is that we have the definition of 'insurance' in this country and every country in the world completely convoluted...

Let's examine...
"Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss."

Well in medicine insurance is a complete misnomer... people pay for everything that involves health care with insurance, and this is the exact problem. We need to realize insurance is only for catastrophic care (death, brain cancer, cancer, heart attacks, stroke) ... insurance is meant so people hedge against risk and thus avert financial catastrophe if the slim chance that something disastrous happens in fact does occur. For example, one has fire insurance for the slight chance that their house or part of their house or belongings is damaged due to fire... now I am sure the risk of that is inherently slim and as such insurance is not nearly as costly, but premiums cover the cost over the long term... and such a happening as a fire is financially very expensive, but the risk is also very small, thus low premiums and coverage so you are not financially destroyed.

Healthcare on the other hand is not anywhere close to this model. People file millions of sheets of paper to the insurance company for things such as checkups, ankle sprains, infections, etc... and as such people don't care WHAT the cost is nor due to doctors.

A good example is cosmetics. Cosmetic surgery is not usually covered by insurance companies and as such is payed for out of pocket. Costs in cosmetic surgery have increased at less than 1/3 the rate of other comparable surgeries, and the quality of the doctors (due to if I botch a surgery, my reputation is on the line) and the fact that people are paying through savings rather than through some system where they never see a first hand cost-benefit to shopping for a cheaper procedure.

The doctors are also payed much more because there is a lot less insurance overhead and it is much easier to process patients. If we cut the middle man (insurance) markup on health care costs, and we eliminate the tax incentives for employers to provide health insurance, and instead decrease income taxes and encourage people to save for health expenses, while still having catastrophic care insurance, we could save an extremely large amount of money.

Granted, there will be people in this country that would be uninsured, but it is up to the society/voters to determine whether it is more beneficial to cover the uninsured at a large premium and provide health care through redistribution of income, or have healthcare be an individual choice that is saved for and is not payed for through a third party that extracts trillions in overhead costs...

There is no risk management with the current system, as almost everyone uses it from anything like sprains and check ups, to heart attacks and emergency room visits...

 

[cristo]

outlaws private contracts? here is a fact check, for the record, britain ( the standard of socialized medicine) has a very health private insurance market ( half the population uses the private sector.)

Have you got any facts to back that up, because I don't believe it!

http://news.bbc.co.uk/1/hi/health/8201711.stm

About 11% have private health insurance. Private GP services very small.

http://www.euro.who.int/document/Obs/Private_Medical_Insurance_UK.pdf

Private health coverage as % of UK population: 2003, 11.2%

 

[Al68]

I still don't see where the link confirms private contracts will be outlawed.

Well, I saw it right away. And of course it's in the text of the bill. Why would your link point out that some private policies wouldn't be outlawed if none were outlawed? Why am I wasting my effort explaining the obvious?

And it was precisley the laissez free economics that destroyed the banking industry and put us in the mess we are in.

That's just false. Government intervention created the problems. Government created the artificial demand for bad mortgages. There was never any private demand for them.

The biggest problem with "mixed" economies is that socialists claim credit for the benefits of the capitalism, while blaming capitalism for the negative effects of socialist policy. And they succeed with large numbers of people simply by repeating lies continuously and convincingly.

And the simple fact is that I don't need to justify my liberty to make private agreements between private parties. Yet those that would use force to infringe on my liberty act like they're not the bad guys, and demonize anyone who opposes their oppression.

 

[adrenaline]

Please explain the danger of "patchwork" as you described the plan.

I often hear it referred to as over-layed, and other descriptions - basically layers of regulations imposed instead of fixing the initial problem. As is often the case with Government efforts, they often transform one problem into a different problem (or worse).

here is a good synopsis about the public option facts and myths
http://www.pnhp.org/change/Public_Option_Myths_and_Facts.pdf


see page 2


Obama's public option won't save me on my adminstrative and beaurocratic costs.


I have one medicare/medicaid coder and biller, I have a army to deal with the 200 private insurance plans, I have six check in and check out people to confirm insurances, wether they pay for physicals, what labs I must send blood work to etc., I have over 8 -telephone people at all times not just fielding questions but also helping with prior authorizations and precerts, etc. If the public option now offers me another say 100 plans, all with different formulaies, contsraints on procedures, which labs I have to send my blood ( lab corp,quest etc.) I will have to hire another slew of office workers just to deal with them.

