Official Health Care Debate Thread

[utvol23]

Originally Posted by 360wavesandxbox

The top executive of Medicare gets about $150,000 annually. Here are the salaries of some health insurance executives for the year 2006: Ronald A. Williams, chair-CEO, Aetna Inc., $23,045,834; H. Edward Hanway, chair-CEO, Cigna Corp, $30.16 million; David B. Snow, Jr, chair-CEO, Medco Health, $21.76 million; Michael B. MCallister, CEO, Humana Inc, $20.06 million; Stephen J. Hemsley, CEO, UnitedHealth Group, $13,164,529; Dale B. Wolf, CEO, Coventry Health Care, $20.86 million; Jay M. Gellert, president-CEO, Health Net, $16.65 million; Raymond McCaskey, CEO, Health Care Service Corp (Blue Cross Blue Shield), $10.3 million.

If you can afford health insurance, if you can get it at all, this is where a lot of your premium is going. Is it any wonder that the insurance companies are fighting reform?

That was taken from another poster on a different site..
This is my point. People are so worried about paying a little more to benefit other people that might not be deemed "worthy" by them..Um HELLO..where do u think your money is going now?
It always baffles me how people can be so insensitve to people of lower classes and not do anything for their benefit but insist on making the rich even richer while they themselves stumble along.. See the Banking industry and Car Industry and all the opposers of what Obama is doing...WAKE UP

Sorry but it is not a little more. You can tax those making over 250K at 90% and you still wont have enough money to cover the costs of coveringeveryones healthcare, and the implications on medicine are a lot greater than just not wanting to care for the lower class. I think there needs to be majorinsurance reform that is probably the biggest problem now but with Obama's plan the major insurance companies will eventually be pushed out cause theycannot compete with the govt. For example right now the reimbursements rates to anesthesiologists from medicare are 1/3 of what the insurance companies pay.Basically they are making up for what the govt is underpaying. If everyone is under the govt the reimbursements to anesthesiologists will plummet as will theirsalaries and they will no longer be profitable.

 

[utvol23]

Originally Posted by LittlePeteWrigley

Originally Posted by wawaweewa

Originally Posted by LittlePeteWrigley

UTVOL23 wrote:

---

1. TORT REFORM- so that physicians do not have to practice cover your butt medicine. Fat chance this will happen with a bunch of lawyers in congress and the
white house. Funny how tort reform isnt part of Obama's plan.




The cost of healthcare in the US is unsustainable and alot of it comes back to unneccesary tests and procedures which are consistently being performed by
physicians to cover their +#* because if they dont a lawsuit is eagerly awaiting them.

I haven't been keeping up with all the health reform rhetoric but, didn't Obama say something about "reforming" this? I do remember the part
about unnecessary tests being emphasized.

They want to cut "unecessary tests" as in " simply not pay for them" so physicians will have no incentive to perform them.
However, physicians perform many of those tests to guard against malpractice suits.

Mosr people don't realize how expensive malpractice inurance is. Those costs become part of the service the physician provides and are passed on to the patients.

Do you have any ideas on a possible solution to this dilemma? How can this be ameliorated? It seems like finding a happy medium for all parties involved is not feasible.
Sure a solution that I already mentioned is TORT reform. If the doctors werent scared to death of being sued they wouldnt have to perfrom all theextra tests and thus that would markedly drive down the cost of medicine. Well that and not spending millions of dollars to extend someones life for an extracouple weeks to months but that is a whole nother topic, and a very sticky subject.

 

[wawaweewa]

Originally Posted by LittlePeteWrigley

Originally Posted by wawaweewa

Originally Posted by LittlePeteWrigley

UTVOL23 wrote:

---

1. TORT REFORM- so that physicians do not have to practice cover your butt medicine. Fat chance this will happen with a bunch of lawyers in congress and the
white house. Funny how tort reform isnt part of Obama's plan.




The cost of healthcare in the US is unsustainable and alot of it comes back to unneccesary tests and procedures which are consistently being performed by
physicians to cover their +#* because if they dont a lawsuit is eagerly awaiting them.

I haven't been keeping up with all the health reform rhetoric but, didn't Obama say something about "reforming" this? I do remember the part
about unnecessary tests being emphasized.

They want to cut "unecessary tests" as in " simply not pay for them" so physicians will have no incentive to perform them.
However, physicians perform many of those tests to guard against malpractice suits.

Mosr people don't realize how expensive malpractice inurance is. Those costs become part of the service the physician provides and are passed on to the patients.

Do you have any ideas on a possible solution to this dilemma? How can this be ameliorated? It seems like finding a happy medium for all parties involved is not feasible.

First of all, cap malpractice payouts.
Secondly, malpractice claims with certain procedures should be severely limited. Doctors are not magicians. The application of medicine involves risk. Theapplication of invasive medicine involves a higher degree of risk. The law, as it stands now, barely takes this into account.

