Whoa This Economy stinks

[Jeff Matthews]

This is not a question of "needy" or "helpless people," so much as it is a question of whether government should be involved to force the act of procurement of coverage. You can't just persuade everyone to spend money a certain way, so should the cost be legislated? I think it might not be such a bad idea.

This is pretty much found in the model of motorcycle helmet law, and seatbelt law. When a person chose to NOT wear a helmet, and suffered paralysis, the State picked up the tab, which ultimately ran into the hundreds of thousands of dollars. Thus the State declared (and proved) its financial interests benefitting its taxpayers.

Frankly, this is ALSO TRUE in healthcare. We spend MORE THAN FRANCE on healthcare, and get half the benefit. This is not hard to understand. We have a middle entity called "private insurance" which removes, sucks, takes, grabs, drains, massive amounts of the healthcare dollar without providing ANY ACTUAL CARE. It is simply a paper profit business attached to the sourcing of healthcare. Imagine paying WalMart a $7 entry fee to get in the door for the right to shop!

Mark, indeed an interesting thought. One thing insurance companies have done is to negotiate reasonable rates with providers. Remember my cracked rib debacle and the gouging I got? Figure the price for Procedure X to be like this:

Jeff is charged: $650.00

Insurance Co. is charged $111.00

What would be the cost of the profit AND some of the cost from insurance carrier was removed?

Of course, if insurance was mandated, rather than destroyed, we might still see efficiency gains through a competitive market.

[colterphoto1]

I've been discussing this 'discounted billing' with my various Dr's offices. Seems that insurance gets to pay around 50-70% of the total billing and if I go in with cash money and pay the day of the office visit they'll offer me a whopping 20% discount.

[Jeff Matthews]

I know. Let's expatriate Joe to one of those nanny states.

[Jeff Matthews]

Of course, if insurance was mandated, rather than destroyed, we might still see efficiency gains through a competitive market.

Just to clarify for myself, in "single payer" we eliminate "insurance" as a concept all together. We simply negotiate the best deals and then pay the bills. "Insurance" per se, is a betting game which is attached to various aspects of life. We bet we will have XYZ problem, and they bet you won't.

The bets have to have house odds. Otherwise, they, like Casinos, would be out of business in no time. It is precisely the "house odds" end of it which is added on to the cost of the actual care, for which there is NO VALUE. It really is like asking for $7 to get in the door. Companies that are financially savvy and sound, do "self insurance" which means they simply pay the bills. Countries that are financially savvy do the same thing. And, in doing so, pay a lot less of their GDP for healthcare.

In a way, the "political and emotional argument" isn't anywhere near as important as the financial prudence argument.

All good, except one problem. The idea and purpose of insurance is to mutualize the risk. There is no doubt that there "house odds" built-in as you suggest. But if we do not have a collective pool of contributors, there will be no mutuality, and calamity threatens the supply of health care and the ability to pay for it.

[Hifi jim]

Your story proves my point. We live in a free country. We have the right to choose what we want. I do not think that we should give up the right to choose the path in life for ourselves by mandating from the government what we will and will not do for ourselves. In the decisions we make in life we should be accountable to oursleves. If we choose poorly, we shoud bear the brunt of our decisions.

Cal, you seem to have missed the point of my story. I didn't choose not to have health insurance as much as I was forced to not have it because the cost was well beyond my means. Ask me then if I wanted health insurance? You bet. Could I have ever afforded it? No way. That's not a choice, that's a lack of options.

The physical defense of our nation is prescribed in our founding doccuments, medical care is not and like free speach morphing to free access to porn, our medical system should not be morphed into defense.

If you carefully read my response to yours you'll see I was using the term medical care as you were, that of a medical system or health care provider, not the study and/or practice of medicine. Yes, doctors existed prior to our nations founding, however organized health care was beyond our forefathers vision at that time. Because they were unable to envision the future must we forego all things not itemized by them?

[LarryC]

I think the idea is to take all actuarial concepts out of single payer. Everyone is covered and we just pay all the bills - exactly as we do to finance the military or anything else. The "mutualization" of the risk is simply our tax payment, isn't it? If we chose to continue with insurance model, and simply mandate and subsidize, then we will be strapped with the cost of the house odds again.

