Health Care

[JayB]

I'm moderately relieved that there are people on the left like Tvash who are marginally concerned with the expansion of state power entailed in the entailed in the purchase-or-penalty scheme...

 

Yeah, the "left" has been skeptical of this scheme all along. It was a sop to the insurance industry as a way to spread its risk across the entire population in lieu of a single payer program. As if you didn't know this already...

 

As a fan of the state, you should be thrilled that they've got the insurance companies out front as flack catchers for the backlash that will erupt when the time comes to impose the hard rationing that will be necessary to balance health care costs with health care spending.

 

Think of the kings and tax farmers of yore. If you're sitting on the throne and need to squeeze the people for more revenues, popular anger at the tax-farmers you've contracted with to turn the screws is far preferable to having it directed at the crown.

[olyclimber]

with any system, the screws are turned. the only difference is who is turning the screws.

[tvashtarkatena]

A single payer government monopoly is just what we need to bring health care costs down. What we don't need is a clusterfuck of competing companies merging, going out of business, scamming their customers, and generally fucking us over any way they can to please their constituency, which isn't us. Private companies are great if you want a new widget. Health care billing is certainly not that, nor should it be. Health care billing should be standardized, predictable, boring, and largely invisible to providers and patients alike. Why this is a huge industry in this country and practically no where else is utterly beyond me.

 

There's a difference between prices and costs. Government can enact legislation that puts caps on prices, but it can't control the gazillion factors beyond its control that determine what it actually costs to make things or bring services to the market. Government can cap the price of milk at 1$ a gallon, but hard as it may try, it can never control the real cost of all of the inputs that go into producing the said gallon of milk. When the real cost exceeds the price the government sets, then farmers stop producing it. If they're forced to keep delivering it they'll degrade the quality as much as possible in an effort to stay afloat you probably won't want to drink it.

 

Health care is no different. Governments can control the price of delivering healthcare, but they can't control the cost of doing so, much less the demand for it.

 

As of right now, something like 86% percent of all premiums are used to pay for goods and services, and the profit margins run around 2.2%. When you control for the real cost of Medicare, most of the efficiencies disappear.

 

Even if there is a real margin there, the notion that it holds the key to making healthcare more effective is difficult to comprehend. The right way to value the efficiency of health care is to divide the benefit to the patient over the total cost of delivering it. What really matters is the numerator, and of the components that make up the denominator, the .1 to 0.05 that's in play in the "administrative efficiency" component aren't terribly significant.

 

When you actually look at major drivers of total health costs, the obsessive parsing of marginal differences in administrative costs is even more puzzling. The nation is getting older and fatter, and the number of pills and devices at our disposal to address the health consequences of both is continuously expanding. You can scale administrative infrastructure pretty easily without spending much more money. This is not true for delivery - whether it's CT scanners or bariatric surgeons.

 

I suspect that before long the illusion that it's private sector administrative expenses that are driving up the national tab for health-care will vanish, and then the conversation about how to best contain them will start to get very interesting.

 

You've missed the cost savings entirely. Other countries are currently, right now, enjoying a 12% discount due to lower admin/billing costs. Right now. It's not theory, it's not idle CC chat, its reality.

[prole]

I'm moderately relieved that there are people on the left like Tvash who are marginally concerned with the expansion of state power entailed in the entailed in the purchase-or-penalty scheme...

 

Yeah, the "left" has been skeptical of this scheme all along. It was a sop to the insurance industry as a way to spread its risk across the entire population in lieu of a single payer program. As if you didn't know this already...

 

As a fan of the state, you should be thrilled that they've got the insurance companies out front as flack catchers for the backlash that will erupt when the time comes to impose the hard rationing that will be necessary to balance health care costs with health care spending.

 

Think of the kings and tax farmers of yore. If you're sitting on the throne and need to squeeze the people for more revenues, popular anger at the tax-farmers you've contracted with to turn the screws is far preferable to having it directed at the crown.