The law needs to acknowledge and allow more liberally for mistakes while physicians administer medicine. Especially when many patients are child like in theirunderstanding of the risk inherent in medicine and of their own health.

 

[Jordan8]

Can someone post all these Town Hall mayhem videos without the news on them I cant find any on youtube

 

[btrbean]

High deductible HSA with maybe governent assistance to poorer people who meet certain criteria with paying the deductible. You need to make people take someresponsibility for themselves by not letting them abuse the system like you can now if you have access to it . . . the ole' morale hazard . . . When peopleare indifferent about prevention because they have access to unlimited healthcare, costs are bound to become too high for everbody/a lot of people to affordcomprehensive coverage. We also need to streamline and make electronic everybody's medical records . . . even though that raises a whole other set ofconcerns (cost, privacy, utility) . . .

Arguments both ways, but I definitely do not think that a government option is the way to go . . . bureaucracy is slow/inefficient and will inevitably raisecosts to the point where the quality of care that an average "pubic plan" purchaser receives becomes diluted and ineffective.

We need to get the #'s down on obesity which leads to diabetes and heart disease . . . How do you really influence what people ultimately put in theirmouths?

We also need to start to incentivize our leading drug producers differently so that they have an interest in producing lower costing drugs to the massesrather than expensive drugs to the few . . . People also need to stop medicating by seeing every commercial on tv and immediatley running to their physicianwith a self-diagnosis that the doctor can't refute because the commercial says so . . .

Last but not least . . . doctors should be compensated based on the results they are able to achieve with their "book" of patients . . . Not where itis in their benefit to prescribe and diagnose everything under the sun . . .

What should we do?

 

[jinkazama]

Been lurking in this thread for a minute and have tried not to respond but I do want to add my two cents.

A lot of you guys ideas are based on sound capitalistic economic principles. Unfortunately the economics of healthcare are a completely different animal. Itstoo complicated to put in a post so I'll respond directly to the comments that have jumped out at me.

TORT REFORM

#1 is right on. Fixing tort reform would solve a huge part of the problem, but tort lawyers have the messiah and numerous congressman in their back pockets, which is why it is not even mentioned in the plan.

One big issue with health care costs is the need for doctors to practice defensive medicine, by ordering a lot of unnecessary tests to make sure the malpractice lawyers stay away. Do something about capping malpractice awards and then the government may have my attention.

Secondly, malpractice claims with certain procedures should be severely limited.

First of all, cap malpractice payouts.

Tort reform is absolutely NOT the answer. The size of settlements is not the problem. The problem is malpractice insurers inflating rates unnecessarily basedon the adverse events of a few physicians. Here is how malpractice rates are set. Let's say you have a pool of 100 docs. Let's say 5 docs get hitwith malpractice suits...the insurer will justify raising all 100 of those docs rates based on those 5. More than likely even if they have paid out millionsthey have pulled down a 100 to 200% margin off the rates paid (I've witnessed this first hand). Yet docs get increases and don't push back on theinsurers, they want to demonize the lawyers and penalize the patient. You want Tort reform america this how you do it...

#1 Docs need to push back HARD on these malpractice insurers THEY are the real crooks not the lawyers. If docs could see how the money flows in the insuranceindustry they would realize they are getting robbed and making a lot of stuffed suits rich. You can fight back docs (ask for the actuarial analysis, get yourown actuary to run some numbers, refuse to accept the increases...)

#2 The Insurers need to be regulated, like I said, it is borderline immoral how these rates are set. I am all for capitalism and making a profit, but pushinga 20% rate increase based on the sob story that the "malpractice lawsuits of the past year have just killed us..." when you easily paid thosesettlements and made a 90% margin is just wrong.

They want to cut "unecessary tests" as in " simply not pay for them" so physicians will have no incentive to perform them.
Not necessarily. Stimulus funds have already been set aside for physicians and hospitals to upfit their IT infrastructure to share test results,medical records... across a myriad of organizations. 95% of the problem is that a patient goes from doc to doc, hospital to hospital, and gets the same orsimilar tests run on them every single time. Because there is no centralized way for docs and hospitals to find out what tests a patient has had recently oreven see their most updated medical record, they have to rely on the patients "recollection". This leads to a lot of the waste and cost in thesystem. These proposed HIE's (Health Information Exchanges) the stimulus funds would establish, will allow docs and hospitals to have real time access tothis information thus reducing unecessary procedures and tests.

The second part of this is that the adminstration wants to base reimbursement on "evidence based practice" or proven medical practices that producegood outcomes. Sound in theory, but there are holes in that logic also...but that's another discussion.

The cost of healthcare in the US is unsustainable...
The truest thing said in this entire thread. If we continue the way we are going in the next three to five years the healthcare industry will bewhere the banks were 9 months ago. Hospitals will begin to close, Physicans will leave the profession, and the entire healthcare infrastructure in thiscountry will completely collapse...and trust me, the bailout required of the healthcare industry will make the bank bailout look like pennies. I wish I hadtime to go into specifics but trust me folks we are on the brink of something catastrophic if things don't change.

