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Author Topic: This is reform?  (Read 3369 times)
Finnegans Wake
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« on: Aug 18, 2009 at 08:16 »

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Steelerdipwad
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« Reply #1 on: Aug 18, 2009 at 10:02 »

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DocLogic77
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« Reply #2 on: Sep 10, 2009 at 11:44 »

I don't think people understand what they are asking for when they ask for the government to take over our health care. Free is certainly not free.

And we have to think about this in a pragmatic fashion. Do we want a small portion of the population dealing with a lack of quality health care or everyone dealing with a lack of quality health care? Some people seem to think because someone doesn't have insurance that they can't get care which isn't true. I would say 50% of the people that come into our ER are uninsured and don't pay a dime...nor are asked to pay a dime. These people use the ER as their primary care center. Second, when there is a procedure that the ER can't do...there are hospitals much like ourselves who are given governmental $$$ to take care of the uninsured. If they do not qualify there are always spin down programs and they pay pennies on the dollar for care. The system might be broke...but compared to Canada and England we are the mecca of quality medical care.

How to contain costs?

1) Malpractice Reform
2) Incentivize the young and healthy to buy health insurance to spread the risk
3) We have a civic duty to purchase health insurance...those that can not financially do so can be subsidized through taxation on unhealthy foods and non essential items.
4) Insurance should be for serious illness and injury. If you choose to go to the doctor for a sore throat...you should plan on paying for it just like you pay for gas, groceries etc. Insurance should be meant to protect a family from catastrophic loss...not a 75 dollar office visit.
5) Incentivize those on Medicaid and Medicare to participate in wellness, and for living healthy lifestyles. And there must be consequences for those who abuse the system. The ER should not be a place for those on governmental funds to treat a sore throat or a runny nose. This costs tax payers around $500 as opposed to $75. But, it's done everyday. Those who use the ER to seek narcotics should lose rights to governmental funds.
6) Lower regulation...and you lower our need for staff which = lower overall costs.

Demand the government fix it's current systems before taking over others. Medicaid, medicare and most VA hospitals are broken...and broken badly.

The fact is free markets lower costs and improve services. Lets just fix what we have.
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« Reply #3 on: Sep 10, 2009 at 12:02 »

I don't think people understand what they are asking for when they ask for the government to take over our health care. Free is certainly not free.

And we have to think about this in a pragmatic fashion. Do we want a small portion of the population dealing with a lack of quality health care or everyone dealing with a lack of quality health care? Some people seem to think because someone doesn't have insurance that they can't get care which isn't true. I would say 50% of the people that come into our ER are uninsured and don't pay a dime...nor are asked to pay a dime. These people use the ER as their primary care center. Second, when there is a procedure that the ER can't do...there are hospitals much like ourselves who are given governmental $$$ to take care of the uninsured. If they do not qualify there are always spin down programs and they pay pennies on the dollar for care. The system might be broke...but compared to Canada and England we are the mecca of quality medical care.

How to contain costs?

1) Malpractice Reform
2) Incentivize the young and healthy to buy health insurance to spread the risk
3) We have a civic duty to purchase health insurance...those that can not financially do so can be subsidized through taxation on unhealthy foods and non essential items.
4) Insurance should be for serious illness and injury. If you choose to go to the doctor for a sore throat...you should plan on paying for it just like you pay for gas, groceries etc. Insurance should be meant to protect a family from catastrophic loss...not a 75 dollar office visit.
5) Incentivize those on Medicaid and Medicare to participate in wellness, and for living healthy lifestyles. And there must be consequences for those who abuse the system. The ER should not be a place for those on governmental funds to treat a sore throat or a runny nose. This costs tax payers around $500 as opposed to $75. But, it's done everyday. Those who use the ER to seek narcotics should lose rights to governmental funds.
6) Lower regulation...and you lower our need for staff which = lower overall costs.

Demand the government fix it's current systems before taking over others. Medicaid, medicare and most VA hospitals are broken...and broken badly.

The fact is free markets lower costs and improve services. Lets just fix what we have.


Most of that is what Obama said last night.  My main gripe is that an inordinate amount the health care dollar is spent on the administrative side of things.  Let's get the patient care we're already paying for.
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Finnegans Wake
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« Reply #4 on: Sep 10, 2009 at 12:10 »

I agree with what you've posted, Doc, but those ER visits by the uninsured just spread hidden costs.  As you say, free ain't free.  And per 5) we would do better to have the uninsured covered and going to GPs.

I agree that Medicaid and Medicaire need overhauled, but private insurers are still pitting profits versus care and coverage: that's an untenable model, morally and fiscally.  

Also on points 3) and 5), there was an article by Michael Pollan ("Omnivore's Dilemma") about how we spend so much more than other countries... but that much of that cost is due to downstream effects of diet.  Obesity, diabetes, heart disease...  all very much on the rise due to the elephant in the living room, and NO ONE, R or D, is addressing that very basic cause.  One quick fix would be to eliminate Farm Bill subsidies for commodity crops (corn, soy, etc.) which make up the basis of 90% of industrialized "food."  The high cost of cheap food, as a recent Time cover put it.  

My football analogy for Obama's speech is this, BTW:  he fair catches the kickoff with coverage teams 30 yards upfield.  Calls a time out.  Is heckled by drunken oafs.  First play from scrimmage... PUNT!