 

Once again, this nightmare scenario has played itself out time after time in each and every one of the countries that have adopted universal systems. Do you folks do anything but FEAR anymore?

[Jim]

What? The use of multitude private insurance companies, each inefficient in their own profit grubbing way, and collectively a nightmare, don't contribute to health care costs?

 

Just look around the world - Germany, Japan, Tawian, France, for any number of different models that are working much better, and cheaper, than ours while delivering more and better service.

[JayB]

A single payer government monopoly is just what we need to bring health care costs down. What we don't need is a clusterfuck of competing companies merging, going out of business, scamming their customers, and generally fucking us over any way they can to please their constituency, which isn't us. Private companies are great if you want a new widget. Health care billing is certainly not that, nor should it be. Health care billing should be standardized, predictable, boring, and largely invisible to providers and patients alike. Why this is a huge industry in this country and practically no where else is utterly beyond me.

 

There's a difference between prices and costs. Government can enact legislation that puts caps on prices, but it can't control the gazillion factors beyond its control that determine what it actually costs to make things or bring services to the market. Government can cap the price of milk at 1$ a gallon, but hard as it may try, it can never control the real cost of all of the inputs that go into producing the said gallon of milk. When the real cost exceeds the price the government sets, then farmers stop producing it. If they're forced to keep delivering it they'll degrade the quality as much as possible in an effort to stay afloat you probably won't want to drink it.

 

Health care is no different. Governments can control the price of delivering healthcare, but they can't control the cost of doing so, much less the demand for it.

 

As of right now, something like 86% percent of all premiums are used to pay for goods and services, and the profit margins run around 2.2%. When you control for the real cost of Medicare, most of the efficiencies disappear.

 

Even if there is a real margin there, the notion that it holds the key to making healthcare more effective is difficult to comprehend. The right way to value the efficiency of health care is to divide the benefit to the patient over the total cost of delivering it. What really matters is the numerator, and of the components that make up the denominator, the .1 to 0.05 that's in play in the "administrative efficiency" component aren't terribly significant.

 

When you actually look at major drivers of total health costs, the obsessive parsing of marginal differences in administrative costs is even more puzzling. The nation is getting older and fatter, and the number of pills and devices at our disposal to address the health consequences of both is continuously expanding. You can scale administrative infrastructure pretty easily without spending much more money. This is not true for delivery - whether it's CT scanners or bariatric surgeons.

 

I suspect that before long the illusion that it's private sector administrative expenses that are driving up the national tab for health-care will vanish, and then the conversation about how to best contain them will start to get very interesting.

 

You've missed the cost savings entirely. Other countries are currently, right now, enjoying a 12% discount due to lower admin/billing costs. Right now. It's not theory, it's not idle CC chat, its reality.

 

For the sake of argument - let's take your figure as granted.

 

If all we were concerned with was administrative efficiency, the argument would be over. If we're concerned with what actually happens to patients, the analysis is more complicated.

 

Then we have to look at what treatment the patient receives, and the net positive effect on their health. In a world where administrative costs trump all, there's no difference between no treatment, a treatment that makes the patient 0.1% better, and one that makes them 100% better. Once you start caring about the clinical efficacy of a given treatment, then you reduce administrative costs to a minor sub-component of the "cost" denominator in a true measurement of medical efficiency. E.g.

 

Efficiency =(Health Benefit/cost of doctors+nurses+imaging+devices+drugs+etc, etc, etc, etc + administrative costs).

 

 

 

 

[Jim]

IMO - I'm not arguing that you don't have a valid point about the other end of efficiency and patitent care - it's just that you're ignoring the elephant in the room, which is the current insurance mess and lack of coverage for all. THAT is not going to be addressed with the current system. My recommendation:

 

Either singer payer or limited insurance companies with cap of 4% profit.

 

Standard prices for all procedures.

 

 

 

 

[JayB]

What? The use of multitude private insurance companies, each inefficient in their own profit grubbing way, and collectively a nightmare, don't contribute to health care costs?

