OT - A intriguing "open lette"r on health care ...

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Somebody wrote:

The problem is we are already paying the increased costs to cover the under insured as hidden costs of doing business as a society.
As an example, emergency room visits that go unpaid which in many cases requirement of a medical program that has advanced because preventative medice was not available due to cost.
The E/R becomes the court of last result along with it high costs.
In the end it becomes a hidden cost we all pay which is higher than necessary if all were insured.
It becomes a matter of "PAY me now or PAY me later"
Lew
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Lew Hodgett wrote:

For the record, the "somebody" was actually me--
Of course much of the high cost is the cost of the under/non-insured being paid by the responsible/insured. But, I fail to see how/why people seem to think that adding additional clientele who aren't payers to the system is somehow going to reduce the actual expenses--it's only going to raise demand and (at least everything I've seen proposed so far) take money from a government pocket to artificially reduce _apparent_ individual cost. Meanwhile, non-itemized expenses in the form of alternative and higher taxes (remember, the whole point of the proposed C cap&trade fiasco is to generate a multi-billion revenue stream to the federal government to pay for this) is going to skyrocket.
Unless and until there's some technique to generate more actual revenue from those who are actually in the pool that aren't currently paying there's no relief. I've yet to see proposals that seem to be effective in doing that.
My suggestions to open up the existing large insurance pools to the self-employed and for small businesses that currently can't afford any or at least very good programs for themselves and their employees would allow for a large population to actually contribute that currently aren't.
In addition, I think it should be required that all salaried workers contribute something to a plan regardless of salary level--opting out unless demonstrate are covered under a spousal plan or independently (similar to showing proof of auto insurance for registration) would not be allowed.
Also, the earlier point someone made upthread of raising contribution limits and relaxing restrictions on usage of the various health savings plans would allow for more people to be able to do better in becoming self-insured either fully if of high-enough income or partially if lesser. There would be far more participation in these if, for example, it wasn't "use it or lose it" on a yearly basis as the most obvious.
More controversial, the inevitable cheats who don't have coverage at the minimum as outlined above get nothing but the most basic of services. There have to be consequences for bad behavior or there is no incentive for the irresponsible and as is currently the case the good will continue to carry the bad.
--
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dpb wrote: ...

Another suggestion/possibility along the above line occurred to me -- While in general I'm not a fan of tax policy for behavior, in some instances it does have beneficial uses. How about if can't show contribution from employer or self-paid premiums or adequate/equivalent coverage at a fixed level depending upon AGI, additional charge (not tax) for the medical pool added. If there's a federal coverage, it's the premium for it; otherwise premium to carrier of choice w/ at least minimum coverage.
That'll pick up the doofuses like ex-SIL who dropped participation and the court-mandated childrens' coverage and claimed penny-stricken and broke when granddaughter had short hospital stay during visit here leaving daughter holding the bag. Yet, always has plenty of $$ for the toys, etc., etc, etc., ... :(
--
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"dpb" wrote:

We are faced with a health care system with a cost structure that can not be maintained and that fails to cover all its people.
A system put together as a patchwork of special interest programs with more exceptions and loop holes than the federal income tax laws.
An underling thread in the above seems to be that somehow, just because you are poor, you will cheat the system and get benefits you are not entitled to have.
Some how this baffles me.
All people, poor or not, want to improve their lot in life.
I've met very few that were unwilling to work to improve thier lot in life.
The idea that somebody might get something free or at less cost than somebody else borders on paranoia, if you ask me.
There is not doubt that including EVERYBODY in a health plan is going to increase the initial cost of a medical plan; however, offsetting cost savings are MANDATORY, if health care, 100% or otherwise is to continue to be provided.
The status quo can NOT be sustained.
There is the obvious low hanging fruit such as records computerization and allowing Medicare to negotiate competitive drug prices, and the reduction of CYA tests used by doctors today, but that doesn't scratch the surface.
Reorganization such that competitive bidding can be introduced will go a long way; however, the health insurance lobby is/will fight that one all the way.
I'm certainly not a health insurance expert; however, it doesn't require much thought to realize serious changes must be made to the existing system.
Lew
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Lew Hodgett wrote: ...

