US reform of healthcare. Good or bad?

Sounds nice but for the middle class taxing the rich, not paying for public services whether used or not is a better proposition.

Thanks

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Sounds like theft to me.:shrug:

No problem; so you must agree with my ideas about the merits of dictatorship, then, huh?

 

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That way robinhood was an infamous villain

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As a pragmatic, no.

 

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When you guys quote the CBO, you're only talking about the first 10 years immediately after the bill is passed. Even if this bill miraculously comes in to reduce the deficit by $1 after the first decade, remember that the first 3-4 years contributed next to no spending (2%) to the total cost. Nearly all of the spending (98%) comes in after 2014. If you'd like to look at the real cost of this when it's fully up and running, start measuring the costs in 2014 an then stop a decade after THAT. You don't get the oft-quoted $871 billion; instead you get a mind numbing $2.4 trillion (also from the CBO). Please explain to me how that is "budget-neutral".

Secondly, one of the largest things that is driving up healthcare costs are lawsuits - an issue which, as far as I can tell, isn't even touched by this bill. A doctor I know pays over $1 million a year in malpractice insurance, and he's never even been sued before. Even cut that by 25% and you start making up some pretty big figures.

There's no denying that American healthcare is expensive and there's no denying that something does need to change, but let's not misconstrue what this bill is doing as "healthcare reform" -- call it what it is: health insurance reform. Ironically, the senate/house can't even successfully reform that: most figures indicate that this bill will cause insurance costs to skyrocket as well(anywhere from 105% to 178%+).

Finally, when you thought that they couldn't fail reform any more than they are, you start looking at all of the bullshit "pork" that these senators stuff in at the last moment (ie: 400 page amendments) and then force a vote the next day at 1am. It's enough to make anyone sick.

I don't see how anyone can have any faith in the government "helping" anyone after they continuously and religiously produce legislation this complex, convoluted and ineffective.

http://online.wsj.com/article/SB10001424052748704254604574614043538946528.html
http://online.wsj.com/article/SB10001424052748704398304574598130440164954.html

 

In the second decade the savings are estimated to be even larger than the first decade. But the CBO is reluctant to score that far into the future. Two, I would like to challenge you to identify that which you claim is pork in this bill and then compare that to the Mediare Prescription Drug bill of 2003 passed by Republicans and signed into law by a Republican president.

Three, malpractice liability reform is not the solution nor is it the problem. All estimates I have seen show that torts/malpractice costs are small fraction of one percent of all money paid to physicians. It is not at all signficant.

So then then the typical tort arguement moves on to the threat of malpractice causing physicians to order a bunch of unneeded tests...which I find a difficult claim to believe too. Because in order for a physician to become professionally liable they must demonstrate that they have acted unreasonably. If a physicians follows accepted standards, there is no liability issue, no need to order unneeded tests or proceedures. And if you can isolate the unneeded tests, how do you know the tests were not ordered to increase the financial reward for the provider- the physicians pay check. I would like to see some study on this issue. The only study I have seen thus far on the issue, is that when physicians are rewarded based on proceedures and tests they tend to order more proceedures and tests and not becasuse of liabiltiy issues. Under the current system there is certianly a strong incentive to charge a lot (more proceedures) to those who can afford to pay.

Now malpractice liability insurance premiums may be rising faster than the professions would like. But is that because of increasing malpractice or is it because the insurance industry is acting as a trust (oligopoly or monopoly)? I think the solutions to professional malpractice claims (tort reform) are better standards (healthcare), infrastructure and a competitive insurance industry and not tort reform (making malpractice more acceptable).

http://www.centerjd.org/air/pr/AIRhealthcosts.pdf

I look forward to proof from you that malpractice liability insurance is the largest cause for expensive healthcare in the US. Are American doctors that bad that they are driving malpractice claims to unprecidented levels? If so, then we need to focus on improving the quality of physicans in the US, not prohibiting physicians from compensating those they damage. Courts in the US already have ways of dealing with frivilous law suits, wittness what happened to the "birthers". They got a healthy fine for filling their silly law suits.