Medicare's rules are simple, their formulay does not change every three months, I know where I stand with them. WHen they privatized into competeing HMOs, most of us just could not handle the "patchwork" of differing regulations and rules etc, hence, most of us don't take privatized medicare. ( in my county)

 

[turbo]

That's just false. Government intervention created the problems. Government created the artificial demand for bad mortgages. There was never any private demand for them.

That's the Kool-Aid talking, Al. The government did not create the demand for bad mortgages, and there is no way that you can back that up. The government (GOP administration) refused to rein in highly leveraged investments made on bundled mortgages of dubious value. Government was NOT the problem, but should have been the solution, and it was not. The GOP has made a name for itself claiming that government causes all problems and cannot work, and then when they get elected, they obstruct everything possible to make that come true. I quit the GOP when then became the party of jingoism and nihilism. There are precious few conservatives left on the "right".

 

[adrenaline]

The way the bill is written, it completely bans private policies in one section - but in the next, it allows them again, through a new mechanism. It merely changes the way they are sold, instead of banning them. But the law has to be written all legal-like. This is typical legal crap.

If you go read the bill, you see the language in Title I referred to in this article, and you see that it contains an exception. That exception is Title II, which allows PRIVATE insurers to offer PRIVATE plans through a new mechanism called a Health Insurance Exchange. I don't know the details yet, but it looks like it's basically one-stop shopping for health insurance, to make it easier for people to compare plans. They could choose a private plan, the government's plan, or Medicare, etc. if they qualify. I think it also makes it possible to choose a plan from any state, nationalizing the health insurance market and making more competition possible. It has some kind of tax benefits too. I found this article praising the idea, from a CONSERVATIVE think tank:

http://www.heritage.org/research/healthcare/wm1230.cfm

Short of congressional action to reform the tax code, the burden to improve health coverage rests with state officials. The best way to enable individuals and families to buy, own, and keep health insurance from job to job—without losing the tax advantages of the employment-based coverage—is to transform the balkanized and dysfunctional state health insurance market into a single health insurance market. This new market would function well for all sorts of individuals and small businesses, not just workers employed by large companies....



The best option is a health insurance market exchange. A properly designed health insurance exchange would function as a single market for all kinds of health insurance plans, including traditional insurance plans, health maintenance organizations, health savings accounts, and other new coverage options that might emerge in response to consumer demand. In principle, it would function like a stock exchange, which is a single market for all varieties of stocks and reduces the costs of buying, selling, and trading stocks. For the same reasons, other types of market transactions are also centralized, such as farmers’ markets, single locations where shoppers can purchase a variety of fresh fruits and vegetables, and Carmax, where consumers can choose from among all kinds of makes and models of automobiles.



In the case of a statewide health insurance exchange, employers would designate the health insurance exchange itself as their “plan” for the purpose of the federal and state tax codes. Thus all defined contributions would be tax free, just as they would be for conventional employer-based health insurance. The major benefits of this arrangement for employers, particularly small employers, are a reduction in administrative costs and paperwork and the ability to make defined contributions to their employees’ preferred plans.



As a vehicle for a defined-contribution approach to health care financing, an exchange would expand coverage and choice. Rather than have to decide whether to pay for full coverage or not, employers could make defined contributions of any size to the exchange. Moreover, employers could also enable employees, including those working part-time and on contract, to buy health insurance with pre-tax dollars. Under a Section 125 plan, any premium payments made by workers, even part-time workers or contract employees, would be 100 percent tax-free. This is especially important for workers in firms that require them to pay part of the health insurance premium. Employees, not employers, would buy the health care coverage with pre-tax dollars, would own their own health plans, and would take them from job to job without the loss of the generous tax benefits of conventional employer-based coverage. This is a revolutionary change in the health insurance market.



Unlike other state-based initiatives, the creation of a statewide health insurance exchange would not violate the Employee Retirement Income Security Act of 1974 (ERISA). This approach complies with ERISA because employer participation in an exchange is voluntary—though, given the benefits of an exchange, few small businesses would turn down the option. An exchange can be designed within the existing framework of other federal insurance laws, including the Consolidated Omnibus Budget Reconciliation Act (COBRA) and the Health Insurance Portability and Accountability Act (HIPAA).

