Obama Healthcare Lies

[StevenSeagal]

 

So, I hear your concerns too. Could reform *start* with just the following 1) ensuring catastrophic coverage is affordable - meaning monthly charge and a reasonable annual deductible 2) ensuring insurance companies may not stall, delay, avoid paying out - how about pay first, then ask questions, 3) figuring out a way to eliminate the "preexisting conditions" requirements balancing that with folks being "forced" to buy coverage (instead of just paying nothing until they are hurt or sick and then suddenly applying for coverage). I could also see progressive premiums (or tax credits to ensure this) for 1), but would never support zero copays/deductibles for large numbers of people.

 

 

Certainly these could be common ground proposals; for 1) something like a sliding scale according to one's income for premiums. But really it is not the premiums per se that are as problematic as the high deductables and large out of pocket limits. Somebody has to bear the costs so how can these costs be reduced? They are being passed onto us by the insurance companies to the point where insurance doesn't ensure much.

 

I like 2) and 3) but that's where I think staunch conservatives are going to

have a real issue and sensitivity towards perceived "regulation" of industry by government; but reality suggests that some form of regulation is needed here to make these things happen.

 

I also don't think zero copayment options are realistic, but I would like to see something like a fixed rate for doctors office visits and specialists that is affordable. Say $50 per visit or something reasonable. Just going for a checkup or a minor concern is expensive enough right now that it's enough to discourage people from going at all. What I mean is we need an increased emphasis on preventative care. The current system we now have does not encourage regular visits for routine checkups. In the long run I believe that will contribute to better overall health in society and, hopefully, decreased burden on the system.

 

The preexisting condition deal is one of the biggest travesties since it effectively removes one's choice of plan if one is already sick since nobody will insure them. Not to mention it often strays into things like family history and whatnot. It's like insurance for insurance that they won't ever have to pay benefits, and it punishes people who aren't blessed with good health or good luck.

 

[tvashtarkatena]

i sent u a box of twinkies and a fry daddy...

 

Good, cuz my Fry Daddy busted when I tried to crisp up an entire ham hock in it.

[KaskadskyjKozak]

The preexisting condition deal is one of the biggest travesties since it effectively removes one's choice of plan if one is already sick since nobody will insure them. Not to mention it often strays into things like family history and whatnot. It's like insurance for insurance that they won't ever have to pay benefits, and it punishes people who aren't blessed with good health or good luck.

 

It's not just that, there are two other issues: insurance co's stalling when you really do get sick/hurt (and are covered) and the "absolute limit" that you can hit (2 million for lifetime).

 

Most people who are insured never really get sick or hurt. Sure there is an emergency visit here and there, a few doctor's appointments every year, etc. Only a few people really get sick and hurt, and the story I am hearing over and over again from the "our health care system is broken crowd" is that insurance companies try to avoid paying these expenses when they actually are incurred. I don't know how much of this is truth and how much hyperbole, but if it's the former, it's BS, and I could see how this is not on everyone's radar screen since it affects few - of course you are happy w/ your coverage if you've never really gotten sick/hurt and never had to make huge claims that are stalled/denied.

 

Anyways, in general my preference is to identify the worst 2-3 problems, and improve them first. You can't fix everything all at once. And I prefer reasonable legislation/regulation to a parallel public system, or massive overhaul. The latter is what is making people really fucking nervous. So, if rising costs is the #1 problem, well, fine address that in isolation or with one or two other problems, but don't try to do it all - all at once.

 

[Kimmo]

as a principle, does for-profit health care cause you concern?

and, do the profits enjoyed by said companies cause you concern?

[KaskadskyjKozak]

as a principle, does for-profit health care cause you concern?

and, do the profits enjoyed by said companies cause you concern?

 

I proposed in an earlier thread/post to this thread requiring health care insurers, providers, etc to be non-profit. I think this would likely improve a lot of our problems.

[JayB]

well its more disappointing to see such an apparently bright person unable to use basic reasoning.

 

scale might be more significant than structure? no shit sherlock.

 

 

Scale is more important than structure? Interesting viewpoint - I hope that you'll expand on this point in more detail.

[KaskadskyjKozak]

as a principle, does for-profit health care cause you concern?

and, do the profits enjoyed by said companies cause you concern?

 

I proposed in an earlier thread/post to this thread requiring health care insurers, providers, etc to be non-profit. I think this would likely improve a lot of our problems.