 

Just look around the world - Germany, Japan, Tawian, France, for any number of different models that are working much better, and cheaper, than ours while delivering more and better service.

 

Jim - you keep trotting these claims out - and when the time comes to separate lifestyle factors and registration artifacts from things that doctors, nurses, and hospitals can actually do something about you seem to disappear.

 

I hope you aren't going to use the infant mortality and life expectancy stats again to try to make this case, since adult life expectancy tells you nothing about the clinical efficacy of care when you are comparing one advanced country to another (life expectancy is high everywhere these days, and death by accidents, suicides, etc generate most of the variance), and infant mortality is defined and measured very differently from one country to the next.

 

Even metrics that seem relatively straightforward when you are comparing clinical outcomes for the same disease, etc can be compromised by selection bias in the patient pool. That is - one country may go forward with treatment that another country would rule out on the basis that it'd most likely be futile for the patient in question. In this case, the outcomes might be worse for the first country simply because the patients that they're treating are sicker, on average.

 

Anyhow - bring out your stats and we can have an interesting discussion.

[JayB]

IMO - I'm not arguing that you don't have a valid point about the other end of efficiency and patitent care - it's just that you're ignoring the elephant in the room, which is the current insurance mess and lack of coverage for all. THAT is not going to be addressed with the current system. My recommendation:

 

Either singer payer or limited insurance companies with cap of 4% profit.

 

Standard prices for all procedures.

 

 

 

 

Gotta go - but you realize that a giant chunk of the insurers are non-profit, and that profits at for profit health insurance companies has been something like ~2.2% on average for the past few years?

[Jim]

IMO - I'm not arguing that you don't have a valid point about the other end of efficiency and patitent care - it's just that you're ignoring the elephant in the room, which is the current insurance mess and lack of coverage for all. THAT is not going to be addressed with the current system. My recommendation:

 

Either singer payer or limited insurance companies with cap of 4% profit.

 

Standard prices for all procedures.

 

 

 

 

Gotta go - but you realize that a giant chunk of the insurers are non-profit, and that profits at for profit health insurance companies has been something like ~2.2% on average for the past few years?

 

I'd like to see that statistic from a reliable source. And of course profit does not include CEO compensation. For a taste of that go here: http://www.fiercehealthcare.com/special-reports/total-package-health-plan-ceo-compensations-2008

 

So CGNA might post a 5% profit but pays over $12M to its CEO and another $50M+ for a handful of other executives. My heart aches for them.

[tvashtarkatena]

A single payer government monopoly is just what we need to bring health care costs down. What we don't need is a clusterfuck of competing companies merging, going out of business, scamming their customers, and generally fucking us over any way they can to please their constituency, which isn't us. Private companies are great if you want a new widget. Health care billing is certainly not that, nor should it be. Health care billing should be standardized, predictable, boring, and largely invisible to providers and patients alike. Why this is a huge industry in this country and practically no where else is utterly beyond me.

 

There's a difference between prices and costs. Government can enact legislation that puts caps on prices, but it can't control the gazillion factors beyond its control that determine what it actually costs to make things or bring services to the market. Government can cap the price of milk at 1$ a gallon, but hard as it may try, it can never control the real cost of all of the inputs that go into producing the said gallon of milk. When the real cost exceeds the price the government sets, then farmers stop producing it. If they're forced to keep delivering it they'll degrade the quality as much as possible in an effort to stay afloat you probably won't want to drink it.

 

Health care is no different. Governments can control the price of delivering healthcare, but they can't control the cost of doing so, much less the demand for it.

 

As of right now, something like 86% percent of all premiums are used to pay for goods and services, and the profit margins run around 2.2%. When you control for the real cost of Medicare, most of the efficiencies disappear.