Health reform is coming no matter what...america needs to decide if we want that reform in the form of revamping our current system now or waiting for thecollapse and building the system up again from the ground up.

 

[theconditioner]

True but for the most part people are too stubborn to change their own destructive ways. Everyone knows that smoking causes cancer in fact it is the #1 risk factor for many types of cancer not just lung, but millions and millions of people continue to smoke their lives away. The public has been informed to exhaustion of the dangers of smoking but that falls on deaf ears of many individuals.

First, I understand what you're saying, but cigarettes and food are different. In my opinion, cigarettes should be taxed to the extreme sincethey destroy public welfare. This may at least discourage individuals from smoking The reason for this argument is because 1) individual smokers inevitablyrequire more medical attention than non-smokers, which wastes resources and time, and 2) because smokers are usually adversely affecting the health of thepeople they're around (through second-hand smoke and influencing others to pick up the habit; in fact, I believe that smoking should be banned inhouseholds with children). The key assumption to my opinion is that smoking does not provide enough benefits to keep cigarette demand where it is. In otherwords, the costs of not regulating smoking further are higher than the benefits. But of course there is the common slippery slope argument, where someone willsay "if cigarettes are regulated, why not _______?" Tough question, but again, trade-offs must be made. In my opinion, policymakers must determinea threshold at which demand-curbing regulation must be made. Very tough, but necessary.

Foods, however, do at least provide some benefit to you, namely nutrition. The problem, however, is that most foods have unhealthy ingredients in them, butusually ingredients that can be removed with hardly any consequences to the consumer. People may think that as companies have more food guidelines to adhereto, such as lowering the amount of preservatives in their food (which leads to higher costs), prices will be passed onto the consumer. In the short run thismay be true, but in the long run, if demand for healthy food increases, the price of healthy food should decrease.

I think the problem is our culture. That is why, again, I say that there needs to be an effort to educate people on what they're consuming, as well asstart considering the effects of the media on health. In the short term, there may not be much progress, but in the long term, I'd say it will have aneffect. In fact, take a look at the way things are now, compared to a decade or two ago. There is a much larger consumer movement to live healthierlifestyles. By allocating resources that further promote transparency, society will continue this trend - perhaps more aggressively if the right regulation isenacted.

 

[theconditioner]

BTW, this thread gets two thumbs up.

 

[rexanglorum]

The Economics of health care is something that I cannot help but find very fascinating because there are so many factors all in play all at once. There is anendless supply of thinks to talk about regarding this issue. With that in mind, I do not want to go on and on for too long so I am going to mention a fewthings which are facts and then a few ideas about how we can achieve the goal towards which all American agree is worthwhile and that is controlling cost andimproving quality and accessibility.

First, we need to realize a few facts that people on one side or another of this national debate wish would simply go away and never return.

- Americans spend more (in absolute terms and in terms of share of our GDP) on health care than in any other other country.This is not necessarily bad. Whilethere are many inefficiencies that plague the US health care sector, there are also good reasons for why we spend so much more on medical acre than others. Wewant to extend life and quality of life for the old and/or sick and it is only because of government rationing that other nations spend so much less on healthcare. There is no one "correct" ratio of GDP to health care spending. The ideal levels are whatever peopel want but are purged of ineffciencies sopeopel do not have to waste money to do the right thing and spend handsomely to get a few extra years of life and a little extra comfort for a sick and dyingelderly relative.

- The WHO ranking that have the USA with the #37 best health care system in world should be taken with a massive dose of salt. Only one quarter of the rankingsare actually based on outcomes and that quarter does poor job at accounting for radically different lifestyle factors like obesity and diet and alcoholconsumption. The other 75% of the WHO rankings were based on procedural items like how it is paid for, with single payers being counted as good and our systemcounted as bad. A huge part of the rankings is how equal the quality actually is, mediocre care across the board will create a higher ranking than excellentfor most but bad for some. The WHO rankings have been misused to pain ta picture that is simply untrue.

- On items like cancer survival rates, length of time to get surgery ad comfort for patients, items that are a direct function of the quality of and quantityof medical care, the US is one of, if not the best in the world. Because we still have a degree of a market element, there are much more MRI and CT scanmachines and wait times are shorter and when someone is sick, the US is the best place to be if you are insured.

- The tax system favors very low deductible insurance plans for many American workers and medicaid and medicare are also agents that decouple patients fromeven seeing prices and cause some consumers to have an almost infinitely inelastic demand for health care because they pay nothing or virtually nothing a thepoint of service. This makes insurance and medical care itself very expensive for everyone else and ultimately makes taxes and insurance premiums increase soeven those with good employer provided insurance or government funded medical care face mounting costs.