I think if you will look into the admendment issue, it is the Republians who are responsible for most of them and I would love to see some non biased study to support your claims that the current heatlhcare reform bills in congress will cause the average healthcare premium to rise. Health insurance premiums have been increasing year after year for decades, so there is nothing new in seeing health insurance premiums rise.

And if health insurance premiums do rise with healthcare reform, compare that to what the rates would be without healthcare reform legislation. I suspect both will rise at least initially. The real question is which event will cause an even greater rise in premiums. I suspect that the do nothing approach or the Republican approach will yield even higher premiums as there is nothing in those programs that make healthcare in the US more competitive and competition is the bottom line to lower healthcare costs. And the current Senate healthcare bill falls short on the competition front as well, but at least it is a start. If the insurance industry and the heatlchare industry cannot be forced to face free markets, then they need to be regulated as oligopolies. And I don't like the idea of perpetual regulation of these industries.

There is already to much healthcare supply manipulation and market manipulation going on by the industry and for the industry. It is high time the consumer has a seat at the table.

When we have physicians competing for my business rather than picking and choosing their patients, then I will know that we have a competitive healthcare industry in the US.

If you are concerned about the early morning vote, I think you should talk to the Republicans who held up the vote with every parlimentary proceedure available to them. Additionally, it is not without precident. Republicans did something similar a few years ago when they pushed through the Medicare Prescription Drug bill in 2003 - a big budget breaker that the Republicans did not even attempt to fund with increased taxes or spending reductions.

Republicans even held the vote open until they had enough pork (special deals) to get an afirmative vote...getting senators to change their votes with pork and getting other favors from the industry. Now contrast that the to the Democrats and the Senate healthcare reform voting on Monday. The vote took less than 15 minutes and no votes were reversed. Democrats did not hold the voting open until they could bribe enough people to change their votes like the Republicans did in 2003. Funny I did not hear any Republcians claiming that Medicare Prescription Drug program made them sick in 2003.

One final point, the WSJ stopped being a credible journal when Rupper Murdock, father of Fox News, picked it up. It is now just another political rag for the right wing. I am a big capitalist. I believe in free markets. And I think private enterprize leaning on government to restrict their markets from open competition as is the case with the healthcare and insurance industry is the lowest of the low...scumbag territory. There is no reason why it should be illegal for me or anyone to buy prescription drugs from outside the country.

Since our system of government is not able to prevent these abuses of power because of the complexity of our laws (federal, state and local laws) the only solution is more government regulation to off-set the powers these special interests hold over our government and the industry.

There is no reason in hell why people in the US should be paying more than twice what anyone else in the industrial world and getting a small fraction of the healthcare and a quality which lacks world standards. It is an outrage! People should be as mad as hell about this situation.

 

Everybody uses public health care all the time.

It's availability, or lack of same, influences every major decision and every cost of ordinary life in an industrial economy.

About half of one percent, not counting the paperwork and "defensive medicine" burden. Chicken feed.

And that's free market for you. You have to allow lawsuits in business contracts, or you have no quality and delivery control. The alternative is government standards and regulations.

 

Budget-neutral doesn't imply zero spending. It means that all spending is paid for through new or existing revenue sources. The Senate bill continues to reduce the deficit after 2019 because its revenue sources are sufficient to pay for the costs of the bill (and then some). Which is why the CBO says things like:

All told, CBO expects that the legislation, if enacted, would reduce federal budget deficits over the decade after 2019 relative to those projected under current law—with a total effect during that decade that is in a broad range between one-quarter percent and one-half percent of GDP.​

 

and yet you describe yourself as a socialist so what's the problem?

http://www.sciforums.com/showpost.php?p=1971731&postcount=164

ps - I still only beleive you on the first point - how is it in that closet? Have you reached Narnia yet?