 

Even if there is a real margin there, the notion that it holds the key to making healthcare more effective is difficult to comprehend. The right way to value the efficiency of health care is to divide the benefit to the patient over the total cost of delivering it. What really matters is the numerator, and of the components that make up the denominator, the .1 to 0.05 that's in play in the "administrative efficiency" component aren't terribly significant.

 

When you actually look at major drivers of total health costs, the obsessive parsing of marginal differences in administrative costs is even more puzzling. The nation is getting older and fatter, and the number of pills and devices at our disposal to address the health consequences of both is continuously expanding. You can scale administrative infrastructure pretty easily without spending much more money. This is not true for delivery - whether it's CT scanners or bariatric surgeons.

 

I suspect that before long the illusion that it's private sector administrative expenses that are driving up the national tab for health-care will vanish, and then the conversation about how to best contain them will start to get very interesting.

 

You've missed the cost savings entirely. Other countries are currently, right now, enjoying a 12% discount due to lower admin/billing costs. Right now. It's not theory, it's not idle CC chat, its reality.

 

For the sake of argument - let's take your figure as granted.

 

If all we were concerned with was administrative efficiency, the argument would be over. If we're concerned with what actually happens to patients, the analysis is more complicated.

 

Then we have to look at what treatment the patient receives, and the net positive effect on their health. In a world where administrative costs trump all, there's no difference between no treatment, a treatment that makes the patient 0.1% better, and one that makes them 100% better. Once you start caring about the clinical efficacy of a given treatment, then you reduce administrative costs to a minor sub-component of the "cost" denominator in a true measurement of medical efficiency. E.g.

 

Efficiency =(Health Benefit/cost of doctors+nurses+imaging+devices+drugs+etc, etc, etc, etc + administrative costs).

 

 

 

 

Administrative costs trump all? Never said that, but idealize the argument (consider the spherical chicken...old engineer joke) to put it in a lab box if you need to.

 

You seem to be ready to trot out the old 'you'd be dead in France' line. Spare us.

 

And for the 30 + million Americans who aren't covered at all, none of what you just posted matters at all.

[sirwoofalot]

The facts are simple.

 

Obama is a Socialist. You can wrap him in as many layers of sheep’s clothing as you wish. Look up Fabian Socialist and you will understand.

 

Socialism does not work.

Examples are:

Russia

Cuba

China

North Korea.

 

The new health care is Socialized Medicine and one giant leap forward for the Fabian socialist.

 

That’s it I’m done, I’m out of here.

 

[Fairweather]

http://abcnews.go.com/Technology/wireStory?id=10212257

 

"AT&T Inc. will take a $1 billion non-cash accounting charge in the first quarter because of the health care overhaul and may cut benefits it offers to current and retired workers. The charge is the largest disclosed so far. Earlier this week, AK Steel Corp., Caterpillar Inc., Deere & Co. and Valero Energy announced similar accounting charges, saying the health care law that President Barack Obama signed Tuesday will raise their expenses. On Friday, 3M Co. said it will also take a charge of $85 million to $90 million..."

 

[prole]

http://abcnews.go.com/Technology/wireStory?id=10212257

 

"AT&T Inc. will take a $1 billion non-cash accounting charge in the first quarter because of the health care overhaul and may cut benefits it offers to current and retired workers. The charge is the largest disclosed so far. Earlier this week, AK Steel Corp., Caterpillar Inc., Deere & Co. and Valero Energy announced similar accounting charges, saying the health care law that President Barack Obama signed Tuesday will raise their expenses. On Friday, 3M Co. said it will also take a charge of $85 million to $90 million..."

 

Where is that public option when you really need it?

[KaskadskyjKozak]

That’s it I’m done, I’m out of here.

 

You on the same flight with Rush?

[StevenSeagal]

That’s it I’m done, I’m out of here.

 

You on the same flight with Rush?

 

 

He would be, but there's no room on the flight- weight restrictions, and all...