- The overwhelming consensus in out society is that everyone is entitled to, at the very minimum, emergency medical care. Others in society believe thatmedical care in general is a right. All or almost all agree that unlike many other goods in the economy, there are some instances where we cannot, ethically,expect a person to do with out, at minimum this applies to situations where a lack of immediate care means certain death. This ethical consensus makes healthcare different from most other sectors of the economy which can be left almost entirely to the free market.

-The demand for health care is sometimes anticipated like annual checkups, elective surgeries and all of the medical care that is necessitated by pregnancy. Inmany cases though the demand for medical care is sudden and unexpected and satisfying that demand can be very expensive. This is why people are supposed tohave insurance so any solution for improving health care has to be good at protecting people from the risk of financial ruin in the event of unexpected illnessor injury.

- Lifestyle plays a huge role in life expectancy. It is popular, for many, point to higher life expectancies in France and Japan and Italy but in thosecountries, the lifestyle is conducive to longevity. Consider how bad so many Americans treat their bodies; if the use had medical care that was on par withthose aforementioned countries, there is no doubt that our life expectancy would be several years shorter than it is now.


Here are a few things that can be done, it is not an exhaustive list but it covers what my research has found to be very important items related to health careand health care policy.


- The most important thing is changing how health care is paid for amongst the general public, seniors, young children, those who are very sick and very poorare not among the general public in this context. For everyone else, there needs to be a shift away from low or no deductible insurance towards one where theconsumer of health care is aware of the costs and does bear some of the burden of paying for it on the his or her self. As others have already stated, thereshould be a change in the tax code, which would take away tax incentive for low or no deductible employer provided insurance and give the tax advantages tohigh deductible insurance and Health Savings Accounts. These accounts, HSA's, for short, should be given tax free status, there should be a mandate orincentive for employer matching and to get the account set up, there would be large tax credit for those who are just beginning to fill their HSA and/or taxexemptions for lower deductible insurance during the first few years of an HSA.

Those ideas an other tweaks would be used in concert with high deductible insurance so the consumer is made awar of the cost, will consume medicine moreprudently but is always protected from financial loss. That would reduce demand and reduce cost. Also, in order to entice people to really be serious aboutpreventative care and healthy lifestyle changes, HSA funds, that reach a certain age could be removed and not be subject to a tax penalty. So if you arethrifty when you get medical care and need less medical care because you live healthy life style, you are financially rewarded. That would reduce costs withoutsacrificing any quality of outcomes and in some instances, it would reduce costs and improve outcomes.

- Of all of the sweeping measure that would effect the insurance industry in general, one of the most intriguing ideas is a "community rating." Dueto the persistence of asymmetrical information, between insurance companies and those seeking insurance, and the adverse selection that results therefrom,there is natural separating equilibrium used by insurance companies. What this equilibrium does is forces healthy people to buy more insurance than they wouldlike and sick people are unable to get as much insurance as they would like. A community rating, a pooled average of the health of those in the pool, whom theinsurance company insures, that would be used as the basis of the insurance company's actuarial basis for determining premiums and levels of coverage forall of its policy holders, would be at a point that would have healthy people buying less insurance and sick people able to buy more. A community rating wouldmake all parties, the insurance companies, the sick consumers and healthy consumers all happier.

- We need a mix of much freer markets in health care but in a few areas, the government should have a clear and coherant approcah to helping those too sichand/or poor to be involved in buying their own insurance. For the that sick and/or poor minoeirty of the population, there should be a public option, withrates being based on your ability to pay. The very poor and/or sick would have their medicine paid for and those who are low income would be in the public, notfor profit, subsidized public option and they would be in the same HSA-high deductible system as most Americans but with the government helping them with someof the expenses.

This type of public option, a public option, which is not able to compete on the open market, could have access to the treasuy and the ability to make surethat everyone has at least basic and decent health care. However, this limited public option would be unable to crowd out private insurance plans and turn intoa single payer system.

- Aside from this cheap or free public option for the sick and the poor, the rest of health care generally needs less and more government control. When itcomes to insurance, state mandates for minimum scope of coverage drive up the cost. In most states, the state legislatures have decreed that all healthinsurance policies have to contain many elective surgeries, annual check ups and things that should not be converged by insurance (or at least not required, bylaw, to be a part of an insurance policy which is supposed to protect against financial risk caused by unforeseen illness and/or injury). These mandates makeinsurance very expensive in some states and that is big cause of people, especially young and healthy people, not buying insurance. It is like requiring thatall cars on the road be luxury cars, there would be a lot of people "without access" to cars as is the case with health care/health insurance.

In addition to these mandates, it is illegal to buy policies that originate in another state. Take away that prohibition and there would be competition amongvarious plans and the likely outcome is that it would create much more consumer choice and that would mean more consumer welfare because people could shoparound and insurance companies would lobby state legislatures to give them more flexibility to make a variety of policies.