Personally, as a small business owner who spends an exorbitant amount of my overhead on health insurance premiums this "stock exchange" set up for when I shop around for health insurance can be very appealing.

As a doctor, it sucks, because that means many more players to deal with and it does not streamline my adminstrative work and overhead.

 

[Al68]

The way the bill is written, it completely bans private policies in one section - but in the next, it allows them again, through a new mechanism.

No, it doesn't allow the same policies it bans. It outlaws private policies, then in the other section, it allows only private policies that meet the criteria and are part of the "exchange", or temporarily grandfathered.

The "exchange" only allows comprehensive health plans that meet the requirements. All other (new) private policies are outlawed.

Anyone who can read and takes the effort knows this, so there is no reason to deny it in this forum.

 

[Evo]

I have to sy, that as an employee of a large company that has incredible health insurance, this plan scares the crap out of me. For me, it means higher health costs to maintain the same level of healthcare, if I can even get the same level of healthcare, my doctor is afraid that if this passes he will no longer be free to fight the battles to get the best care for his patients. He feels he will be forced to accept whatever is deemed "acceptable".

Adrenaline, I know you are one of those saints that helps the poor in your area. So, you care more about universal care. But what are your thoughts on the future of cutting edge medicine in the US if the health industry is limited to government fixed costs?

 

[Al68]

That's the Kool-Aid talking, Al. The government did not create the demand for bad mortgages...

Yeah, banks were just making loans they knew would lose money for themselves. It had nothing to do with Fannie Mae and Freddie Mac wanting them. And of course F&F didn't want bad mortgages bundled with the good ones.

Seriously, I asked in another thread if anyone could show a single example of those bad mortgages being issued for any other reason than to sell to Fannie and Freddie (government created demand). Can you?

 

[adrenaline]

I have to sy, that as an employee of a large company that has incredible health insurance, this plan scares the crap out of me. For me, it means higher health costs to maintain the same level of healthcare, if I can even get the same level of healthcare, my doctor is afraid that if this passes he will no longer be free to fight the battles to get the best care for his patients. He feels he will be forced to accept whatever is deemed "acceptable".

Adrenaline, I know you are one of those saints that helps the poor in your area. So, you care more about universal care. But what are your thoughts on the future of cutting edge medicine in the US if the health industry is limited to government fixed costs?

large companies are the only ones with any advantage in purchasing group health insurance, small to medium size business owners like myself, it is breaking our backs and the the growing percentage of our overhead is exploding. The statistics show that the percentage of businesses offering health insurance as a benefit has been dropping steadily, this is before any
"public option" was proposed. http://www.usatoday.com/money/small...1-health-care-reform-and-small-business_N.htm

This trend will continue if we do nothing. the cuurrent toxic environment punishes small businesses, it is unsustainable, the backbone of the american workforce is being royally screwed in terms of an ever burdensome share of providing health insurance. If we do nothing, only our children who work for big conglomerates will have health insurance. the single payer option will help them. remember, i don't like obama's plan, but support a single payer option.


Let's not forget that close to 40% of all medical research funded in this country is through the NIH ( tax govt sponsored) and gets the most return. For three decades between 1965 -1995 7/21 life changing drugs were govt sponsored research , that's just drugs, not other biomedical advances. Everyone assumes that a " socialized" medicine" will stop any new advancements, heck the singular AIDs drug that altered the course if childhood aids was 3tc invented by Canadian researchers and there are numerous numerous advances coming from that country published in my medical literature.

if you want to see what counteries with "government constraints"capable of. let's look at Canada,




http://www.lhsc.on.ca/About_Us/LHSC/...akthroughs.htm

Canadian first for totally endoscopic closed-chest robotic bypass surgery...


Media ReleaseCanadian first for totally endoscopic closed-chest robotic bypass surgery


On May 4, 2007, CSTAR (Canadian Surgical Technologies & Advanced Robotics) announced that a cardiac surgery team led by Dr. Bob Kiaii, cardiac surgeon and director of Minimally Invasive and Robotic Cardiac Surgery, performed a totally endoscopic closed-chest robotic coronary artery bypass surgery on a patient’s beating heart at University Hospital.

Canadian first for robotic assisted gallstone surgery..


LHSC physicians achieve a Canadian first in using new technology to treat atrial fibrillation...