[Fairweather]

http://abcnews.go.com/Technology/wireStory?id=10212257

 

"AT&T Inc. will take a $1 billion non-cash accounting charge in the first quarter because of the health care overhaul and may cut benefits it offers to current and retired workers. The charge is the largest disclosed so far. Earlier this week, AK Steel Corp., Caterpillar Inc., Deere & Co. and Valero Energy announced similar accounting charges, saying the health care law that President Barack Obama signed Tuesday will raise their expenses. On Friday, 3M Co. said it will also take a charge of $85 million to $90 million..."

 

Where is that public option when you really need it?

 

Didn't Obama promise a "three thousand percent" reduction in corporate health care costs pre-passage? More lies from a fucking socialist. No surprise.

[Hugh Conway]

IMO - I'm not arguing that you don't have a valid point about the other end of efficiency and patitent care - it's just that you're ignoring the elephant in the room, which is the current insurance mess and lack of coverage for all. THAT is not going to be addressed with the current system. My recommendation:

 

Either singer payer or limited insurance companies with cap of 4% profit.

 

Standard prices for all procedures.

 

 

 

 

Gotta go - but you realize that a giant chunk of the insurers are non-profit, and that profits at for profit health insurance companies has been something like ~2.2% on average for the past few years?

 

non profit meaning build vast executive temples, lavish them with benefits, and pay them handsomely?

[layton]

Rush is gonna have to live in a pretty shitty country since every major industrialized country has a socialized version of healthcare.

[Phil K]

http://abcnews.go.com/Technology/wireStory?id=10212257

 

"AT&T Inc. will take a $1 billion non-cash accounting charge in the first quarter because of the health care overhaul and may cut benefits it offers to current and retired workers. The charge is the largest disclosed so far. Earlier this week, AK Steel Corp., Caterpillar Inc., Deere & Co. and Valero Energy announced similar accounting charges, saying the health care law that President Barack Obama signed Tuesday will raise their expenses. On Friday, 3M Co. said it will also take a charge of $85 million to $90 million..."

 

Where is that public option when you really need it?

 

Didn't Obama promise a "three thousand percent" reduction in corporate health care costs pre-passage? More lies from a fucking socialist. No surprise.

 

Up to your old tricks again I see, you lying sack. Let's see your source for this one.

[prole]

 

Mitt Romney, Socialist.

 

New health insurance requirement ... was GOP idea

 

WASHINGTON – Republicans were for President Barack Obama's requirement that Americans get health insurance before they were against it.

 

The obligation in the new health care law is a Republican idea that's been around at least two decades. It was once trumpeted as an alternative to Bill and Hillary Clinton's failed health care overhaul in the 1990s. These days, Republicans call it government overreach.

 

Mitt Romney, weighing another run for the GOP presidential nomination, signed such a requirement into law at the state level as Massachusetts governor in 2006. At the time, Romney defended it as "a personal responsibility principle" and Massachusetts' newest GOP senator, Scott Brown, backed it. Romney now says Obama's plan is a federal takeover that bears little resemblance to what he did as governor and should be repealed.

 

Republicans say Obama and the Democrats co-opted their original concept, minus a mechanism they proposed for controlling costs. More than a dozen GOP attorneys general are determined to challenge the requirement in federal court as unconstitutional.

 

Starting in 2014, the new law will require nearly all Americans to have health insurance through an employer, a government program or by buying it directly. That year, new insurance markets will open for business, health plans will be required to accept all applicants and tax credits will start flowing to millions of people, helping them pay the premiums.

 

Those who continue to go without coverage will have to pay a penalty to the IRS, except in cases of financial hardship. Fines vary by income and family size. For example, a single person making $45,000 would pay an extra $1,125 in taxes when the penalty is fully phased in, in 2016.

 

Conservatives today say that's unacceptable. Not long ago, many of them saw a national mandate as a free-market route to guarantee coverage for all Americans — the answer to liberal ambitions for a government-run entitlement like Medicare. Most experts agree some kind of requirement is needed in a reformed system because health insurance doesn't work if people can put off joining the risk pool until they get sick.