There is no "free"--_SOMEBODY_ has to pay.
I know quite a few who aren't rich but do work; otoh, the inner cities are rife w/ millions who do nothing but collect welfare and are an utter drain on any system. There's no end to pouring money down that rat hole unless there is some system brought into play to make personal accountability a part of it.

I don't see how it can help but increase costs on a continual and continually rising basis as you expect to add more covered and more services.
I don't for a moment believe this saw of computerized records will cut anything at all in actual costs--it will simply shift one level/group/type of recordkeeping costs from one form to another. Sys-admin, Q/A-Q/C, initial inputting and correcting data, etc., etc., etc., will end up being as expensive overall as the system it will replace. There _may_ be some enhanced features come with it, but I expect they will, like other advanced technologies that have been introduced, simply raise expectations of services and have commensurate higher costs associated with those.
There is undoubtedly some small amounts to be gained in better Medicare cost control including the prescription drugs you mention but as you note, even though it may help in individual cases dramatically, overall it's still the tail of the dog.
The issue of superfluous tests is primarily related to one of two things--fraud as a secondary one; liability avoidance as the other (which may be your CYA target, I'm not sure). That, however, can and will only go away with tort reform to limit liability and frivolous lawsuits. One might as well in this day and age wish for the free bubble-up and rainbow stew.
As expressed upthread, I also do not believe that normal market competitive forces are or will be at play for most medical services--there are simply more patients than doctors and when or if controls are introduced that excessively limit the freedoms of physicians to practice there will be larger numbers of existing ones who will leave the field and fewer new ones interested in joining up. As I mentioned, in this rural area, the easiest place from which to recruit physicians over the last 20 years or so has been from Canada where experienced, quality physicians have become so fed up w/ their system they're willing to relocate out of country rather than remain at home. At last count roughly a third of our local hospital resident staff are Canadian and there are several other private practices as well. In addition, people generally are more concerned about the quality and other factors when it comes to health care than simply shopping for price. That is only natural and I don't expect human nature to change in that regard.
There does need to be some change but I personally don't think government-controlled systems are likely to help. Instead, as outlined earlier, what's needed are innovative ways to enroll the currently un-enrolled into becoming payees as well as just recipients in some fashion other than simply taxing the already-taxed who currently carry the load additionally.
--
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"dpb" wrote:

Glittering generalities of the uglest kind.

By including people who in many cases would be receiving preventitive care for the first, you reduce the necessity of requiring high cost proceedures later.
The result is an overall lower cost of servives.

To each his own.
Even if the cost difference is a wash, other benefits not even considered at this point will produce added economies.
That is simply the history technological evolution.

Wrong competitors, it's not the medical community but the insurance providers that will be the competitors with each other.

Government and BAD are not necessairly mutually equivalent.
GOOD government can have a very positive effect on the society.
Social Security, G I Bill, the Interstate Highway System, the Peace Corps, NASA are just a few programs that never would have happened without GOOD government.
Lew
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Lew Hodgett wrote:

But, unfortunately, easily verifiable as true regardless of whether one wishes to admit it or not. W/O personal accountability which present systems tend to not have, there's no hope of ever changing the mindset of the dependent nor is there then any limit to the resources that can be absorbed. Remember Johnson's "war on poverty"????

I don't believe that would actually turn out that way overall. I think the demand for increased services will far outstrip the benefits to be gained. Only time will tell for sure.

Again, time will tell, but I would be _MOST_ surprised if it turns out to actually have any significant reduction in cost. Health care isn't turning out widgets on an assembly line so production can't really go up much just because there's a computer-generated record as compared to introducing robotics or other technologies in manufacturing. It's a flawed comparison.
I've yet to see any specific cost-avoidance that the implementation of computerized records is going to achieve documented. The folks keep repeating the promises, but don't ever say how.