Right now, in US health care industry has competition when it comes to quality and the results have been exception level of quality and innovation. However,there is little reason or room to compete on costs and efficiency. Rules on scope of practice are instances where competition on cost is forbidden in manyplaces. Scope of practice requires that a doctor can be the only person to perform a particular procedure even though a well trained and/or experienced nursecould do that same procedure. It drives up costs to require that a doctor, who needs years and years of costly education, doing what a nurse, who needs muchless formal training, can do with an equal level of competence. If they competed on cost, hospital and doctors' offices would reach an efficient ratio ofdoctors to nurses, with nurses doing everything that they can do and doctors only being needed to do procedures which only an MD can perform.

This competition on cost would also mean that there would less duplicate testing, which is a very costly inefficiency in the US health care industry. It wouldalso mean that manufactures would try to find ways to make the many great medications and medical machines and equipment cheaper and still top notch. Imagineif health care, had developed in the last 30 years in the same way as personal electronics. Imagine not only having outstanding equipment but it also becomingcheaper and there for more and more common and accessible year after year. This could very well be possible with a greater degree of competition on cost,coupled with the unshackling of the many, many special interest dictated restrictions on health care that makes competition on cost illegal.

Another free market solution in health care, that has been allowed in a few states have been mini clinics. These mini clinics are usually in large pharmaciesand/or big box retailers. They are staffed by nurses, who can handle all sorts of routine medical procedures, which should not require doctor visit. Expandingon the idea of mini clinics, should be a chance in how pharmaceutical are distributed. There should a "behind the counter" class for medication,which would require an a brief inquiry from the pharmacist and/or a an examination on site at the mini clinic in order to obtain a prescription for this"behind the counter medicine" (less accessible than over the counter but more accessible than prescription medication), that save many trips to thedoctor and brings down costs without sacrificing the quality of outcomes.

Finally, under the banner of a freer market health care system. There have to more medical schools open. There are many more smart and qualified kids, whocould become excellent doctors, if there were more medical school seats. The fact that the American Medical Association, the AMA, gets to accredit new medicalschool, which they have not done for nearly a century, is a rank example the fox being allowed to guard the chickens. The number of seats in medical schoolshould be expanded at a rate that is more proportional to the aspirations of the universities and those young people, who are seriously aspiring doctors.


These ideas, again, are not meant to be exhaustive. There are other items, which others can and should mention to the few people in our small online communityand to people in our own flesh and blood, congressional representative voting communities and districts. More than in any other domestic policy issue, beingopen minded and as free of ideological taint is crucial for a productive dialogue and any chance of health care reforms that will actually increase access,control costs and not have to ration.



Cliff Notes: No cliff notes this time. This issue is too important and there is so much misinformation and such a lack of focus on what should be thediscussion at hand that you owe it to yourself to read what I wrote, which is the distillation of some very detailed and thorough research, that I did not toolong ago.

Please read and fee free to ask questions.

 

[360wavesandxbox]

Great and very informative post..great research and info thus far in this thread..

 

[j burner]

Look, its as simple as this. If the proposed health care reform is soooo good, why won't ONE SINGLE POLITICIAN WHO SUPPORTS IT ACTUALLY USE IT??? Obamahimself said it is not good enough for his family, and he would not want his daughters on the governemnt run plan. So ask yourself, again, if its such a goodidea, why do the politicians who support it still get their own special first class health care? Hmmm......

 

[sorkoram]

Originally Posted by Rexanglorum



- The overwhelming consensus in out society is that everyone is entitled to, at the very minimum, emergency medical care. Others in society believe that medical care in general is a right. All or almost all agree that unlike many other goods in the economy, there are some instances where we cannot, ethically, expect a person to do with out, at minimum this applies to situations where a lack of immediate care means certain death. This ethical consensus makes health care different from most other sectors of the economy which can be left almost entirely to the free market.

Finally, under the banner of a free market health care system. There have to more medical schools open. There are many more smart and qualified kids, who could become excellent doctors, if there were more medical school seats. The fact that the American Medical Association, the AMA, gets to accredit new medical school, which they have not done for nearly a century, is a rank example the fox being allowed to guard the chickens. The number of seats in medical school should be expanded at a rate that is more proportional to the aspirations of the universities and those young people, who are seriously aspiring doctors.

I wholeheartedly agree.

 

[chickhien]

excellent discussion.

my concern with this healthcare reform is the timing. with the current state of the economy, are we really trying to establish a universal healthcare system?where was all the reform talk with the bush and clinton years?

i know i am making a gross analogy right now, but i see a universal healthcare system turning out like public schools and private schools. i think people willhave access to excellent universal healthcare depending on where they live...so those in low income neighborhoods are gonna get screwed because i dont foreseedoctors choosing to work and live in low income areas. and private insurance will be for those who want the bentley healthcare.

i agree with REX, tooooo many factors involved with healthcare to assume a universal healthcare system will fix everything.

 

[incredibleev]

Originally Posted by chickhien

where was all the reform talk with the bush and clinton years?