 

In the early 1970s, President Richard Nixon favored a mandate that employers provide insurance. In the 1990s, the Heritage Foundation, a conservative think tank, embraced an individual requirement. Not anymore.

 

"The idea of an individual mandate as an alternative to single-payer was a Republican idea," said health economist Mark Pauly of the University of Pennsylvania's Wharton School. In 1991, he published a paper that explained how a mandate could be combined with tax credits — two ideas that are now part of Obama's law. Pauly's paper was well-received — by the George H.W. Bush administration.

 

"It could have been the basis for a bipartisan compromise, but it wasn't," said Pauly. "Because the Democrats were in favor, the Republicans more or less had to be against it."

 

Obama rejected a key part of Pauly's proposal: doing away with the tax-free status of employer-sponsored health care and replacing it with a standard tax credit for all Americans. Labor strongly opposes that approach because union members usually have better-than-average coverage and suddenly would have to pay taxes on it. But many economists believe it's a rational solution to America's health care dilemma since it would raise enough money to cover the uninsured and nudge people with coverage into cost-conscious plans.

 

Romney's success in Massachusetts with a bipartisan health plan that featured a mandate put the idea on the table for the 2008 presidential candidates.

 

Democrat Hillary Rodham Clinton, who failed in the 1990s to require employers to offer coverage, embraced the individual requirement, an idea advocated by her Republican opponents in the earlier health care debate.

 

"Hillary Clinton believed strongly in universal coverage," said Neera Tanden, her top health care adviser in the 2008 Democratic campaign. "I said to her, 'You are not going to be able to say it's universal coverage unless you have a mandate.' She said, 'I don't want to run unless it's universal coverage.'"

 

Obama was not prepared to go that far. His health care proposal in the campaign required coverage for children, not adults. Clinton hammered him because his plan didn't guarantee coverage for all. He shot back that health insurance is too expensive to force people to buy it.

 

Obama remained cool to an individual requirement even once in office. But Tanden, who went on to serve in the Obama administration, said the first sign of a shift came in a letter to congressional leaders last summer in which Obama said he'd be open to the idea if it included a hardship waiver. Obama openly endorsed a mandate in his speech to a joint session of Congress in September.

 

It remains one of the most unpopular parts of his plan. Even the insurance industry is unhappy. Although the federal government will be requiring Americans to buy their products — and providing subsidies worth billions — insurers don't think the penalties are high enough.

 

Tanden, now at the Center for American Progress, a liberal think tank, says she's confident the mandate will work. In Massachusetts, coverage has gone up and only a tiny fraction of residents have been hit with fines.

 

Brown, whose election to replace the late Democratic Sen. Edward M. Kennedy almost led to the collapse of Obama's plan, said his opposition to the new law is over tax increases, Medicare cuts and federal overreach on a matter that should be left up to states. Not so much the requirement, which he voted for as a state lawmaker.

 

"In Massachusetts, it helped us deal with the very real problem of uncompensated care," Brown said.

Edited March 27, 2010 by prole

[Crux]

Of course, as the article posted by Prole makes clear, the mandate requiring everybody to have insurance is another idea from the big-government, tell-people-what-they gotta-do-folks, the Republicans. It might seem paradoxical that the Republicans now unanimously oppose the plan, until one remembers these people have moved so far to the political right that even the Democratic party, a somewhat conservative political entity, now seems leftist by comparison.

[Fairweather]

 

Didn't Obama promise a "three thousand percent" reduction in corporate health care costs pre-passage? More lies from a fucking socialist. No surprise.

 

Up to your old tricks again I see, you lying sack. Let's see your source for this one.

 

Right from the horse's mouth, shitbag. It's at 1:23--this may help with your attention problem:

[video:youtube]

 

BTW: is your brand of VooDoo covered under this bill?

[StevenSeagal]

Spilled anyone's blood on that tree, yet?

[Fairweather]

What do you think of the AT&T announcement in light of Obama's pledge?