The insurance companies have to pay the medical costs w/ generated revenues. The discussion is to bring more people into the covered fold w/o additional identified sources of that revenue. How that is to reduce costs is somewhat of a mystery.

True, but in most instances it is fairly well demonstrated that it isn't efficient. USPS, Amtrak, ... ????

Of those, only the SSA is even remotely close to health care and it surely is not a model of actuarial soundness.
It is, in fact, almost a poster child for what happens to any government largesses program. It began as a minimal supplemental stipend during The Depression and has now grown to be expected by many to be a full retirement benefit plan and promising more benefits is routine campaign rhetoric of self-serving politicians. The result is that it has been a significant negative influence in the savings patterns of a large fraction of the working population who count on it rather than on their own resources for their retirements. Not to mention it is about to collapse within the next 10-20 years or so (I forget when doomsday is projected to be just now, but I do know it got quite a few years closer w/ the present economic downturn).
All I'm advocating is that somewhere there has to be a way to create the revenue stream and that imo it is the responsibility of the individual to be the contributor directly for their own welfare.
I'm willing to share to a degree for the less fortunate, but not to the degree of simply continuing to carry the load for those who choose not to as is the present plan (and, as far as I can tell, the intent of this Congress is to make that even more so).
--
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dpb wrote:

I think what Lew is saying is that use of terms such as "rife w/ millions", "rat hole", etc. are not helpful in any sort of discussion. If you are interested, DAGS on "usa welfare statistics" or somesuch. It will give you all the facts about welfare trends. For example, http://www.census.gov/compendia/statab/files/govtsoclaw.html#footnoteNA is a collection of census bureau dollar statistics. http://www.welfareprogram.info/ is a gateway page to specifics in several areas. Have fun.     mahalo,     jo4hn
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jo4hn wrote: ...

If you can actually refute anything, I'm all ears...
Food stamps alone are 30+ million recipients at roughly $40B for it and associated expenses. I saw where something like an _additional_ $300M was appropriated for administrative costs alone as part of TARP. That pretty much is a definition of "millions" and "rat hole" in my book.
SNAP is just the tip of the iceberg...
Anybody who can suggest SS as a model for a financially successful program isn't paying any attention at all to realities.

Wake up to the facts, unpleasant as they may be... :(
--
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"dpb" wrote:

Be my guest.

And where is the lack of personal accountability?

This campaign to revise the health care system is not being driven by wanting to increase costs but rather the necessity too reduce them.

The impact that the internet and digital technology is having on information systems is such that the half life of anyones knowledge of information systems is measured in months not years.
There will be growing pains to implement the technology; however, there is no way to totally comprehend the benefits to be gained at this point in time.

See above.

The name of the game is to implement a new model that is more efficient, not stay with the status quo..
People are demanding more miles per gallon from their health care $, and come hell or high water, it's going to happen.

Once again, how does a health insurance program that covers the total population eliminate the contribution requirement of all participants?

It may surprise you but I look at this rather selfishly.
By including everybody in the gene pool with no "cherry picking" allowed, I fully expect my health care costs to be reduced.
Lew
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Lew Hodgett wrote:

Does this make sense? Our current health care system developed over many decades and is honed by literally millions of transactions per day. To replace it with an untested paradigm and hope for the best is lunacy.
In spite of our president's declaration, "Hope" is not a strategy.
Those who claim we can get better efficiency and lower costs by eliminated waste and duplication are pandering to the masses. You can't build a house without making sawdust (usually). There is waste and inefficiency in virtually every endeavor. That said, what does your experience say about who will do a better job of eliminating waste and duplication - insurance companies or the federal civil servants?

It may happen, but not for the reason you claim. The demand for change is being driven by those who do NOT have dollars invested in the process. By every survey, the vast majority of people are satisfied with the health care they get for the dollars they pay (excluding, of course, those who pay nothing).

