Healthcare & rationing

[MSimon]

Dave,

I think the answer to the question you pose is catastrophic insurance coupled with MSAs. And MSAs should be allowed to accumulate allowing you to by insurance with higher deductibles as time goes on. That would give you price shopping in procedures costing under $10,000 or so.

It would also help if there were price lists.

[Maui]

...but medical debt is not a large portion of those defaults, partly because there are state laws on how medical debt is treated which generally make paying it back very easy, and partly because people are often able to obtain charity privately or from Medicaid.

Is debt from the aftermath of car accidents a huge part of defaults? Would it be even if car insurance was not required? Your point about government helping out when the uninsured need medical care is part of my original point-- rather than ask taxpayers for that $ to make up for an uninsured person's bill, why not ensure everyone is contributing up front?

People don't like the idea of a gov't board deciding whether Grandma really needs that new hip or is going to die anyway, as Obama suggested.

Nor do they want a corporate board doing the same. Guess what? It's part of insurance public or private. If you really think the Gov't board will be sinister compared to a corporate board, don't use the public option.

I also don't get the idea that the GOP doesn't think healthcare is a "right" that everyone should be entitled to, yet at the same time apparently believe that if someone does pay for insurance (no matter how cheap the plan) they are suddenly entitled to every medical weapon in humankind's arsenal no matter how dire an individuals situation or how unlikely the procedure is to help.

They don't, obviously. They just don't want the gov't making that call instead of you and your doctor.

Yes, they are just dying for a middle manager at BCBS with Christmans bonus on his mind to make that call instead. Unless you saved the cash up front, it is a necessary evil of insurance that someone makes that call for you. The public option doesn't change that one iota. Rather, it just gives you one more option.

Neither do I get the idea that it is a crime to look at the health systems of countries which have a much higher satisfaction rate and much lower cost for clues on how we might be able to lower our own healthcare costs

This is a point of factual confusion. The U.S. has, by far, the best medical care in the world. We have the best cancer survival rates (in some cases, 4 or 5 times better than socialized systems).

Breast cancer deaths per 100,000
Cervical cancer deaths per 100,000
Colon cancer deaths per 100,000
Liver cancer deaths per 100,000
Lung cancer deaths per 100,000
Prostate cancer deaths per 100,000
Stomach cancer deaths per 100,000

We have 5 times more MRIs and other diagnostics per capita.

A heck of a lot of people think this is part of our problem. Too much focus on costly "defensive" medicine.

We do twice as many organ transplants per capita as Europe. We have much shorter wait times for specialists, which in many cases saves lives.

Yes, we spend a lot of money. They question is, is that reflected in our overall health?

Now much of that expense is marginal; e.g. nine of ten MRIs don't find a problem -- but that's why we have better outcomes: that tenth MRI finds early cancer or etc. Of course, in the end ALL health care is marginally useless; so far, everyone that was born has eventually died despite all medical care, and the outlook isn't good for those alive today.

And there's where the perspective comes in. How much money, with sharply deteriorating returns, should we throw at preventing an outcome that cannot, in the end, be prevented?

I think the problem is that when it comes to the impending death of ones self or a loved one, obviously everyone in that situation would go to the ends of the Earth to save the life. The doctor's knowledge and ability needs to be second to none-- he/she certainly shouldn't be capable of honest mistake. There is no possible treatment that is not deserved. Who in the right mind would not fight for that when the time comes?

But in that moment (not that I've really had yet to deal with such a scenario, thankfully) I think it's gotta be hard to keep things in perspective. The perspective is that there obviously seems to be diminishing returns on the amount of good $ thrown at healthcare can do given that stats seem to say we're not doing 2 or 3 times better that the rest of the western world (if better at all). If you step back for a moment, is death is a part of life... and I do think it would be best if we could, in general, find a way to focus more on acceptance rather that what more could have been done or what was done wrong. There's a balance to be struck and, IMHO, we've slid a good deal to the "scared reaction" side of the spectrum rather than having a healthy balance.

So I think the struggle over healthcare really kinda boils down to the fact that we've recognized this diminishing return and though both sides appear to be coming at the problem from completely different angles, they are both saying in their own way that we need to acknowledge saving lives should certainly be given a hard and honest effort, but that the result isn't always going to be the one we hoped for and we need to accept death as part of life when that happens. Yet the two sides then simultaneously attack the fact that the other side doesn't promise a perfect health care experience for all... but that was kinda the point in the first place.

Because we've embraced the free market, we are the richest group of 300 million people you can assemble using national borders. Hopefully, rather than making America poorer with more socialism, we can eventually get the rest of the world to join us in prosperity.