 

Another thing. I heard some conservative critics of the Health Care reform saying that if we want more competition, then you should be able to buy insurance from an insurer in another state.

 

I recall the last time I bought insurance on my own (Jan 2007) that I was surprised by how few companies I could purchase from. It was one or two, if I recall correctly. Why the fuck is this? I assumed that only a few companies were willing to sell policies outside of an employer, but now wonder if there is some legal bullshit/gov't influence in this. Why can't I buy insurance from a company in Pennsylvania, Florida, or anywhere for that matter?

 

[JayB]

but seriously Jay. If you're going to dis the WHO report, as least be a little more responsible in your own analysis. like steven said, give us some pie charts. make real scientific analysis rather than just being the snide and sarcastic counter point to those you despise. that my job anyway. non-sequiter.

 

I'd say that actually:

 

1)Looking up the rankings.

 

2)Taking the time to read the methodology WHO used to generate them.

 

3)Noting a few of the bizarre inversions in the said rankings...

 

Comes much closer to "analysis" than people who have done none of the repeating "37th" over and over. Google away! Read the report - then we can have an informed discussion about whether or not the rankings are actually meaningful.

[KaskadskyjKozak]

as a principle, does for-profit health care cause you concern?

and, do the profits enjoyed by said companies cause you concern?

 

I proposed in an earlier thread/post to this thread requiring health care insurers, providers, etc to be non-profit. I think this would likely improve a lot of our problems.

 

And I don't consider doctors, nurses and other health care providers making a good salary the problem here. It's more on the macro scale of large corporations (insurance companies, hospitals, etc) being profit-driven and being manipulated by stock holders, boards of directors, and senior execs ("our profit was 30 billion last year - how to increase it to 35 billion,next year??")

 

 

[Kimmo]

1)Looking up the rankings.

 

2)Taking the time to read the methodology WHO used to generate them.

 

3)Noting a few of the bizarre inversions in the said rankings...

 

Comes much closer to "analysis" than people who have done none of the repeating "37th" over and over. Google away! Read the report - then we can have an informed discussion about whether or not the rankings are actually meaningful.

 

would your post above indicate support for the system as it currently stands, or simply a support for critical understanding of all viewpoints/analyses?

[JayB]

as a principle, does for-profit health care cause you concern?

and, do the profits enjoyed by said companies cause you concern?

 

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers.

 

 

[KaskadskyjKozak]

as a principle, does for-profit health care cause you concern?

and, do the profits enjoyed by said companies cause you concern?

 

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers.

 

 

Corporations seek to maximize profits. That leads to pressure from the board of directors, stakeholders, and senior management to do things like what we see today:

 

- resist payouts

- increase premium prices every year at an unsustainable rate

- establish absolute lifetime maximums (and make these smaller)

- establish guidelines on preexisting conditions - make application as difficult as possible

 

 

[olyclimber]

plus they have Capitalist Death Executives, instead of spreading the responsibility across a committee.

[JayB]

1)Looking up the rankings.

 

2)Taking the time to read the methodology WHO used to generate them.

 

3)Noting a few of the bizarre inversions in the said rankings...

 

Comes much closer to "analysis" than people who have done none of the repeating "37th" over and over. Google away! Read the report - then we can have an informed discussion about whether or not the rankings are actually meaningful.

 

would your post above indicate support for the system as it currently stands, or simply a support for critical understanding of all viewpoints/analyses?

 

I'd say that it has more to do with support for a critical understanding of the limitations of broad statistical aggregates, particularly those of of dubious quality, when engaging in comparisons of the health care in country A versus country B.

 

Life expectancy and infant mortality are two such measures that, like the WHO data, tell us very little about how any of the variables that come into play when patients are actually being treated compare from one country to the next. There are others that apply within the US, like the oft cited Dartmouth Atlas and the "X die because they lack insurance studies." The latter often compare two demographic cohorts that have massive and sustained differences in diet, excercise, education, income, etc and attribute 100% of the mortality difference between the insured and uninsured to their insurance status.

 

If your aim is to fix what's broken without destroying what works, these things matter quite a bit.

 

 

[olyclimber]

as a principle, does for-profit health care cause you concern?

and, do the profits enjoyed by said companies cause you concern?

 

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers.

 

 

you're going to the extreme there jay. its not "cheating consumers" its "maximizing share holder value". you see, it isn't all bad...because someone is winning! the shareholder. thats why the corporation exists.

