OT: Car insurance complaints

Don't think of military medicine as only treatment of active duty. The entire family (and most are married these days) gets treated, as well as retired military and their spouses at many if not most military treatment facilities. With the all voluntary military, sick call abuse is a trivial to almost non-existent problem anymore. Also, the earlier reference you made to over treatment resulting from patient demand, i.e., antibiotics for a cold, is (I believe) just a specific manifestation of what I've referred to in earlier postings as "defensive medicine" as a consequence of our litigious society. I suspect civilian docs would be more resistant to patient pressure if they weren't worried that the very rare "cold" might really be an atypical presentation of a more serious bacterial infection and that a disgruntled patient in that circumstance might be likely to sue for malpractice. Of course, we both know that if instead, an antibiotic is prescribed for a cold and the patient gets a severe allergic reaction to the antibiotic that requires hospitalization, the doc might also be sued for inappropriate prescription of an antibiotic for an obvious viral infection. In the military, the Feres doctrine effectively protects practitioners from personally being sued and effectively insulates against the perceived need to practice defensive medicine.

Long waiting lists for indicated surgery to treat non-elective diagnoses is obviously highly undesirable in any medical care system. Nonetheless, the countries with more "socialized" systems of medical care seem to have lower infant mortality and longer population longevity than in the U.S. It isn't easy, but we must be alert to ensure that our choice of statistics, and how those numbers are derived are valid metrics to test the hypothesis being studied and not merely less accurate surrogates for what really needs to be measured.

Reply to
Peter
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So, given the precedent you set earlier, I am now free to think that you are arguing for actually trying free markets before we institute OCare? (grin).

And I find more than adequately supported. (g).

The VA can because it is a SYSTEM. The ACA is not a single entity. In essence you are suggesting that Congress should come in and give insurance companies this big cost reduction?

I used to make this suggestion, too. Until I couldn't find any indication (other that the gut feeling that it should) that it actually happens. And God knows I tried. If there is some newer information (I gave up around 2000), it would be most appreciated.

Reply to
Kurt Ullman

[lots of stuff snipped] Bobby, I suspect that there are few if any times that the "free market" as defined and described by Adam Smith work well on anything other than a few anecdotal micro-economic examples. In most cases, vested interests have their fingers on the scale and everything seems to be for sale to the highest bidder.

Ever see sustained free market pricing among a group of 3 or more gas stations within eyesight of each other? Why is so much merchandise marketed to the public by multiple retailers at the absolutely identical price (before local sales taxes are considered), even on the web? Most items are price controlled if not outright price-fixed to the advantage of a variety of all the interested parties except for the end purchaser.

Reply to
Peter

Either way, I think an all volunteer Army, as you mention, is not a really good surrogate for the population as a whole.

Also, the earlier

One of the more interesting things about a lot of reform (and this even goes to the private guys) is the increasingly importance of patient satisfaction. MCare, for instance, is basing a certain amount of your payment as a doc on how well you do on that assessment. Seems like this is working at cross purposes to keeping costs in line since it gives incentives for the doc to give the patient what they want, instead of what they need. (Especially interesting in view of the emerging studies showing no relationship between satisfaction and outcomes). This is very much multifactorial. I think the fact that someone else is paying for it increases the demand, I think some of it is defensive, I think some of it is pay for services.

But we also must look at things other than just the medical system. Society in the US has lost the stigma against teen sex, for instance. We lead the league in teen pregnancies which increase the percentages of very low birth weight babies and we all know how that impacts on fetal death. Also, many countries don't even count births under a certain weight as live births, while if the draw one breath, the are a live birth in the US. I have seen only one study that controls for this and when it did, the infant mortality differences decreased. While docs can have some impact on this, the vast majority of this is societal in nature and really outside the purview of medicine. We stop teen pregnancies, we lower our infant mortality. Societal influences on life expectancy are also involved. Every person that dies at 19 in a drive by or mugging and everyone that ODs in their 20s and 30s, lowers life expectancy much more than keeping a geezer alive between 70 and 75. Heck if anything I would submit that without the advances in NICUs, etc., our infant mortality would be even worse. There have been a couple of studies suggesting that trauma units may be lowering the murder rate by keeping people alive (and thus making it attempted murder). This may also make that indicator better that it might be without our medical system.

Reply to
Kurt Ullman

That is competition. They go up AND down, quite substantially as we have found out over the last few years. If one goes down, the others follow, also.

Reply to
Kurt Ullman

Even if you could tell the doctor, it wouldn't do much good. A doctor would have to be nuts to take a patient's word for any important test results. If the patient has it wrong, the doctor listens to them and then there is a bad outcome, the doctor gets sued and is very likely liable. He can't even prove what the patient had told him.

There are two different issues here. One is insurance, national health insurance, Obamacare etc. The other is computerized health records that are readily accessible when needed. If you arrive at a hospital unconscious, for the hospital to be able to instantly access your health history could save your life. It could also save money, because Dr B would know that Dr A had already given a test.