A world first at CSTAR: surgical robot helps to reduce stroke in common cardiac disorder



Canadian first for robotic assisted gallstone surgery... etc.

i know that new magnetic contrasts agents for biomedical imaging research and applying nanotechnology to it is being conducted in Université Laval, Québec...etc.

Many of the high quality medical research I am seeing in my medical journals are coming from countries where "government" control of health care plays a major role ( most of europe, Canada etc.)

to say cutting biomedical research will tank is absolutely not true. As for our drug companies, I have not seen any real revolutionary products come down the pipeline , only the "me too" drugs and slight modifications over existing drugs that are pushed once the others go generic.

 

[WheelsRCool]

That's the Kool-Aid talking, Al. The government did not create the demand for bad mortgages, and there is no way that you can back that up.

Fannie Mae and Freddie Mac were established to create demand for the bad mortgages. George W. Bush tried multiple times to bring them under heavier regulation and oversight, but Fannie/Freddie gave large contributions to politicians in Congress from both parties, so Congress killed all attempts to bring them under greater oversight. Barack Obama himself was the second-largest recipient in campaign contributions from Fannie Mae, and Fannie/Freddie had been large sources of campaign contributions for politicians for years.

Quasi-government, quasi-private institutions like Fannie/Freddie need to be watched closely.

The government (GOP administration) refused to rein in highly leveraged investments made on bundled mortgages of dubious value.

For one, I doubt most of the people in government had any idea of how risky much of the investments were, this being because the financial institutions themselves didn't. Big companies hate risk. They do everything they can to minimize it. They thought they had. They had no idea they were playing Russian Roulette with billions of dollars.

Right prior to the crash, it had actually become believed by many that we had reached a point where financial instruments were so accurate that they could allocate capital precisely to those who needed it (and maybe they could, but they tied everything ultimately into the housing market, which crashed nationally).

Government was NOT the problem, but should have been the solution, and it was not. The GOP has made a name for itself claiming that government causes all problems and cannot work, and then when they get elected, they obstruct everything possible to make that come true.

For the most part, government does cause most problems and it doesn't work. You want to see how the Left run things, with government trying to fix things, take a look at California, New York City in the mid-1970s, New York State right now, Michigan, Illinois, or any of the other Leftist-run states or cities.

And the GOP is not the party of small government. They never have been. Ronald Reagan was. The GOP has always been a party for bigger government, just a different kind of bigger government than the Democrats. The only time the GOP revert to being for limited government is when the Democrats are in charge.

When Ronald Reagan sought to deregulate the financial industry, it was the Republican establishment on Wall Street at the time that fought very hard against it, because they knew it would end their monopoly on the industry by creating competition. The great irony to this is that because of Reagan, Wall Street now is no longer any Republican stronghold, it has a lot more Democrats on it.

The truth is that this crises is more complex than a claim of too little government or too much. In some areas of the financial industry, it is possibly too under-regulated. Or it just may need re-regulation.

But ask yourself, if the big corporations couldn't see the enormous risks they were taking on, what makes anyone think a regulator would have been able to spot them?

Fannie/Freddie were clearly under-regulated.

I quit the GOP when then became the party of jingoism and nihilism. There are precious few conservatives left on the "right".

You sure about that, b/c right now, the GOP is being accused of being too "right-wing."

As for this universal healthcare, I notice that the President is now trying the religion card. Now if it was a Republican president and they were trying this, there'd be hell to pay in the mainstream media I have a feeling.

 

[Evo]

Before I delete more off topic threads...this is about HEALTH CARE.

 

[WheelsRCool]

Before I delete more off topic threads...this is about HEALTH CARE.

OKAY! Sorry.

 

[adrenaline]

http://www.care2.com/causes/health-...practice-of-canceling-insurance-for-the-sick/

Probably my biggest reason for some sort of health care reform from the goverenment is the continued practrice of "rescinding" health care policies that is happening at a more alarming rate with my privately insured patients. I am right now struggeling with a 42 year old I diagnosed with burkitts lymphoma. I have been his doc for 11 years and his insurance carrier told him his diagnosis was a preexisting condition based on some fatigue complaints he expressed to a nurse practioner 4 years ago. ( at the time he was working second shift and was diagnosed with shift work disorder and improved when he was able to get first shift duty). His physicals year after year did not relieve any lymphadenoapthy until his last one. They dropped him. He can't obtain private insurance, I have had him put all his assets in his exwifes name and soon he will qualify for medicaid which will pick up all his treatment 100% this was a man who worked full time since he was 17 for this paint production factory.