I think even a single payer will have to mutualize using actuaries. Social Security is single-payer for retirement and disability under its system, and they have always had their Office of the Actuary to estimate future income, FDIC tax needs, and trust fund balances over time, specifically 75-year periods.

Medicare, which is a kind of single payer, has to do the same thing and has its own Office of the Actuary. It also estimates outlays and taxing and co-payment needs into the future. (You might be surprised to know that the OA even has to model past and current expenditures, as opposed to just adding up bills and checks.) Also, Medicare doesn't simply pay bills -- rather, there is a heavy cross-current of cost- and quality-controlling policies (how much to pay hospitals and doctors) and "coverage" decisions (decisions on when/where to pay for "huffer-puffer" [breathing aide] wheelchairs, for example, or which centers to limit payment to for heart transplants).

And, Medicare does not pay the amounts billed! Rather, it determines how much to pay for what services. If all we had to do for health care was to pay all the bills, all health insurance plans would be bankrupt in nothing flat, unfortunately.

[Cal Blacksmith]

Let Joe Noinsurance Dude, ask his family for help, if not, well there is a shortage of organ doaners isn't there?

[Cal Blacksmith]

OK Mark,

You have now had someone tell you, leave him alone.

I go back to my position that if you don't have a private plan, you just get the basics, that is it. I can't see any way to have government take over paying for everyone to have healthcare and NOT have them make all the rules on life and death due to charts, graphs and cost projections. I want big government out of my life as much as possible. As to the programs you mention. I never said doing away with police, fire, FDA, etc, that is a red herring you put into the mix. I am talking about healthcare which is a private system and if the government takes over payments for everyone, they run the show. The golden rule is: he who has the gold, makes the rules. It is that simple.

[LarryC]

I don't know if you were too general, but you may have meant taking "all experience rating" out of health care insurance. If so, I absolutely agree with that!!

Experience rating is the pricing of insurance according to the cost "experience" of an insured group. Many health insurance plans, especially Blue Cross and Blue Shield, used to be "community-rated" 20 or more years ago, which meant the same price was paid by individuals and groups within each area's plan. They could do this in part by writing primarily GROUP policies, issued by employer, because they had better cost experience when they could enroll an entire group at one time.

It's telling, though, that the Blues couldn't afford to do that if they took individual enrollees! Thus, they had "individual" rates, which were much more expensive. This is one important reason people can't opt out and in again as they please unless they don't mind the much larger cost. It's a main reason why proponents of universal insurance don't want to comtemplate optional individual month-by-month or year-by-year enrollment in such a plan. The switching in and out makes welfare medical care very expensive, btw.

Perhaps 20 or 30 years ago, the commercial insurance industry persuaded some lawmakers and policy makers that "competition" and greater "equity" in insurance prices between individuals and groups would help lower costs. It was bullshat, of course, but we see the ultimate result today: dramatically different prices, not only by group, but within a group if an unusually sick person is added to the employer group. I think it's often a mess, although companies such as Klipsch with young workers can get better prices.

Then there's the problem of declining industries and companies, like US car manufacturers, who have an aging workforce (costs rise geometrically with age) and huge "legacy" costs, i.e., lots of retirees to support and fund to supplement Medicare.

Will community rating ever come back?

[colterphoto1]

woohoo, my COBRA coverage just went up 20%! Groceries are sky high, and utility bills are out of sight. I paid almost as much to heat my house this winter as I did 3 winters ago before I had about 12" of insulation blown in the attic.

If everything is sucking so badly, why do prices keep heading towards the stratosphere?

[colterphoto1]

the Juice is killing us.

[sean5340]

Well, down in South Louisiana the economy is quite good right now. There are "Now Hiring" signs everywhere. Other than my 401k and company stocks all is well. I wait in long lines everywhere I go and traffic is the worst that it has ever been around here. Real estate prices have not changed and demand for rental property is strong.

I realize this could all change but it doesn't seem apparent. The area isn't as dependant on the oilfield as it once was and has seen big growth in the medical field. Cool since my wife is a CCRN.

I personnally believe that individuals over extending their credit has a huge role in this economy. When the people get their personnal books straight things should begin to improve. Lenders can't lend if people don't pay back.

Sean

[Gilbert]

and you want to take more from the most productive members of our economy, those who take the risks, for good or ill?