Then look at the "assigned risk" pools for auto insurance. Or better, look at the formularies for British or Canadian systems where many treatments and drugs are denied because of their cost.
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On Thu, 04 Jun 2009 07:47:28 -0500, HeyBub wrote:

I think a couple of quotes from today's newspaper might apply - one directly, one indirectly. First the direct one:
"One-third of every health care dollar pours into industry profit, administrative redundancy, congressional campaign funding, marketing, and lobbying."
If that's correct, a single-payer federal system could waste 1/3 and still break even.
And since most of the opposition to single payer comes from the right wing of American politics, herewith the indirect quote:
"It has long been a problem for the GOP that some of the party's most cherished positions are embraced most enthusiastically by people whose grip on reality is sometimes tenuous."
Sorry, the devil made me do it :-). And I expect at least one response that takes the previous sentence as the "gospel" truth :-).
Oh yes, as far as competition lowering costs. A study from some group at Harvard found that the more medical professionals there were in a given area, the more expensive the care was without any corresponding increase in positive results. IOW, since each doctor was getting a smaller slice of the pie, he or she raised fees to compensate. So much for competition. BTW, I recall several earlier studies that found the same results.
--
Intelligence is an experiment that failed - G. B. Shaw

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Larry Blanchard wrote:

Assuming, arguendo, that the 1/3 number is correct: So what? One-third seems like a lot, but how does it compare to the alternatives?
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On Thu, 04 Jun 2009 14:23:30 -0500, HeyBub wrote:

We'll never know unless we try the alternative, will we?
--
Intelligence is an experiment that failed - G. B. Shaw

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Larry Blanchard wrote:

Why won't we know? "The alertnative" has been tried in many places and a comprehensive study of that experience should yield the answer to that question.
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On Thu, 04 Jun 2009 22:31:50 -0400, J. Clarke wrote:

Because the places have greatly varying results. From all accounts, Britain's national health program is a mess. Canada's is a little better, and the systems in Germany and Japan seem to be working quite well.
--
Intelligence is an experiment that failed - G. B. Shaw

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Larry Blanchard wrote:

So you're saying that you have every confidence that the politicans will screw it up worse than Britain?
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Here is an interesting set of statistics. They are from "The Economists World in Figures" and quoted in: http://www.frontlinethoughts.com/pdf/mwo060509.pdf
They show we (the US) are spending more and getting less (in terms of longevity) than many other countries. It says nothing about how to fix, just that fixing is needed.
According to the Economist the total US spend on healthcare is 15.4% of GDP including both state and private . With that it gets 2.6 doctors per 1,000 people, 3.3 hospital beds and its people live to an average age of 78.2
UK - spends 8.1% of GDP, gets 2.3 doctors, 4.2 hospital beds and live to an average age of 79.4. So for roughly half the cost their citizens overall get about the same benefit in terms of longevity of life.
Canada - spends 9.8% of GDP on healthcare, gets 2.1 doctors, 3.6 hospital beds and live until they are 80.6 yrs
Now if we look at the more social model in Europe the results become even more surprising: France - spends 10.5%, 3.4 docs, 7.5 beds and live until they are 80.6 Spain - spends 8.1% , 3.3 docs , 3.8 beds and live until they are 81
As a whole Europe spends 9.6% of GDP on healthcare, has 3.9 doctors per 1,000 people, 6.6 hospital beds and live until they are 81.15 years old.
-- Doug
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On Sat, 06 Jun 2009 10:04:19 -0500, Douglas Johnson

"Longevity" isn't a good measure of health care at all. Equalize infant mortality, and drop suicide and murder out of the "health care" equation.

Quoting a quoted source? WHy don't you go to the horse?
Yes, fixing is needed. The government broke it and you expect the government to fix it with more government?
<snip>
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Let's see. According to the CDC the US death rate is about 810 deaths per 100,000 population. The suicide rate is 11.1 per 100,000 and the murder rate is 6.5. Not a significant factor. Especially since other countries have murder and suicide rates in the same neighborhood. For example, western Europe has a murder rate of 5.4 per 100,000.
Infant mortality is definitely a heath care issue. As someone mentioned, there is some difference in how those are accounted for. But I will need to actual numbers to decide if those differences are significant.
-- Doug
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