Though not an example of rescinding I had a 41 year old diagnosed with cutaneous t cell lymphoma, two years into her treatment ( full body radiations, sepsis from repeated pseudomonas infections etc.) she reached her one million dollar lifetime maximum and was essentially going to have to pay 100% of any future medical costs and treatments. her employer did not offer her any other type of plan. I put her on disabilty and now medicare and medicaid secondary has stepped up to the plate and has been paying for her treatments for the last 9 years. ( she is now 50).

If you think the government rations care, think again...when a government plan forgoes say an expensive 35,000 dollar defibrillator in a 95 year old it is socialism, if a private insurance plan "rescinds" it is less evil since free market forces have dictated their actions.

 

[mheslep]

The free market has not been given much of chance to work in US health care. Some states have only one insurance company left, and they're protected from the competing firm in other states. Patients for the most part have no idea of the cost incurred; they pay their copay or deductible and walk. In some other related businesses with no insurance model, like Lasik eye surgery, or Veterinary medicine* the costs have remained flat or even dropped while the state of the art has advanced.

*per pet. $120 each pet in 2001, $127 in 2007
http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf
http://www.avma.org/reference/marketstats/ownership.asp

Edit: In case of the high technology medicine is driving costs up argument:
http://www.petsdx.com/"

 

[WheelsRCool]

If you think the government rations care, think again...when a government plan forgoes say an expensive 35,000 dollar defibrillator in a 95 year old it is socialism, if a private insurance plan "rescinds" it is less evil since free market forces have dictated their actions.

Those against things like socialized medicine and universal health insurance (I know government-run healthcare and government health insurance are not necessarily the same thing), are not saying the healthcare system does not need reform. But to switch from the current system to a government model seems like trading one set of problems for another.

Right now, U.S. healthcare is not really free-market. It is about 50% government (Medicare and Medicaid) and the private insurance sector I believe is very highly regulated by the states, some so heavily that it is nearly impossible for them to function in the states they're in. It isn't really a free-market in the normal sense. Healthcare seems like a double-edged sword. With the private health insurance sector, you have corporate bureaucrats making decisions. With government, you have government bureaucrats.

For-profit health insurance companies will try to do everything as efficiently and cheaply as possible, which can mean denying care, while government-run health insurance companies waste money and are very inefficient.

For example, Medicare and Medicaid I believe are government-run health insurance companies, and they are monuments to waste, fraud, corruption, etc...

Since hospitals and so forth (I believe) have a ceiling on what price they can charge to people with Medicare or Medicaid, the healthcare businesses would pass those costs onto those with private insurance.

I would imagine that since Medicare and Medicaid's costs have ballooned way beyond what they were ever intended to, that this contributes to the rising costs of the private sector healthcare. Lawsuits I also think are a contributing factor.

Then there's regulations, for example, in my state of New York here, I remember during the Congressional elections, there was a radio commercial in which some candidate criticized his opponent for refusing to sign a bill that would prevent health insurance companies from raising the price on X service for customers.

If health insurance companies cannot charge higher prices for Medicare and Medicaid people, and cannot raise prices for certain services in the private sector either, what do people think will happen? The only option left is to flat-out deny said service (i.e. ration).

I think it is all these things combined (various price controls, lawsuits, Medicare and Medicaid costs), throughout the states (I believe health insurance companies are regulated by the states), that contribute to rising healthcare costs.

In theory, that would mean one way to begin to control healthcare costs in the private sector is to get Medicare and Medicaid under control.

But that also leads to the other parts I don't get: Medicare and Medicaid are both government-run. And both have ballooned way out of control cost-wise. So wouldn't the logical thing be to figure out how to get them both under control first, before creating a whole new government health program?

We also have the example of the Massachusettes universal care experiment, which was supposed to not balloon out of control cost-wise, yet that is what has happened. And the fears that creation of a public option would be a Trojan horse to destroy the private insurance industry to eventually push the country onto a single-payer system.

 

[Al68]

...when a government plan forgoes say an expensive 35,000 dollar defibrillator in a 95 year old it is socialism, if a private insurance plan "rescinds" it is less evil since free market forces have dictated their actions.