Hilary has always fought for health care reform, probably most during the Clinton years

Bush didn't care he had more important things going on i guess

 

[chickhien]

^makes me wonder if it was all posturing since it seems all politicians have special interest paying them

 

[trelvis tha thrilla]

Originally Posted by DaGreatJ

i have to laugh at all these upset White people making fools of themselves at town halls.... They see the Blacks taking OVER and they HAVE HAD A ENOUGH . As for Health Care Reform it is needed and the Government should be an option along side the Private companies. It's funny because the White people that are upset probably don't even have health care and just don't like the fact that a $+%!%$ is running the show.

Ban this ignorant racist.

 

[superantigen]

Just read this article--



[h1][/h1]

[h1]Britons defend their health care from US criticism[/h1]

By MEERA SELVA, Associated Press Writer Meera Selva, Associated Press Writer - 22 mins ago

LONDON - Britons reacted with outrage Friday at American criticism of the country's health care system and defended their cradle-to-grave medical coverage on Twitter, television and in the tabloids.

Right-wing attacks on President Barack Obama's health reform plans have struck a nerve in Britain, where residents broadly take for granted their universal coverage under the state-funded National Health Service - and look askance at the millions of Americans without insurance.

"Land of the Fee," declared the Daily Mirror in reference to the United States' high-charging health model. The London newspaper called the "lies and distortions" being circulated in the United States about the National Health Service "truly sickening."

"Jaw droppingly untruthful," said the British Medical Association's chairman, Hamish Meldrum.

"NHS often makes the difference between pain and comfort, despair and hope, life and death," Prime Minister Gordon Brown tweeted. "Thanks for always being there."

Even British health campaigner Kate Spall - who criticizes NHS failings in U.S. television ads produced by Conservatives for Patients' Rights, a lobby group that opposes Obama's plans - declared that the group had misled her and was distorting her true views. Spall's mother died of kidney cancer while waiting for treatment.

"There are failings in the system but I'm not anti-NHS at all," Spall told the British Broadcasting Corp.

"I help the vulnerable patients in our country that come to me for help, those that have been denied treatment," she said. "So the irony is, the people that are falling through the net in the U.S. are patients that I would support anyway."

Britain's opposition Conservative Party is distancing itself from its maverick member of European Parliament, Daniel Hannan, who has criticized the NHS on U.S. news programs.

Conservative leader David Cameron dismissed Hannan as having "eccentric views."

In an e-mail to Conservative Party workers published on his blog, Cameron said millions, including his own family, were grateful for NHS-provided care.

"Just look at all the support which the NHS has received on Twitter over the last couple of days," he wrote. "It is a reminder - if one were needed - of how proud we in Britain are of the NHS."

The NHS, founded in 1948, is the cornerstone of the United Kingdom's welfare state.

About 12 percent of the UK's 61 million residents have private insurance, but the vast majority rely on state-funded emergency care, surgery and access to family doctors. Even those who complain about the system say they want it improved, not dismantled.

British officials acknowledge that their system has been struggling to cope and faces a 15 billion pound ($24 billion) deficit. Hospitals are often overcrowded, dirty and understaffed, which means some patients do not get the care they are promised.


...

 

[wawaweewa]

Originally Posted by JinKazama

Been lurking in this thread for a minute and have tried not to respond but I do want to add my two cents.

A lot of you guys ideas are based on sound capitalistic economic principles. Unfortunately the economics of healthcare are a completely different animal. Its too complicated to put in a post so I'll respond directly to the comments that have jumped out at me.

TORT REFORM

#1 is right on. Fixing tort reform would solve a huge part of the problem, but tort lawyers have the messiah and numerous congressman in their back pockets, which is why it is not even mentioned in the plan.

One big issue with health care costs is the need for doctors to practice defensive medicine, by ordering a lot of unnecessary tests to make sure the malpractice lawyers stay away. Do something about capping malpractice awards and then the government may have my attention.

Secondly, malpractice claims with certain procedures should be severely limited.

First of all, cap malpractice payouts.

Tort reform is absolutely NOT the answer. The size of settlements is not the problem. The problem is malpractice insurers inflating rates unnecessarily based on the adverse events of a few physicians. Here is how malpractice rates are set. Let's say you have a pool of 100 docs. Let's say 5 docs get hit with malpractice suits...the insurer will justify raising all 100 of those docs rates based on those 5. More than likely even if they have paid out millions they have pulled down a 100 to 200% margin off the rates paid (I've witnessed this first hand). Yet docs get increases and don't push back on the insurers, they want to demonize the lawyers and penalize the patient. You want Tort reform america this how you do it...

#1 Docs need to push back HARD on these malpractice insurers THEY are the real crooks not the lawyers. If docs could see how the money flows in the insurance industry they would realize they are getting robbed and making a lot of stuffed suits rich. You can fight back docs (ask for the actuarial analysis, get your own actuary to run some numbers, refuse to accept the increases...)