What good is all the extra money if we have to throw such a huge chunk of our "wealth" down the healthcare toilet? It's arrogant, myopic and, in many cases, dangerous to think that just because we've done a lot of things right over the course of our history, that we can do no wrong.

[Maui]

Here's a breath of fresh air for everyone. I am opposed to government mandating ANY insurance, including car insurance.

Insurance is nothing more than legal gambling. They are betting you won't need it, you are betting you will.

That's great what you are able to do for your friend, but certainly what you did is extremely rare. In most cases, other people would have ended up footing much of the bill. And that is why insurance needs to be mandated-- because you are gambling with other people's money.

I certainly agree that insurance is a sucker bet. If you have the means, health savings accounts (or a just a lot of cash, period) is certainly the best healthcare plan.

[Maui]

Let's be realistic: who is really selling fear? Obama keeps throwing out scary numbers like "47 million uninsured" (the actual number is closer to 6 million, when you take out people who make >$75K, are illegal immigrants, etc) and talking about a "crisis."

No, you are just reading the GOP's talking points. Anyway, while I do think everyone should be insured, I certainly don't think that's our biggest problem. Our biggest problem is simply cost.

http://politicalticker.blogs.cnn.com/20 ... 8-million/
http://www.factcheck.org/2009/03/uninsured-us-citizens/
http://kff.org/uninsured/upload/7451-04.pdf

Obama's whole pitch comes down "You better let the government take over health care or terrible things will happen."

Huh? Obama recently said the public option is not even an "essential element". And even if it was an element, as has been repeated ad infinitum, nobody's making anyone give up their current private insurance. If you are going attribute this to congressional Dems, maybe. But if you are talking about Obama, listen to what he actually says, not what Rush said he said.

And people wonder why there are "angry mobs" opposing socialist medicine at these town halls.

You guys need to chill out. Nobody is taking away your insurance. Nobody. Breathe.

[TDPerk]

Huh? Obama recently said the public option is not even an "essential element".

Only to try to get the townhall attendees to stay home. Before that it was essential.

Was Obama lying then or now?

You guys need to chill out. Nobody is taking away your insurance. Nobody. Breathe.

That's exactly what he was talking about doing. No private plan could deviate from the common public guidelines after 5 years, and they could take on no new enrollees. There is no substantive difference between that and taking them.

Why are you repeating Obama's lies?

Do you think this is a forum where people are dumb enough to believe you? I think everyone here has addition and subtraction down pat.

[TDPerk]

Nor do they want a corporate board doing the same. Guess what? It's part of insurance public or private.

You must take us for morons. If a private insurance company screws up, you can sue them.

If they pay up per policy, they haven't screwed up.

BTW, ever hear of sovereign immunity?

[MSimon]

People don't like the idea of a gov't board deciding whether Grandma really needs that new hip or is going to die anyway, as Obama suggested.

Nor do they want a corporate board doing the same. Guess what? It's part of insurance public or private. If you really think the Gov't board will be sinister compared to a corporate board, don't use the public option.

Ah. But with a corporation you have a contract. With government you have sovereign immunity.

If the government decides pacemakers for those over 70 make no sense who will you complain to? Who can you sue?

A law is not a contract and is not enforcible.

[MSimon]

Nor do they want a corporate board doing the same. Guess what? It's part of insurance public or private.

You must take us for morons. If a private insurance company screws up, you can sue them.

If they pay up per policy, they haven't screwed up.

BTW, ever hear of sovereign immunity?

I hadn't read yours when I posted mine. Despite the similarities it was not a crib. Great minds etc.

[Maui]

Only to try to get the townhall attendees to stay home. Before that it was essential.

Was Obama lying then or now?

I'm sure he would still prefer it. He certainly argued for it. But he certainly didn't fear-monger it the way the GOP is fear-mongering what a public option would do. He has argued it was a good way to force private insurers to bring costs down. He didn't say private insurance would kill your grandma if we didn't have a public option.

And, actually, Obama took a lot of flak early on for not stating exactly what he would accept and wouldn't accept.

That's exactly what he was talking about doing. No private plan could deviate from the common public guidelines after 5 years, and they could take on no new enrollees. There is no substantive difference between that and taking them.

You are refering to the house version

You said:
No private plan could deviate from the common public guidelines after 5 years, and they could take on no new enrollees
the bill says:
If you accept an individual plan (not employer, etc) that takes on new enrollees after 5 years yet doesn't meet common public guidelines, you'll have to pay an extra tax.

There is a very substantiative difference between these two.

Why are you repeating Obama's lies?