 

 

 

 

[KaskadskyjKozak]

as a principle, does for-profit health care cause you concern?

and, do the profits enjoyed by said companies cause you concern?

 

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers.

 

 

 

 

 

you're going to the extreme there jay. its not "cheating consumers" its "maximizing share holder value". you see, it isn't all bad...because someone is winning! the shareholder. that why the corporation exists.

 

 

 

 

I'll repeat what I said earlier. I'm all good with a doctor making a good salary and benefits - they earned it. Ditto for his/her nurses, administrative staff, etc.

 

But I'm not good with a corporate hierarchy (or governmental one) telling the doctor how much he can/should charge to maximize profits (or implement price controls), stating what treatments are allowed and when (to control costs), etc, etc.

Edited August 19, 2009 by KaskadskyjKozak

[olyclimber]

well its more disappointing to see such an apparently bright person unable to use basic reasoning.

 

scale might be more significant than structure? no shit sherlock.

 

 

Scale is more important than structure? Interesting viewpoint - I hope that you'll expand on this point in more detail.

 

well it can be. if you're attempting to compare what works for a nation of a few hundred thousand (of a certain economic and social make up) to a country of hundreds of million on the other side of the globe with a completely different economic and social make up...thats scale...i don't think you can hardly compare the two. it doesn't even matter what structure they have. maybe that is what the WHO report is doing, but if conclusions one draws from the report don't take the complexity of scale, esp. when the differences are huge (i.e. Malta vs. the US) then structure doesn't even hardly matter.

[bstach]

so again, paging any christians in the crowd, how can you deny your fellow man esential healthcare on the grounds of his poverty or even laziness and not feel like a complete hypocrite? did lazarus have to pay for the crash-cart? did the blind dude get a bill from j.c. for the spit/mud pack and the services rendered?

 

I think everyone here agrees with your point. But instead of putting all Christians in your hyocrite basket, consider that people that are true followers of authentic religion of any stripe are actually on your side, as opposed to those who use religion to further their political goals. Thats why there will never be a shortage of religious hypocrisy. This has been going on for thousands of years. And the authentic religious practitioners rarely make news headlines.

[JayB]

as a principle, does for-profit health care cause you concern?

and, do the profits enjoyed by said companies cause you concern?

 

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers.

 

 

Corporations seek to maximize profits. That leads to pressure from the board of directors, stakeholders, and senior management to do things like what we see today:

 

- resist payouts

- increase premium prices every year at an unsustainable rate

- establish absolute lifetime maximums (and make these smaller)

- establish guidelines on preexisting conditions - make application as difficult as possible

 

 

That's certainly true - but it's difficult for them to do any of the above unless there are structural impediments to competition that prevent people from comparing company A to company B and switching, not getting their policy from company A in the first place because the word on the street is they don't cover the claims that they're legally obligated to, etc.

 

There are other variables that drive premiums higher, like an aging population, medical innovation, defensive medicine, and cost-shifting from the public onto private payers that insurance companies have little or no control over. What you typically find is that the cost of premiums is highest where the mandates that all policies offered for sale have to satisfy - like guaranteed issue - are the greatest.

 

As things stand now - in some guaranteed issue states, people who don't carry insurance can wait until they're ill to start paying premiums and drop them as soon as they've received the treatment that they need - then start all over again. The end result is that premiums go up for people who stay insured regardless of their health status, fewer people can afford the premiums, and more people go without insurance. In this case, as with those above, the shortcomings of the current regulatory model have more to do with driving up the cost of insurance than insurance companies cheating consumers. I'm sure that this happens given the incentives that you cited, but it'd be interesting to look at what percentage increase in premiums due to cheating consumers is relative to other factors.

 

Unless we have the evidence necessary to conclude that it's impossible to address the problems that you noted by some mechanism other than making profits illegal, or centrally administered price controls - it seems worthwhile to consider other options first. Simply allowing insurers to sell policies across state lines would enable millions of people who can't presently afford insurance to do so.

[Off_White]

so again, paging any christians in the crowd, how can you deny your fellow man esential healthcare on the grounds of his poverty or even laziness and not feel like a complete hypocrite? did lazarus have to pay for the crash-cart? did the blind dude get a bill from j.c. for the spit/mud pack and the services rendered?

 

Why bother?

 

"Trying to have a conversation with you would be like trying to argue with a dining room table...I have no interest in doing it."