#2 The Insurers need to be regulated, like I said, it is borderline immoral how these rates are set. I am all for capitalism and making a profit, but pushing a 20% rate increase based on the sob story that the "malpractice lawsuits of the past year have just killed us..." when you easily paid those settlements and made a 90% margin is just wrong.





To absolve lawyers when it comes to malpractice rates is laughable. There are more than enough crooks among both the insurers and the lawyers.

There are many malpractice suits that are thrown out of court or where the physicians is found not guilty but the insurers are still obligated to pay for thephysician's litigation fees. It's not only about cases where compensation is awarded to patients.
There are a lot of malpractice suits. There are also lots of threats of malpractice suits which cost money to get rid of as well.

How can physicians put pressure on insurers when they are threatened with suits and have suits filed against them left and right? They have no leverage becausea single guilty verdict from a malpractice suit will put 99% of physicians in horrendous debt if they had to pay it out of their own pocket.


You think insurers make ridiculous margins? Look at the lawyer side of the medical malpractice industry. They take nice cuts as well.

 

[nicedudewithnicedreams]

Originally Posted by Sorkoram

Originally Posted by Rexanglorum



- The overwhelming consensus in out society is that everyone is entitled to, at the very minimum, emergency medical care. Others in society believe that medical care in general is a right. All or almost all agree that unlike many other goods in the economy, there are some instances where we cannot, ethically, expect a person to do with out, at minimum this applies to situations where a lack of immediate care means certain death. This ethical consensus makes health care different from most other sectors of the economy which can be left almost entirely to the free market.

Finally, under the banner of a free market health care system. There have to more medical schools open. There are many more smart and qualified kids, who could become excellent doctors, if there were more medical school seats. The fact that the American Medical Association, the AMA, gets to accredit new medical school, which they have not done for nearly a century, is a rank example the fox being allowed to guard the chickens. The number of seats in medical school should be expanded at a rate that is more proportional to the aspirations of the universities and those young people, who are seriously aspiring doctors.

I wholeheartedly agree.

Seriously now. I hear people complaining about physicians getting their salaries reduced because of this reform which leads to physicians leavingthe medical field. Sign me up when that happens. While making six figure is important, that should not be the only reason why you want to be a physician.

 

[verynecessary]

Originally Posted by nicedudewithnicedreams

Originally Posted by Sorkoram

Originally Posted by Rexanglorum



- The overwhelming consensus in out society is that everyone is entitled to, at the very minimum, emergency medical care. Others in society believe that medical care in general is a right. All or almost all agree that unlike many other goods in the economy, there are some instances where we cannot, ethically, expect a person to do with out, at minimum this applies to situations where a lack of immediate care means certain death. This ethical consensus makes health care different from most other sectors of the economy which can be left almost entirely to the free market.

Finally, under the banner of a free market health care system. There have to more medical schools open. There are many more smart and qualified kids, who could become excellent doctors, if there were more medical school seats. The fact that the American Medical Association, the AMA, gets to accredit new medical school, which they have not done for nearly a century, is a rank example the fox being allowed to guard the chickens. The number of seats in medical school should be expanded at a rate that is more proportional to the aspirations of the universities and those young people, who are seriously aspiring doctors.

I wholeheartedly agree.

Seriously now. I hear people complaining about physicians getting their salaries reduced because of this reform which leads to physicians leaving the medical field. Sign me up when that happens. While making six figure is important, that should not be the only reason why you want to be a physician.

QFT.

Coming from a pre-med background, I find the current state of the health care system so undeniably flawed that even though I'm still geared for gettinginto medical school, I almost can't see myself continuing my education because I can't stomach the way the medical profession has turned physiciansinto a simple commodity. There are so many people who have a desire to practice medicine that are ruthlessly denied entry into medical schools while currentphysicians are being forced to process patients as quickly as possible, only to the point of not being sued for malpractice.

Medicine has gotten far too reactive, and far less proactive. There should be far less of an incentive to medicate than to address the root causes of theproblem. Unfortunately, the vast majority of the American people have a grade school level understanding of health. Our education system and otherinstitutions impart so little knowledge to us about what being healthy is all about. The food, pharmaceutical, and health insurance industries are lookingafter their shareholder's interests, and that means more unhealthy diets, more pills, and the least amount of care.

 

[jinkazama]

To absolve lawyers when it comes to malpractice rates is laughable. There are more than enough crooks among both the insurers and the lawyers.
Nobody is absolving Lawyers...everybody knows the only winners in any lawsuit is the lawyers. All I am saying when it comes to health reform andspecifically Tort Reform..reducing settlements to patients is not the answer.

There are many malpractice suits that are thrown out of court or where the physicians is found not guilty but the insurers are still obligated to pay for the physician's litigation fees. It's not only about cases where compensation is awarded to patients.
There are a lot of malpractice suits. There are also lots of threats of malpractice suits which cost money to get rid of as well.