Are you sure you're not just repeating GOP lies?

Do you think this is a forum where people are dumb enough to believe you? I think everyone here has addition and subtraction down pat.

Yeah, but I was really hoping everyone could read as well.

But if this clause is scary, why not debate the clause rather than the public option as a whole? Again, I don't even really have any conviction myself about whether the public option really is the best way to go, but please I think its worth debate and its a shame that the talking heads are able to so effectively use fear to distract from honest debate on whether a public option will help or not.

[TDPerk]

Great minds etc.

Great. Now I have a tingling up my leg.

Chris Matthews, call your office.

One guess about whether Maui will perceive our comments to be an immediately valid criticism, or a "talking point".

[Maui]

Nor do they want a corporate board doing the same. Guess what? It's part of insurance public or private.

You must take us for morons. If a private insurance company screws up, you can sue them.

Isn't the GOP version of healthcare reform to make it illegal to sue? As I pointed out in my original response to Simon, I don't believe its impossible to sue government insurance. For example, and another.

BTW, ever hear of sovereign immunity?

Jeepers-- where do I get the cheat sheet? It's like talking to parrots. This ground has been covered, ask a new question please.

[TDPerk]

RE

One guess about whether Maui will perceive our comments to be an immediately valid criticism, or a "talking point".

Maui posts.

Are you sure you're not just repeating GOP lies?

I won, I won!!! I guessed right!

[Maui]

Ah. But with a corporation you have a contract. With government you have sovereign immunity.

I at least expected you to remember this was already hashed out on page one-- after all, you're the one that first made the comment. I guess if you guys are going to copy and paste, I will too:

[snip]Yet the GOP's idea of healthcare reform is to make it illegal for patients to sue. How, then, is the end result any different?

Anyway, I don't think its impossible to sue government insurance. For example, and another.[/snip]

If the government decides pacemakers for those over 70 make no sense who will you complain to? Who can you sue?

With sovereign immunity there is no one to force the government to hear lawsuits and complaints. But do you really think lawsuits and complaints will be ignored? Whatever the problem would be a political gem for one party. Forget the lawsuit, you can have special congressional and presidential commissions.

But better yet, just switch to another group health plan instead. Problem solved.

[TDPerk]

"Isn't the GOP version of healthcare reform to make it illegal to sue?"

Tort reform and making it "illegal to sue" are not synonymous.

As I pointed out in my original response to Simon, I don't believe its impossible to sue government insurance.

No, they just have to agree they can be sued...

...Like I said, have you heard of sovereign immunity? Just because it can be waived does not mean it will be.

Bottom line, my healthcare decision should be my healthcare decisions, not someone else's political decisions. Medicare will go bankrupt, why do you want to reinforce a failure?

What improvement in lowering cost and improving efficiency do you think single payer insurance will provide which the government can't first implement in the medical coverage it already provides?

I'm sure he would still prefer it. He certainly argued for it.

In fact , he said it's a crisis that will bankrupt the nation, but he's not fearmongering.

He didn't say private insurance would kill your grandma if we didn't have a public option.

He did say out loud it would be quite questionable if she should have a hip replacement. Immobility hastens death...but it is cheaper.

The only way a single/government payer insurance can lower end-of-life costs is to provide less end-of-life care, that means the end of life comes more quickly. Deciding what end-of-life care will be denied is the job of a "death panel" whatever you call it. Quit lying about it, Obama, and you too Maui.

You are refering to the house version

I'm referring to the Democrat's frequently discussed version, which is Obama's version because he is the head of the Democratic party. His ditching a particularly unpopular version only after he sees how very unpopular that version is births no confidence in his leadership or inclinations.

The public is speaking loud and clear, about 70% do not want increasingly socialized healthcare.

Yeah, but I was really hoping everyone could read as well.

I'm reading you fine, you want to double down on FDR's screwups and make us more socialist.

No sale.

But if this clause is scary, why not debate the clause rather than the public option as a whole?

It is emblematic of the whole.

Again, I don't even really have any conviction myself about whether the public option really is the best way to go,

Yeah, and you want me to buy a bridge cheap too.

Realizing and stating the obvious is not using fear unless the truth is fearful. Making the government's command of healthcare near total, and implicitly eventually total, is a fearful thing. Saying it out loud is not out of bounds.

[Maui]

Okay, I want to write this down so I can be sure to benefit from your wisdom:

Why are you repeating Obama's lies?

= Thoughtful, intelligent question
(after all, I've been blowing sunshine up Obama's holy hole right from the first post, right?)

Are you sure you're not just repeating GOP lies?

= Naive

Great. That clears everything up.