It's less evil because no one is using force against their fellow man to coerce them. Or are you just pretending to not understand what is meant by the term "socialist" when used by those opposed to this proposal?

And the tax penalty isn't for not wanting to buy medical insurance, it's for not participating in the government system. But I assume you knew that already.

And as far as the "grandfather" clause, while it would temporarily allow some existing private policies, it will immediately eliminate the ability of consumers to shop around for a private policy that isn't in the "exchange".

 

[Al68]

Right now, U.S. healthcare is not really free-market. It is about 50% government (Medicare and Medicaid) and the private insurance sector I believe is very highly regulated by the states, some so heavily that it is nearly impossible for them to function in the states they're in. It isn't really a free-market in the normal sense.

This is a good point. We have seen decades of government regulation repeatedly being used to correct problems caused by previous regulation. Then each time regulation causes more problems, they are blamed on capitalism, and the solution is more regulation. And now after decades of ever increasing regulation causing increasing problems, we're told that the solution is, guess what: government regulation.

 

[wildman]

http://www.care2.com/causes/health-...practice-of-canceling-insurance-for-the-sick/

Probably my biggest reason for some sort of health care reform from the goverenment is the continued practrice of "rescinding" health care policies that is happening at a more alarming rate with my privately insured patients. I am right now struggeling with a 42 year old I diagnosed with burkitts lymphoma. I have been his doc for 11 years and his insurance carrier told him his diagnosis was a preexisting condition based on some fatigue complaints he expressed to a nurse practioner 4 years ago. ( at the time he was working second shift and was diagnosed with shift work disorder and improved when he was able to get first shift duty). His physicals year after year did not relieve any lymphadenoapthy until his last one. They dropped him. He can't obtain private insurance, I have had him put all his assets in his exwifes name and soon he will qualify for medicaid which will pick up all his treatment 100% this was a man who worked full time since he was 17 for this paint production factory.

Though not an example of rescinding I had a 41 year old diagnosed with cutaneous t cell lymphoma, two years into her treatment ( full body radiations, sepsis from repeated pseudomonas infections etc.) she reached her one million dollar lifetime maximum and was essentially going to have to pay 100% of any future medical costs and treatments. her employer did not offer her any other type of plan. I put her on disabilty and now medicare and medicaid secondary has stepped up to the plate and has been paying for her treatments for the last 9 years. ( she is now 50).

If you think the government rations care, think again...when a government plan forgoes say an expensive 35,000 dollar defibrillator in a 95 year old it is socialism, if a private insurance plan "rescinds" it is less evil since free market forces have dictated their actions.

This is what I mean when I say we already have socialism. The problem is that it is an uncontrolled crazy form of socialism. It is far more expensive (if you figure in emergency room costs that are spread over all the insured, medicare and medicaid) than the more rational forms of socialism in other countries. It is literally driving us bankrupt. I am not sure what we should replace it with, but if you don't think we are paying already then I got a bridge to sell you (cheap!).

 

[mheslep]

...Let's not forget, the best avante garde basic medical research is done by NIH, government funded, ( socialized) without profit motive. ...

drug companies are resorting to "me too" drugs or slight modifications of existing drugs ( ie: nexium from prilosec, lexapro from celexa) for the quick profit turn around.

No doubt NIH research has produced countless nobel prizes. It's a national resource for basic research, especially from what little I know about the reported cancer, heart disease, and of course genome research there. But it's hardly the beginning and end of day to day medical advances in this country as I read the history. In that line, a couple years ago Health Affairs published a survey of internists on the top 10 most useful high tech medical innovations world wide, and I can't find NIH footprints on any of them.

