Health Care

[StevenSeagal]

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

 

Not surprised. He's a politician. That 3000% claim was hyperbole.

 

Not everyone is going to love this, and there is much not to love about it. But it is a process that can and should continue to evolve and amend as time goes on. I said it before, at least we are moving on it and we can work towards something that will provide equal opportunity for everyone.

 

Let's see where AT+T and others are in two years. Right now, people who have benefitted all along are naturally throwing a fit. They might have reason. We'll see.

[Fairweather]

Yes. Like the 84 PERCENT of Americans who once had good health care! Is it fair to say you're putting your ideology in front of reality?

[StevenSeagal]

FW, what do you think of the fact that the pundits driving the debate on the conservative side, a la Beck, etc., feel it necessary to remind their listeners not to use violence, "yet"? That one is reminding their listening audience not to kill people if they lose politically. How proud they must be to have this demographic as their audience. But for sensible conservatives, I would think this would be insulting and deeply disturbing.

Today Palin spoke of "taking back OUR country". If you are sensible and believe in a unified country, I would suggest that the first thing sensible conservatives need to do is take back their party from the raving lunatics. Apparently David Frum is now a libtard, as are most of George HW's and Reagan's old advisors. Who are these people speaking for the other side now?

 

[StevenSeagal]

Yes. Like the 84 PERCENT of Americans who once had good health care! Is it fair to say you're putting your ideology in front of reality?

 

ONCE had good health care. Quality of health care not to mention affordability have been declining dramatically, in case you hadn't noticed, and just because things are working out in your household doesn't mean they are for everyone else. And don't try to pull the old "they aren't working hard enough" "poor personal choices" "want something for nothing" b.s. There are a lot of hard working people who pay heavy premiums for health plans that still will yield 5 or 6 figure bills, and possible dropping of coverage, in the event of a serious illness or accident. Even the most fiscally responsible person can't absorb an incident like that. NOt to mention all the problems with denial of coverage. I cannot believe you seem to think this is not a problem.

My main issue like anyone with this bill is whether is really is affordable for the country. The general accounting office (or whatever, I forget, the nonpartisan one) says it will reduce the deficit. I'm skeptical, but we'll see.

My ideology? My ideology is nothing more than I believe that in a country like this that everyone should have equal opportunity to access health care at a rate that each person can afford according to their income. Nothing for free, but no one being left in the gutter.

[Fairweather]

In all likelihood, the Supreme Court will be the arbiter here. When did populist non-sentiment translated by Democrats usurp the Constitution in your world view? As for the blood: I spilled it on The Silver King earlier today--and it was my own.

[Fairweather]

My ideology? My ideology is nothing more than I believe that in a country like this that everyone should have equal opportunity to access health care at a rate that each person can afford according to their income.

 

EXACTLY!!! Read aloud what you just wrote.

[StevenSeagal]

My ideology? My ideology is nothing more than I believe that in a country like this that everyone should have equal opportunity to access health care at a rate that each person can afford according to their income.

 

EXACTLY!!! Read aloud what you just wrote.

 

OK, I did. What's the issue?

You don't feel the same way? You are content with insurance companies dropping coverage after the insured dares to make them do their job. Content with people paying thousands in premiums each year only to get stuck with losing their life savings anyway if they get sick or injured? Or, you just have a great plan and fuck all if others don't?

 

Or are you saying this situation already exists? Because I don't think it does. Yes many of us can afford the premiums, but to actually get sick and make a claim? Maybe you have $150,000 laying around for a rainy day sickness, but I don't, and I could live out of my car and work full time for the next 20 years and I still won't.

 

 

[Fairweather]

Obamacare doesn't leave my "great plan" alone. (See the At&T statement.) It tears down a legitimate contract that I entered into with my employer and my health care provider. It is redistribution; plain and simple. Senator Max Bacus of Montana (D) admitted as much today.

 

I am interested in your take on Obama's statement in the YouTube video I posted. Apparently you are willing to write off as "politics" a blatant lie told by our president only two days before an historic vote. No, this wasn't just politics. And you really need to reconcile the values you hold against the Constitution. We both know what the goal of Democrats is here: a first step toward single-payer.

Edited March 28, 2010 by Fairweather

[prole]

...a first step toward single-payer.

 

Bring It!

[mattp]

...a first step toward single-payer.

 

Bring It!

 

No kidding. I don't much like any mandate to buy private insurance and I was ambivalent about this legislation but maybe the fact that at least we may have strengthened the idea that healthcare for all is something the Federal government should be concerned with will lead to something better. Meanwhile, even if the Republican lawsuits seeking to strike that provision are successful we'll likely see the remainder of the Bill remains in effect. That wouldn't be all bad.