THANK YOU. But I'll bet a nickle he still doesn't get it, because your opinion doesn't reflect that of the governments way of looking at it. Mark and the government are one with each other, need I say more.

[Hifi jim]

Mark, .... I'm sorry, but those are all some of the most assine comparisons I've ever heard anyone use to pass-off their socialist point of views. Completely wrong, and just plain stupid. I'm sorry, just speaking my mind.

Gilbert, in addition to your posts being an informative analysis of the topic at hand and an attempt to exchange ideas freely and openly, they are also just plain [bs]. The first time Mark was socialist, now you've painted him a Liberal. Do you have names for everybody, including yourself? I'm sorry, just speaking my mind.

[Fish]

I've never heard anyone complain of being called"conservative",but if you call someone a liberal(not saying it's happened).........why? Is that a bad thing?

[Hifi jim]

I've never heard anyone complain of being called"conservative",but if you call someone a liberal(not saying it's happened).........why? Is that a bad thing?

I don't believe there is room for name calling in any discussion especially one of politics. To place a person in a group of people as one sees fit, is degrading and insulting and without merit. I align myself with ideas that could be called liberal or conservative, Republican or Democrat, even socialist. Does that mean I subscribe to all of their beliefs? Of course not. To label anyone here a socialist or liberal is only placing the accused in a camp opposite of his own values or ideals. Perhaps Gilbert is a fascist anarchist? Sounds as ludicrous as being called a socialist to me. Freely exchanging ideas is the purpose of any forum, and the use of name calling (any name) only defeats this purpose.

[Fish]

That

I've never heard anyone complain of being called"conservative",but if you call someone a liberal(not saying it's happened).........why? Is that a bad thing?

I don't believe there is room for name calling in any discussion especially one of politics. To place a person in a group of people as one sees fit, is degrading and insulting and without merit. I align myself with ideas that could be called liberal or conservative, Republican or Democrat, even socialist. Does that mean I subscribe to all of their beliefs? Of course not. To label anyone here a socialist or liberal is only placing the accused in a camp opposite of his own values or ideals. Perhaps Gilbert is a fascist anarchist? Sounds as ludicrous as being called a socialist to me. Freely exchanging ideas is the purpose of any forum, and the use of name calling (any name) only defeats this purpose.

That's a well thought response,but not an answer.You can call me conservative till the cows come home(although I bet I'm as liberal as anyone here on some issues)and I don't care.But if you call me a liberal,I would not accept that label.My ? is,why is being called liberal a neg thing?Is there something about the phrase or term that insults people?If I were a bleedin' heart Liberal,I would love the label and wear it as a badge of honor.

I see no connecton with calling someone a fascist anarchist(which could be considered an insult) and calling them a Liberal,am I missing something?Still just wondering why they aren't "proud"to be one?

Freely exchanging ideas is all good and fine,this site is not a political site so we are not(the way I understood it)free to "exchange"all our ideas on politics.I have many,if the policy has changed................

[Hifi jim]

You can call me conservative till the cows come home(although I bet I'm as liberal as anyone here on some issues)and I don't care.But if you call me a liberal,I would not accept that label.

It's clear that you are insulted by being called liberal for reasons that are your own and unknown to me. I cannot speak for others who are, or are not liberal. I personally do not feel branding someone a liberal, conservative, or any other party affiliated name is constructive to freely exchanging political ideas. If one chooses to wear a label of their own free will, then more power to them. That was not the case here.

[Fish]

You can call me conservative till the cows come home(although I bet I'm as liberal as anyone here on some issues)and I don't care.But if you call me a liberal,I would not accept that label.

It's clear that you are insulted by being called liberal for reasons that are your own and unknown to me. I cannot speak for others who are, or are not liberal. I personally do not feel branding someone a liberal, conservative, or any other party affiliated name is constructive to freely exchanging political ideas. If one chooses to wear a label of their own free will, then more power to them. That was not the case here.

I really would not be insulted to be called a liberal(some of my best friends are),it just would not be totally accurate,as I don't agree with many of their issues.Now that I think about it.........calling me a conservative would not really be accurate,I guess I'm a very liberal conservative.

[Jeff Matthews]

Mark, check your PM.