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:roflmao:
How old is that post, exactly? My opinion has changed way since then, you know. You haven't been around here lately, have you?

 

ah ok - so you HAVE finally come out of the closet then?

 

Come out of the closet about what?

 

Alright, conceded.

Apologies, "pork" may not have been the correct term. I meant things like deals for individual states in order to bribe their senators on-board (eg Nebraska). Also note that I didn't once say Democrat or Republican - all I want is something that works, regardless of who it comes from. Bad legislation like this is equally unacceptable from either party.

Alright, granted it may not be significant on a large scale. I still think it is more than reasonable to confront the issue however - it's still an unnecessary cost.

I have no data, but my immediate reaction would be that the doctors aren't the problem, it's the patients: This country is becoming all too eager to file a lawsuit for absolutely anything that they think they might have a chance at money for -- warranted or not. One thing that makes me think this is a study I saw while ago concluding that doctors with good relationships with patients (before surgery) had a hugely reduced rate of being filed lawsuits against than doctors whose relationships with patients weren't so good. I didn't know you filed lawsuits based on how nice your doctor was to you instead of how well he performed.

True, but it also costs alot to defend yourself in a frivolous lawsuit.

Bear with me, this is all relevant:
In the mid 80s, a company named Vitek began producing a temporomandibular joint (jaw) replacement implant. It was a complete disaster. 26,000 in total were implanted and every single one failed or is currently failing. Not only would these implants fail, but they would do so in such a way that it was then impossible to repair. The main load-bearing surface, Proplast, wore away, leaving billions of microscopic wear particles floating around. These particles cause inflammation, pain, and bone loss -- sometimes to the extent that cerebrospinal fluid would drain from the cranial cavity. Lawsuits ensue, and of course these people are looking for every single dime they can (rightfully so... somewhat). Vitek is a small start-up -- you could sue it out of existence and get next to nothing. DuPont chemical sold Vitek one of the raw materials for the implant, polytetraflouroethylene. Natural reaction of the lawyers: go after the giant corporation with nothing to do with the failure (if they won, they could have gotten over $1B)!!! Luckily for DuPont, they had expressly told Vitek that PTFE was a bad idea for implants, not medically approved, should not be used, etc etc -- all the fault for the failure was on Vitek. Because of DuPont's warnings, they successfully defeated all cases brought against them. In the end, however, DuPont spent $60,000,000 defending themselves over the sale of 100kg of PTFE which only netted them about $500 in the first place.

As a result of this and other similar cases, DuPont, the largest maker of PTFE at the time, stopped selling ALL of its materials to ALL medical companies, permanently. Now this created a void, which was filled by new smaller companies. Instead of charging, say, $5 per kg like DuPont had done however, they sell it at $800 per kg. For the same exact material. And now we wonder why simple medical devices cost so much.

In addition to showing how costly frivolous lawsuits are for the defendant, this is also a perfect way to show how frivolous lawsuits also raise the prices of healthcare. If you're not convinced, I encourage you to investigate the case (it's pretty interesting).

Again, I'm not blaming any party -- crummy amendments are crummy regardless of who it comes from.

I can't find the direct study itself, but here is a summary of WellPoint's findings: http://newsinfusion.com/video_details.php?videoId=411&gid=3

I'm not saying do nothing: I'm saying that this bill is a horrid attempt at reform. If the government is serious about reform: stop bribing people to vote for it, stop rushing it and stop forcing it partisanly. If that isn't possible, then we need to find and elect new people, as I'm sure you will agree.

Fixed.

Agreed.

One other thing I'd like to bring up is the idea of forcing companies to accept people with preconditions. Why would an insurance company ever take on someone who they KNOW they will lose money on. If they don't lose money on them, then it just means that that company raised the person's premiums (as they should), which is only encouraging the problem that you set out to solve. If the government forces them to do this, why not just pass a law where the government takes over the insurance company completely. I'll leave that question for a seperate thread, this one should focus on this specific bill.