[mattp]

Fairweather,

I didn't play your video but what did Mr. O say there? As far as I am aware, the lies about this legislation were mostly from the right. Death panels, socialism, rationing, Federally funded abortion, etc. etc.

[Hugh Conway]

In all likelihood, the Supreme Court will be the arbiter here. When did populist non-sentiment translated by Democrats usurp the Constitution in your world view? As for the blood: I spilled it on The Silver King earlier today--and it was my own.

 

Activist judiciary!

 

Faggots falling on the king!

[AlpineK]

...a first step toward single-payer.

 

Bring It!

 

Single payer gets my vote. In reality with the political climate we have I'm skeptical it could have passed.

 

The current bill brings out the racist/anti gay side of Teabaggers. A single payer system would probably inspire them to break out their firearms.

 

Incidentally StevenSeagals figure of $150,000 is a very low figure. Without insurance I amassed about 4 million dollars in medical expenses.

[prole]

The current bill brings out the racist/anti gay side of Teabaggers. A single payer system would probably inspire them to break out their firearms.

 

I'm not sure that would be such a bad thing. In the age of the 12-hour news cycle, we tend to forget that as a nation we've seen all this before. We should not let the threat of terrorism deter us from creating a more just, more democratic society. We have much to learn from the folks who had the courage to continue the march in the face of police dogs, firebombs, lynchings, and beatings from the teabaggers of yesteryear.

 

[StevenSeagal]

http://www.nytimes.com/2010/03/26/opinion/26krugman.html

[Pete_H]

The way I understand it is that companies with over than 50 employees will be required to provide insurance to their employees; companies with under 50 get tax breaks if they do but aren't required.

 

One pitfall I can see is that this plan may cause companies to hire more workers as 1099 contractors instead of as employees in order to avoid paying them benefits. Does anyone know if the bill addresses this problem at all?

[Fairweather]

Without insurance I amassed about 4 million dollars in medical expenses.

 

...no insurance, and yet you received good care? How can this be!

[Fairweather]

 

Faggots falling on the king!

 

Prole? Feck? Segal? Where is the outrage at this statement?

[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?

 

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.

 

The latest quarterly figures for the sector are here:

http://biz.yahoo.com/ic/522.html

 

Scroll down on the right, and look under "Net Profit Margin." The figure there is 4.4%.

 

In the latest ranking of industry profits I could find, circa 2009, Health care plans ranked 86th, a couple of notches below "Packaging and Containers."

 

http://1.bp.blogspot.com/_otfwl2zc6Qc/SuIFQY6zybI/AAAAAAAALwo/IK1ddRvAqhA/s1600-h/profitmargins.jpg

 

It's clear that the CEO's of health insurance companies get paid a ton of money. As is the case with any private sector job that pays a ton of money, the question isn't why they are willing to accept millions of dollars in compensation, it's why the folks who own the enterprises are willing to offer it to them in exchange for running the companies that they own. I'll leave you to ponder that.

 

In the meantime - lets focus on the concrete impact that executive compensation has on the price and availability of health care. If you took total compensation paid to executives, reduced it to zero forever - how many days worth of total health spending could you fund in the US? As a driver of cost increases, where does rising executive compensation fall next to obesity, aging, etc? I'll help you out by noting that the health insurance companies aggregate profits would fund about ~ 2 days worth of the national health bill.

 

 

[StevenSeagal]

Without insurance I amassed about 4 million dollars in medical expenses.

 

...no insurance, and yet you received good care? How can this be!

 

is this really the best you can do? So this is an example of the greatness of our system? Who picked up the bill on this? Is this a sustainable model?

 

Fairweather I sincerely hope your health care plan remains unaffected. Has your employer indicated otherwise?

 

Conservative philosophy suggests that those who work hard and do extraordinary things are rewarded for it. If only this were a universal truth. Apart from being educated and having dedication to your work, did you do something extraordinary to land such a good benefit package? Or was it timing, luck, and circumstance? When it comes to health care, why shouldn't every citizen have the same circumstances? Every single society except ours has already gone that direction. Our system is failing as it stands, and it astonishes me that you would be just fine with a completely disfunctional, unsustainable, and inequitable system so long as it continues to work for you. You don't even want to entertain the idea of trying to make it work for everyone.

 

We're not talking about giving people a free living; we're talking about the health and well being of the population- I think there's a distinction.

[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).

 

 

 

 

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.