* MRI/CT
* ACE inhibitors
* Balloon angiography
* Statins
* Mammography
* Coronary Artery Bypass Graft surgery
* H2-receptor antagonists
* Selective serotonin reuptake inhibitors (SSRIs)
* Cataract extraction and lens implants
* Hip and knee replacements
http://healthaff.highwire.org/cgi/reprint/20/5/30

NIH certainly had no fundamental role in the development of the MRI. Some of the rest:

• Statins come from the work of Japanese biochemist Akira Endo while working at Sankyo, with later work by Merck to isolate a statin from Endo's fungus.
• Captopril, the first available ACE Inhibitor, was developed by Bristol Meyers Squib scientists, based on the fundamental work of English scientists K. K. F. Ng & J. R. Vane.
• Angiography was invented by radiologist Charles Dotter out of the University of Oregon and the first devices made by entrepreneur Bill Cook.
• The first CABG was done at the Albert Einstein college of medicine by US Drs. Goetz, Rohman, Haller, Dee. The first five SSRIs (antidepressants) came out of five different drug companies: Lundbeck, Solvay, Eli Lilly, SmithKline-Beecham, and Pfizer.
• Modern cataract surgery was enabled by the invention of phacoemulsification by US Opthamologist Charles Kelman.
• The MRI was developed by P. Lauterbur of the University of Illinois at Urbana-Champaign and P. Mansfield of the University of Nottingham, Nobel prize winners for their work.

Sorry if this is pedantic, but the above comment is not the first on the 'who needs industry, government/academia does it all anyway' line. There's some notable academic pushing that concept recently, against what seems to me a mountain of evidence to the contrary.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=101126
http://www.preskorn.com/books/ssri_s2.html
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/article/articleDetail.jsp?id=98075

 

[Al68]

This is what I mean when I say we already have socialism. The problem is that it is an uncontrolled crazy form of socialism. It is far more expensive (if you figure in emergency room costs that are spread over all the insured, medicare and medicaid) than the more rational forms of socialism in other countries. It is literally driving us bankrupt. I am not sure what we should replace it with...

That seems like asking someone with a tumor what he would replace it with. The answer is just to get rid of it, not replace it. That's what I'd say about socialist policies in the U.S. They don't need to be replaced, just eliminated. And certainly not expanded even more.

 

[WhoWee]

The way the bill is written, it completely bans private policies in one section - but in the next, it allows them again, through a new mechanism. It merely changes the way they are sold, instead of banning them. But the law has to be written all legal-like. This is typical legal crap.

If you go read the bill, you see the language in Title I referred to in this article, and you see that it contains an exception. That exception is Title II, which allows PRIVATE insurers to offer PRIVATE plans through a new mechanism called a Health Insurance Exchange. I don't know the details yet, but it looks like it's basically one-stop shopping for health insurance, to make it easier for people to compare plans. They could choose a private plan, the government's plan, or Medicare, etc. if they qualify. I think it also makes it possible to choose a plan from any state, nationalizing the health insurance market and making more competition possible. It has some kind of tax benefits too. I found this article praising the idea, from a CONSERVATIVE think tank:

http://www.heritage.org/research/healthcare/wm1230.cfm





Personally, as a small business owner who spends an exorbitant amount of my overhead on health insurance premiums this "stock exchange" set up for when I shop around for health insurance can be very appealing.

As a doctor, it sucks, because that means many more players to deal with and it does not streamline my adminstrative work and overhead.

I'd like to elaborate on the heritage.org piece:
"As a vehicle for a defined-contribution approach to health care financing, an exchange would expand coverage and choice. Rather than have to decide whether to pay for full coverage or not, employers could make defined contributions of any size to the exchange. Moreover, employers could also enable employees, including those working part-time and on contract, to buy health insurance with pre-tax dollars. Under a Section 125 plan, any premium payments made by workers, even part-time workers or contract employees, would be 100 percent tax-free. This is especially important for workers in firms that require them to pay part of the health insurance premium. Employees, not employers, would buy the health care coverage with pre-tax dollars, would own their own health plans, and would take them from job to job without the loss of the generous tax benefits of conventional employer-based coverage. This is a revolutionary change in the health insurance market."

An example of a "Cafeteria" section 125 qualified plan is an Aflac accident policy. Another example is a "flex-spending account". Basically, pre-tax dollars are used to pay premiums.

To qualify, a business needs to register and implement a qualified plan. Assume the business is a light manufacturing company with 100 workers - and the workers earn from $10 to $30 per hour. The Aflac policies will typically cost less than $50 per month and will be paid by the employees that decide to participate.

The direct benefits to the employer are as follows.
1.) The $50 cost is deducted from the employees gross wages - if $15/hour @ 40 hours = $600 per week - $50 Aflac = $550 gross. The employer now pays matching taxes on the lower amount.
2.) With an accident policy in place, a worker is less likely to use a workers compensation plan if injured during non-working hours - this means lower workers comp costs in the long term.
3.) A lower gross also means lower FICA contributions for the employee.