You are right, now how exactly does Tort Reform alleviate that? As a matter of fact what you state is the main reason why Tort reform will produce very littlesavings if any at all. What do you think will happen to retainer rates if settlements are capped? Better yet will physicians even be able to get a lawyer totake their case with capped settlements? The lawyers who do take these cases, what do you think their fee structure is going to look like? With that said,how do you think malpractice insurers are going to deal with the increased fees from lawyers...?

Your obvious response would be...well capping settlements will reduce the number of lawsuits which in turn will drive down the costs. I fundamentally disagreewith that sentiment. The USA is a litigation happy society, if there is ANY money to be made, capped or not, people are going to sue. That is our right andwe should keep that right. For every crook lawyer or con artist trying to make a quick buck off of a malpractice suit, there are just as many people who wereactually wronged by the healthcare system and deserve compensation. Who is the government to say how much they should get? That's why our court system isset up that we are judged by a jury of our peers.

How can physicians put pressure on insurers when they are threatened with suits and have suits filed against them left and right?
Nobody is telling docs to drop malpractice insurance, I'm telling you that when the insurance companies come back with their new yearly ratesdocs need to do more than nod their heads in acceptance. Insurers place physicians in what is called a risk pool or captive. Depending on how docs buy theirmalpractice insurance they are either in a pool with docs who do similar work that they know (co-workers, hospital employees...) or they don't know. Whenthe insurer comes to you or the representative of the risk pool with the rates for the new year or the new term of that agreement... the representative needsto:

#1 Ask to see the numbers and how the insurer determined the new rates
#2 Have their own actuary present who has knowlege of settlements paid, payments to lawyers, and the premiums of all the docs in the captive.
#3 Negotiate, Negotiate, Negotiate

You wouldn't believe how many docs/captives get a 30, 40, 50% malpractice rate increase and SAY NOTHING!

 

[718stylez]

very informative and Rex, thanks for the long, but enlightening read.

seemingly the trouble with getting this reform off the ground is the sheer magnitude of the healthcare industrial complex. while some people fault politiciansfor corruption and criminality i tend to give them the benefit of the doubt, both Rep and Dem. I think our government has grown into something that itwasn't originally set up to do. It's laughable that anyone, let alone Senators who haven't held real jobs in years are the ones trying to tacklethese problems. Who do they turn to to learn about the ins and outs of the industry when there's so much misinformation around? If anything we needgovernment innovation.

While i applaud Obama's efforts and understand the political nature of needing to pass a bill while you still have political capital behind you, it scaresme that this thing is being pushed through so fast. Nothing good happens when the government says, "hurry up and act". look at all the flaws andloopholes that were found in TARP/Bailout. Lets do this right the first time rather than muddle our way through.

 

[rexanglorum]

chickhien wrote:

---

i know i am making a gross analogy right now, but i see a universal healthcare system turning out like public schools and private schools. i think people will have access to excellent universal healthcare depending on where they live...so those in low income neighborhoods are gonna get screwed because i dont foresee doctors choosing to work and live in low income areas. and private insurance will be for those who want the bentley healthcare.


That is a very good point and I have not seen anyone else mention that the long run equilibrium with a public option might be like the K-12educational sector of the economy, with private and public coexistingbut because evryone has to pay taxes, only those who are well off can have anyalternatives and lower and middle income people would be stuck dealing with a monopoly that exists off the backs of their tax dollars.

With K-12 schooling and how it is financed, everyone pays, in fact many state and local taxes are regressive (the less you make the the bigger the share ofyour income ends up going to pay those taxes) so low income peopel have to give a big part of their income in exchange for under performin gschools. Meanwhile,many affluent people see their kids enjoying a great education at public schools, in that same State or even the same district.

A huge reason for the disparity in performance amongst K-12 public schools is that only those parents, wealth yenough to pay the taxes for public school andthe out of pocket costs of a private school, who are able to demand more from public schools. Public schools that service the affluent perform very well in inmost cases and that is because they, those government owned, run and operated are functioning in competitive market for education. Midle and lower incomepeopel cannot afford anything but the K-12 government "option." When dealing with a monopoly, especially a monopoly that existed because ofgovernment decree (as opposed to one that at least became monopoly by succeeding in the market place), expect slow service, usually expect bad service and inmany cases, it will be costly to you and/or the tax payers.

It is a tragic and bitter irony that our system of publically financed K-12 education has such unequal levels of quality. At least for middle income families,the very taxation that is meant to pay for the egalitarian venture of public schooling, is what makes the difference between them being stuck with a bad,government, monopoly school or being able to make credible threats of enrolling their child in a private school and forcing the local public school to servethem as well as they serve upper income families (low income people might not be able to afford private school, even without any tax burden, so that is whyvouchers for lower income people can give to low income families, the options that exist now for upper income families and that would exist for middle incomeAmericans, in the absence of taxation related to school funding).