 

You're the one with the single-metric focus here, kemosabe. Not me.

 

Your claim seemed to be that eliminating marginal differences in administrative costs between would automatically translate into better health care for all by improving "efficiency." I'd be happy to continue that argument for as long as you want to persist in it, but you understandably seem anxious to change the topic.

 

Dead in France? Non, mon ami. Mon Dieu! I do think that any aggregate advantage that the French enjoy in life expectancy has very little, if anything to do with their doctors and hospitals doing a better job, and everything to do with the fact that they take better care of themselves.

 

If you actually look at the life-expectancy rankings from time to time, you'll notice that the differences in life expectancy are:

 

1) Small.

2) Not terribly well related to the clinical efficacy of the care that their doctors and hospitals deliver. Denmark - 78.3. Albania - 77.96. 0.34 * 365 = 124.1 days. (124.1/(365*78.3)*100 = 0.43%

The Danes spend a gazillion times more on their health care and only manage to eke out 0.43% more life than the Albanians.

 

What's the take away here? For me - it's that once you have the rudiments of sanitation and vaccination in place - longevity stats aren't a terribly good basis for making comparative assessments of either the efficacy or efficiency of health care systems. For most of the folks here, it's that Denmark clearly isn't getting much bang for it's health care buck, and it's high time they incorporated the clinical and administrative insights at the heart of the Albanian efficiency miracle into their own system.

 

I wish this was hyperbole, but the the above exercise is no less ludicrous than the claims made by everyone that trots out the infant-mortality/life-expectancy/WHO statistical troika and uses them as a basis to claim that our health care system inferior to country X.

 

All of this will matter a great deal for the 30+ million people who currently lack insurance, and for the 270 odd million people who currently have insurance. That'll be a much more interesting and productive conversation. I can think of lots of topics.

 

-What will happen to the remaining uninsured (illegal immigrants, transients, etc) who rely on hospitals that receive "disproportionate share funding"?

 

-What will happen if the proposed medicare cuts actually go through and even fewer doctors accept medicare patients?

 

-Who will treat all of the new Medicaid patients, since doctors lose money every time they walk in the door, and how will the already bankrupt states foot their share of the bill?

 

Etc, etc, etc, etc.....

 

 

 

 

 

 

 

[StevenSeagal]

 

Faggots falling on the king!

 

Prole? Feck? Segal? Where is the outrage at this statement?

 

My anguish and outrage at this malicious and clearly diabolical, unsatirical remark has been overturned entirely by the joy at seeing your embrace of gay rights. I signed you up for a weekly newsletter from the Tacoma chapter of the Log Cabin Republicans, hope you don't mind.

[KaskadskyjKozak]

 

Faggots falling on the king!

 

Prole? Feck? Segal? Where is the outrage at this statement?

 

It's only homophobic if a Tea Party rally participant says it.

[JayB]

My ideology? My ideology is nothing more than I believe that in a country like this that everyone should have equal opportunity to access health care at a rate that each person can afford according to their income.

 

EXACTLY!!! Read aloud what you just wrote.

 

OK, I did. What's the issue?

You don't feel the same way? You are content with insurance companies dropping coverage after the insured dares to make them do their job. Content with people paying thousands in premiums each year only to get stuck with losing their life savings anyway if they get sick or injured? Or, you just have a great plan and fuck all if others don't?

 

Or are you saying this situation already exists? Because I don't think it does. Yes many of us can afford the premiums, but to actually get sick and make a claim? Maybe you have $150,000 laying around for a rainy day sickness, but I don't, and I could live out of my car and work full time for the next 20 years and I still won't.

 

 

Where were you shopping for insurance? I think we've got about the same age and health status. Catastrophic coverage in Washington was cheap. Ditto for excess major medical insurance that kicks in when you exceed the limits on your primary policy. And Hasn't it been illegal to rescind coverage for illness since HIPAA in '96. Ditto for denial of coverage in group plans?

 

Since we're on the topic, if you're worried about going broke after a medical catastrophe, you should really look into getting adequate personal disability coverage if you're the main earner in your household or you are part of a household that needs both incomes to stay afloat. Even if you don't pay a cent in medical bills, the loss of income can easily put you and or your family under.

 

Probably costs quite a bit more than catastrophic insurance, but well worth it IMO. I'm amazed that neither I nor my wife even thought about this until we were in our early thirties.

 

 

[Fairweather]

What you propose would require Master Segal, Prole, et al to take on a degree of responsibility for their own lives. Clearly it is easier for them to give up yet more freedom in exchange for an additional modicum of security--compliments of a presently benevolent government.