 

Since they will be forced to insure people with pre-existing conditions on whom they will lose money they will have to make up those losses by raising premiums on everybody else.

 

Or they could just reduce their profit margins, considering the consolidated government controlled system for purchasing and choosing insurance and that the insurers will at the very least be competing with non-profit government controlled insurance if not a full out public option the push would be toward reducing prices.

 

Government spending is government spending whether it is paid for by Federal or State Taxes or borrowing. Borrowed money would be the most expensive money because interest must be paid but borrowed money could be paid off with inflation but inflation is like a tax on fixed income investors. The Medicaid expansion forces States to tax more.

The CBO has been accused of producing a misleading essentially dishonest accounting for the Senate Bill.

Scrapping funding for Medicare advantage is probably good but the savings there won't be that large. Eliminating the money Insurance companies spend on avoiding paying for pre-existing conditions will save a large chunk of money but the cost of giving people with pre-existing conditions real medical care will more than offset that.

People talk about the cost of delayed treatment but they are wrong in the big picture because they don't look at the money saved by uninsured people not seeing doctors when they get sick. Everybody dies sometime and the last year of life is the medically most expensive year of life. Keeping people alive longer does not reduce medical spending. It would be nice if everybody had health care but the idea that not delaying treatment will somehow pay for the health care of the currently uninsured is just wrong.

People on Medicaid use Emergency rooms more than anybody else do including the uninsured. When the uninsured go to the ER they end up paying more than anybody else does if they pay at all. The uninsured don't like going to the ER under false names to avoid debts that they can not pay off. People on Medicaid don't end up with a debt when they go to the ER because the system forces the privately insured to pay for the Medicaid recipients use of the ER. The ERs are going to get much more crowded with non-emergency patients if Medicaid is expanded because Medicaid patients can't get treated better at the Medicaid mills than they get treated at the ER if they can even find a Medicaid mill near them.

Do ERs really increase capacity to treat the Medicaid patients and the Uninsured? If they don't increase capacity for that purpose then something is wrong with the often repeated story about non-emergency use of ERs driving up health care.

I don't know what makes the CBO think the increase in Medicare costs per year can be reduced from 8% a year to 6% a year. The basic trend of exponentially increasing expensive treatment options for extending life is not going away and the Baby Boomers are getting older.

 

Yep. The plan is designed to focus insurance companies on health care rather than profit margins.

 

I'm still not convinced about the rest of it, but one thing seems pretty certain now - the public option is a beached and dead whale. The insurance companies' lobbyists wanted it dead and no one in congress is inclined to fight them over it.

 

There is no way in hell the insurance industry and congress will allow a bill to pass that reduces their profits. I believe that even if they were going to reduce there profits their large profits are still not large enough to pay for people with preexisting conditions without having the other insured people subsidize the people with preexisting conditions through higher premiums.

The Senate Bill has no public option and I believe it also has no national exchanges for individuals to form groups to reduce their premiums. I hear the state exchanges are designed to be non-functional and of no use at holding down premiums.

I think the large employers were the driving force behind health care reform and if that is true they won't be the ones subsidizing the people with preexisting conditions. That will have to fall to the individuals and small employers and tax payers.

 

Why do you believe there no way congress would make such a bill, they are doing it now. Your logic states the insures would need to raise premiums to maintain profit, thus the bill reduces profit, if it prevent the insures from compensating is the question.

State exchanges would be less effective but not completely useless, I would wait to see the final bill to see if the exchange program is dropped.

What makes you think that, how would the "large employers" not pay higher premiums, by your logic everyone would get higher premiums.

no they fought tooth and nail, its just too many senators are bought by the insures to make it pass. The choices are either keep fighting and loss all public confidence or compromise. The Bill is definitely weaken but that does not mean its not an improvement over our present situation.