Reply to
trader4

Ashton, you probably meant to say "I couldn't care less".

Ivan Vegvary

Reply to
Ivan Vegvary

When did the price of gasoline go down substantially and stay there for very long due to valid market dynamics? Only after the conclusion of an artificially created shortage and price spike in the early 1970s. (Another example: The artificially created electricity price spike in California a few years ago.)

In my experience, very few items undergo substantial relatively long term price reductions, absent a catastrophic economic deflation. The primary exceptions that comes to my mind are the ticker prices of some securities/commodities and the currency exchange values of some country's currencies. The more common situation is that for some items, the price may go up over time more slowly or stabilize, and eventually in year-equivalent dollars becomes cheaper. Or, due to improvements, you get more for your money and therefore better value.

Reply to
Peter

A bud of my brother heard about caffeine jacking up pressure, and when he got drafted during Viet Nam, he drank a couple quarts of real strong coffee just before his induction physical exam. Didn't work. He passed with flying colors. Got sent to Viet Nam for a tour of duty. Was in some bad spots, saw most of his squad mates die, but never got a scratch himself. Back in the states after his tour, he peeled potatoes for the remaining 5 months of his active duty commitment. To keep from going crazy doing that, he'd repeat to himself over and over, "I'm the luckiest man in the world."

The day he was discharged from the Army, they gave him his discharge physical exam. The medic taking his blood pressure seem confused, and did it 3 times. Told him to see a civilian doc when he got home. Said, "I got no idea how in hell they let you in the Army with such low blood pressure."

Reply to
Vic Smith

That question would make a good study for some sociologist. The armed forces (Navy, Marine Corps, Air Force, Coast Guard AND Army) are made up of a diverse bunch of people from all geographic areas of the country, with maximum formal educations varying from GRE to multiple doctorate degrees and everything in between. Obesity is highly prevalent among the spouses, especially the spouses of junior enlisted members. Many lower rate enlisted personnel qualify for food stamps and have difficulty affording healthy nutrition - even though they can shop at better prices at the military commissaries, or don't have the education or experience to understand what constitutes a healthy diet. Eligible patients vary in age from premature infants to the extreme geriatric.

The major difference in demographics that comes to my mind is a lower percentage of white people compared to the population at large, but I'm not sure that difference between populations is germane to the issue of generalizing management and economics data from the military health system to the US population at large.

I agree completely. The fact that almost all the metrics used to assess the system are strongly affected by multifactorial considerations makes the entire analysis exceedingly complex and difficult to get right.

No argument at all. As we both agree, essentially every consideration has multifactoral considerations. One sees similar problems in analysis when comparing patient outcome rates between community hospitals and tertiary care centers. The tertiary centers get the sickest patients so looking only a raw numbers is totally misleading.

Reply to
Peter

Right, eventually even the OPEC monopoly couldn't hold up against markets and the prices went down.

ANd competition doesn't impact at all??

Reply to
Kurt Ullman

We're in analytic territory as fraught with complexity and multifactoral influences as our discussion of health care reform. I don't deny that competition can, and sometimes does impact pricing, but rarely is the market free from influences that corrupt a pure demand/supply equation. The market only "works" as we wish it would if both the suppliers and the demanders have equal power. If the product is essential for the demander, the demander has no power and must find a way to afford the product. Therefore, the supplier can charge whatever he/she can get away with, even if it means the demander must become destitute to obtain it. Think chemotherapeutic drugs.

I believe that in most cases, the power balance between the supplier and the demander is highly skewed and therefore invoking competition as a justification for exorbitant pricing is a smokescreen. In our society, money provided by wealthy suppliers to lobbyists, in conjunction with laws that encourage private funding of elections almost guarantees that the policy positions favorable to the average Joe citizen will be under-represented in the office of "Joe's" elected representatives and Joe is truly being disenfranchised even though he/she may vote.

Gotta close this now. Real life calls.

Reply to
Peter

Health care is an area where it's almost impossible to "even up" the power differences between buyers and sellers. How can you shop for the "best price" when you're in the ER with severe chest pains and SoB?

Or worse. The ACA is unlike the universal health care plans of any of the industrialized nations that I know of. Charitably speaking, it was structured that way to protect special interests, not to provide the best health care possible to American citizens at the lowest prices possible. Uncharitably speaking, it was structured that way in hopes that it would fail.

I believe that eventually a single payer system like Medicare, but with no age limitations will evolve from the ACA. (Say, isn't giving seniors nearly free health care age discrimination against the young?) The problem is that creating a single payer plan just wasn't politically possible at the time the law was passed. It may be in the future, though.

The problem, as I am sure you know, is "adverse-selection." If insurers charged everyone the same flat rate, buying coverage would be far more attractive financially for people with chronic illnesses than for healthy people. That would cause healthy policyholders to drop out of the insured pool which would fill up with sick people and thus force insurers to raise their rates. That begins a deadly feedback loop because higher rates make insurance even less attractive for healthy people, causing even more of them to drop out.