For anyone interested in learning more, this is worth a look
http://www.mathematica-mpr.com/publications/PDFs/section125brief.pdf

 

[adrenaline]

Healthcare seems like a double-edged sword. With the private health insurance sector, you have corporate bureaucrats making decisions. With government, you have government bureaucrats.

we both agree. At the same time, no other nation would tolerate a system that consumes one-third of insurance premiums on insurance functions.

For example, Medicare and Medicaid I believe are government-run health insurance companies, and they are monuments to waste, fraud, corruption, etc...

The private sector did no better and had more waste ( and most likely fraud as well) in the failed experiment called medicare advantage plans. ( They deny paying the first three days of hosptialization, deny rehab care over three days and still cost more!)

Lawsuits I also think are a contributing factor.

in the form of defensive medicine we both agree. that is one glaring defect of the obama plan, no real call for tort reform.

In theory, that would mean one way to begin to control healthcare costs in the private sector is to get Medicare and Medicaid under control.

All other industrialized nations have universal programs whether through government ownership, single payer insurance programs etc. and have been more successful at slowing the rate of health care inflation, spending much less than we do, while providing care for everyone. We need to engage in an active dialogue and learn from them rather than the general consensus of ignoring them. I believe the government would not make allowances for the 80 percent of research that is designed simply to restart the patent clock.

As for fixing medicare, let's start with overuse of high-tech, specialized services that provide no health care benefit which have characterized much of our system. For example, drug eluting stents cost two to 5 times more than bare metal stents, though they have lower early restenosis rates, they have much higher late restenosis rates ( one year out) so these patients have to take plavix, 300 dolllar a month drug, much longer due to fear of this. A single payer system would have much better information resources to help realign incentives to promote more optimal use of the technologically-advanced products and services. I believe obama's plan calls for such an ovesite board to evaluate effectiveness of different therapeutic options.

Private plans have not been innovators in cost management but have merely followed the government’s lead through measures such as private, managed care price fixining. When I was chief of medicine, many of our quality initiatives in the hospital ( prevention of readmission rates etc.) and efficiency was driven soley by medicare mandates, not private health plans. For instance, medicare does not pay the hospital if the patient is readmitted within 24-48 hours after discharge for the same diagnosis. Otherwise, what was to prevent us doctors from booting out a patient too early and getting paid to readmit them ( admission payments are high) the next day? Thus, there was great incentive to provide for post hospital followup ( home health), predischarge planning ( education about disease) , and keeping them in the hosptial long enough to ensure that the chief medical problem has been resolved adequetly? ( we still need work on that by the way)

We also have the example of the Massachusettes universal care experiment, which was supposed to not balloon out of control cost-wise, yet that is what has happened. And the fears that creation of a public option would be a Trojan horse to destroy the private insurance industry to eventually push the country onto a single-payer system.

let's not forget our media conveniently ignore's taiwan's single payor success story. Right now, the current environment rewards practioners in highly lucriative fields, interventional radiology etc, and has created a shortage of primary care practioners. ( afterall, a family practioner owes as much as a future radiologist when they come out of medical school.) ( Another reason why the massachessets plan failed but that is another long discussion. ) A strong primary care infrastructure provides higher quality care at lower costs. Our primary care system is rapidly deteriorating. A single payer could realign incentives to strengthen our primary care base. Our costs would be lower, and everyone would have access to the quality provided by a medical home of their choice. Right now, primary care docs, paid at the bottom of private and medicare reimbursements must hire the most administrative personell to deal with all the insurance rules and regulations.

 

[adrenaline]

It's less evil because no one is using force against their fellow man to coerce them. .

They are coerced, if you cite lack of choice.

Most of my patients have no options regarding the plan their employer provides.

The woman with t cell lymphoma did not have an option from her employer for a higher lifetime limit plan.( past the million dollars.) Instead, the private plans dumps her after they have spent too much money on her and our tax dollars now have to take care of her ( despite 15 years having wages suppressed and garnished paying the premiums). The man with burkits lymphoma did not have a choice in a company plan that practices rescinding more than others.

I myself can only offer my employees humana ppo or hmo, nothing else. WHen two of my nurses developed breast cancer I could not afford to change insurance carriers.