--Barney Frank responding to a question from a woman holding a picture President Obama with an Adolf Hitler-like mustache drawn above his lip at a recent town hall meeting.

 

Here's the relevant film clip

 

[video:youtube]

[olyclimber]

lulz that clip is very popular.

[JayB]

as a principle, does for-profit health care cause you concern?

and, do the profits enjoyed by said companies cause you concern?

 

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers.

 

 

 

 

 

you're going to the extreme there jay. its not "cheating consumers" its "maximizing share holder value". you see, it isn't all bad...because someone is winning! the shareholder. that why the corporation exists.

 

 

 

 

I'll repeat what I said earlier. I'm all good with a doctor making a good salary and benefits - they earned it. Ditto for his/her nurses, administrative staff, etc.

 

But I'm not good with a corporate hierarchy (or governmental one) telling the doctor how much he can/should charge to maximize profits (or implement price controls), stating what treatments are allowed and when (to control costs), etc, etc.

 

All the more reason to develop mechanisms that keep insurers and government out of such decisions as much as possible IMO.

 

Whether it's students or patients, the best way to insure that the incentives are structured around their interest is to let them control as much of the money spent on their behalf as possible.

 

Catastophic+HSA plans with income indexed vouchers would eliminate these conflicts of interest as well as anything that I've heard proposed thus far.

[olyclimber]

 

C

 

That's certainly true - but it's difficult for them to do any of the above unless there are structural impediments to competition that prevent people from comparing company A to company B and switching, not getting their policy from company A in the first place because the word on the street is they don't cover the claims that they're legally obligated to, etc.

 

There are other variables that drive premiums higher, like an aging population, medical innovation, defensive medicine, and cost-shifting from the public onto private payers that insurance companies have little or no control over. What you typically find is that the cost of premiums is highest where the mandates that all policies offered for sale have to satisfy - like guaranteed issue - are the greatest.

 

As things stand now - in some guaranteed issue states, people who don't carry insurance can wait until they're ill to start paying premiums and drop them as soon as they've received the treatment that they need - then start all over again. The end result is that premiums go up for people who stay insured regardless of their health status, fewer people can afford the premiums, and more people go without insurance. In this case, as with those above, the shortcomings of the current regulatory model have more to do with driving up the cost of insurance than insurance companies cheating consumers. I'm sure that this happens given the incentives that you cited, but it'd be interesting to look at what percentage increase in premiums due to cheating consumers is relative to other factors.

 

Unless we have the evidence necessary to conclude that it's impossible to address the problems that you noted by some mechanism other than making profits illegal, or centrally administered price controls - it seems worthwhile to consider other options first. Simply allowing insurers to sell policies across state lines would enable millions of people who can't presently afford insurance to do so.

 

so that is the big fix? allow policies to be sold across state lines? explain or link please!

[tvashtarkatena]

as a principle, does for-profit health care cause you concern?

and, do the profits enjoyed by said companies cause you concern?

 

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers.

 

 

We don't have anything even remotely close to a system of open competition.

 

What's not being discussed here is how do we get to a system with

 

a) costs under control

b) all citizens adequately insured, and

c) patient outcomes rather than revenue the top priority

 

with as little catastrophic disruption from the present system as possible. Using as much of the pre-existing system as possible was how every first world country save the U.S. got to a fully covered populace.

 

Furthermore, all of us agree on these three objectives for a health care system.

 

Opening up competition across state lines seems like a sound idea.

 

Opening up federal insurance to all seems like an obvious winner.

 

Moving to a not-for-profit structure seems like a good idea, but it is a massive change from what we have. In addition, there are many for-profit providers that keep their costs in check because the incentives for their doctors not to milk the patients are in check. Perhaps as a long term goal, but how far out would this requirement ripple? To drug companies? To makers of medical equipment and supplies (many of which also make non-medical equipment and supplies)?

 

Ranking providers based on where they fall on the cost/outcome curve and requiring disclosure of that information both to consumers and partnering health care entities is a good idea.

 

Providing discounts to consumers for obvious healthy lifestyle choices, like not smoking, seems like a good idea, although this would have to be severely regulated to prevent it from running away and penalizing people for leading interesting lives by, say, climbing.

 

 

 

 

 

 

[olyclimber]

hhahaha the qouting got all fubar on you jay...now you're qouting me spraying your words

 

i hope they address this in the next version of the board. it got screwed up in the last upgrade (by design) and i hope they change it back to the way it was.