The adverse-selection problem explains why almost no countries except for the US leave the providing of health care to unregulated private insurance markets. For that reason alone I don't believe the ACA as written will be sustainable. People will demand a single payer structured like Medicare after they've been burned badly enough by the state insurance exchanges.

When NY passed a law intending to solve the adverse selection problem in the

90's, rates for individual policies skyrocketed making New Yorkers' insurance among the most expensive in the nation. Now, under the ACA and the larger pool of insured that it represents, residents who had been paying $1,000 a month for individual policies *should* now be able to purchase similar coverage on the ACA exchanges for slightly more than $300 a month. They can offer these lower rates because the requirement in the ACA that everyone buy insurance or face penalties ensures a higher proportion of healthy people in the insured pool.

I once asked a Congressman how they justified taking money from so many special interests and the reply was: "By taking money from *everyone* that means in the long term we're favoring no one." Not sure if I believe it, but I am sure plenty of Congressmen do.

Reply to
Robert Green

I can assure you that in the private sector this happens all the time. My MD graduated med school in 1980 and that's where the bulk of his ideas about treatment are stuck. )-: Despite the requirements for continuing their medical training, doctors tend to treat based on what they learned in med school. Worse than that, all the specialists they are likely to refer you to are from the same age cohort.

When my friend had serious prostate trouble he did a lot of research after getting a referral to a 65 year old urologist whom he thought was too "old school." (No hate mail from seniors, please!) He discovered that there's a lot in the way of new technology and found a much younger MD who was working with the latest high-powered green lasers instead of surgical techniques from 20 years ago. The results were outstanding.

In those cases, as you apparently did, you have to "urge them along" into the 21st century. I always did my own research making sure to cite

*reputable* sources when discussing treatment options. It's very tricky because it's easy to offend doctors. They are innudated with dummies bringing in printouts from "Yahoo Answers" who take the word of some whacko as gospel. I always make sure to innundate him with NIH, Medline, JAMA and other "reputable" sources.

(-;

Reply to
Robert Green

Tip of the day for diabetics. Always carry some glucose test strips used for urinalysis with you in some foil in your wallet. A quick dip in a drop of coffee or soda that's supposed to be sweetened without sugar will tell you if they are trying to kill you.

Reply to
Robert Green

And how many of the hospital interactions are like this, let alone how many healthcare interactions? For most you can if you want to and have the time and insurance companies are rolling out websites, etc. for you to compare.

Nearly free? You obviously haven't priced the MCare premiums plus the supplements to take care of the many things that MCare doesn't/

Actually that happens now, look up death sprirals. I have long suggested that all individual policies should be put together in one group. I am not opposed to all regulation.

Given the general contacerouness of the American population, I would be surprised if that happened. Even many more moderately left leaning might take this as a sign that the government can't do the job. We can only hope.

And the areas of the country where the state government did not meddle in areas they did not understand and screw things up will have their premiums go up. (I mean this tried to address adverse selection and managed to make it much more of a problem than it was) BTW: There is fairly decent evidence from MA that great numbers of the young and healthy will see paying the fine (if found out) a better deal than insurance.

"Even I realized that money was to politicians what the ecalyptus tree is to koala bears: food, water, shelter and something to crap on."

---PJ O'Rourke

Reply to
Kurt Ullman

That's a story worthy of "The Gift of the Magi" by O. Henry. That's the one about a poor woman who wants to buy her husband a Christmas gift but only had two dollars. She decides that she will have her long hair cut off and sells it to buy her husband a golden watch chain. He turns out to have sold his watch in order to buy her hair brushes.

Reply to
Robert Green

We are very concerned with patient satisfaction, BUT I am not aware of that having anything to do with Medicare. There are financial incentives to "Meaningful Use of the Electronic Health Record" but all of the goals are things that can actually be measured/counted.

And we have incentives based on treatment guidelines for various conditions.

And a new thing developing is payment for keeping the population healthy rather than payment for specific treatments.

But I am not aware of financial benefit from Medicare for warm fuzzies.

The reason we want the patient happy is so that they will come back instead of going to the for-profit down the street.

Reply to
Wes Groleau

And a good doctor may have so many patients (BECAUSE he's good) that he doesn't have time to do any research. So his only knowledge of new advancements are the reprints cherry-picked by drug salesmen.

Reply to
Wes Groleau

My wife's chemo was $13,000 per dose. And the insurance company declined because it was not officially endorsed for cancer. My appeal was that "if the standard treatment doesn't work, we can't just do nothing." The manufacturer wrote off the whole price though.

As for "supposedly non-profit"--it was claimed recently (yeah, hearsay, I don't know whether it is true) that we are not allowed to use our non-profit status to "unfairly compete" with the for-profit nearby.

But we can't make a lot of money because we are non-profit.

So we have frequent free health screenings and lots of charity write-offs.

Reply to
Wes Groleau

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