I don't agree that free markets lower costs and improve services in healthcare.  How can that be possible with these generous CEO pay packages and profits for shareholders?  Doesn't that money directly siphon from patient care?



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« Reply #5 on: Sep 10, 2009 at 12:27 »

I was actually encouraged by what Obama said last night. Though it does concern me about taxing higher premium insurance plans as a means to reduce costs to consumers. It seems like it will lead right down the road to eventually the only game in town being government run healthcare. I just don't want that. But, like I said, I did like what he said last night.
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« Reply #6 on: Sep 10, 2009 at 12:37 »

I agree with what you've posted, Doc, but those ER visits by the uninsured just spread hidden costs.  As you say, free ain't free.  And per 5) we would do better to have the uninsured covered and going to GPs.

I agree that Medicaid and Medicaire need overhauled, but private insurers are still pitting profits versus care and coverage: that's an untenable model, morally and fiscally.  

Also on points 3) and 5), there was an article by Michael Pollan ("Omnivore's Dilemma") about how we spend so much more than other countries... but that much of that cost is due to downstream effects of diet.  Obesity, diabetes, heart disease...  all very much on the rise due to the elephant in the living room, and NO ONE, R or D, is addressing that very basic cause.  One quick fix would be to eliminate Farm Bill subsidies for commodity crops (corn, soy, etc.) which make up the basis of 90% of industrialized "food."  The high cost of cheap food, as a recent Time cover put it.  

My football analogy for Obama's speech is this, BTW:  he fair catches the kickoff with coverage teams 30 yards upfield.  Calls a time out.  Is heckled by drunken oafs.  First play from scrimmage... PUNT!

I don't agree that free markets lower costs and improve services in healthcare.  How can that be possible with these generous CEO pay packages and profits for shareholders?  Doesn't that money directly siphon from patient care?





I hear ya and totally respect that moderate view.  I would agree with some of that.  Our current free market system isn't working...that is very obvious.  Insurance companies are a problem for both the patient and the provider.  There has to be competition.  What I fear from government competition is that this will lead to only one option...the government.  How can a private insurance company compete with an entity that prints money?  Also, many providers won't even deal with medicaid and medicare because of low reimbursements.  In many areas of the country the reimbursement for an office visit is around $32.  Family docs might get a few extra bucks for a strep test or some blood work but it's not much.  So, if the average FP sees 26 patients a day at 40 bucks a patient he is making about 5K/week in a 5 day work week.  The problem?  The overhead is absurd due to red tape and regulation.  Most offices need at least 4-5 employees, lights, supplies, office space etc.  Pocketing 30% of that reimbursement is the norm.  So, that FP will see about 1500/week if he were to only see medicaid or medicare.  78K per year might sound like "enough" to most.  But, when you consider the fact that most didn't work for 12-16 years during training and the fact that they are now 200K in debt...I think those numbers are very low.  78K per year is about the national average in Canada for a family doc.  When it comes to my health...I want to attract the best and brightest.  78K/year won't do that...especially not with all the malpractice worries we have to deal with.

If you really want to cut costs...you need malpractice reform.  I would say about 80% of the tests I order are to cover my butt.  I need about 20% to make a decision and the other 80% for show.  I have to protect my license and ability to earn.  With multimillion dollar decisions being common place I have to order a CT for that belly I could probably observe.

As for those that if they had insurance they would go to the GP...welp that doesn't happen much around here.  I deal with sore throats and sniffles all the time in the ER.  These people are on the government dollar.  I work a small ER with little to no wait...so they come here to get in and out faster.  I see constant abuse and misuse of dollars by those who we are supposed to help.
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DocLogic77
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« Reply #7 on: Sep 10, 2009 at 13:21 »

I don't think people understand what they are asking for when they ask for the government to take over our health care. Free is certainly not free.

And we have to think about this in a pragmatic fashion. Do we want a small portion of the population dealing with a lack of quality health care or everyone dealing with a lack of quality health care? Some people seem to think because someone doesn't have insurance that they can't get care which isn't true. I would say 50% of the people that come into our ER are uninsured and don't pay a dime...nor are asked to pay a dime. These people use the ER as their primary care center. Second, when there is a procedure that the ER can't do...there are hospitals much like ourselves who are given governmental $$$ to take care of the uninsured. If they do not qualify there are always spin down programs and they pay pennies on the dollar for care. The system might be broke...but compared to Canada and England we are the mecca of quality medical care.

How to contain costs?

1) Malpractice Reform
2) Incentivize the young and healthy to buy health insurance to spread the risk
3) We have a civic duty to purchase health insurance...those that can not financially do so can be subsidized through taxation on unhealthy foods and non essential items.
4) Insurance should be for serious illness and injury. If you choose to go to the doctor for a sore throat...you should plan on paying for it just like you pay for gas, groceries etc. Insurance should be meant to protect a family from catastrophic loss...not a 75 dollar office visit.
5) Incentivize those on Medicaid and Medicare to participate in wellness, and for living healthy lifestyles. And there must be consequences for those who abuse the system. The ER should not be a place for those on governmental funds to treat a sore throat or a runny nose. This costs tax payers around $500 as opposed to $75. But, it's done everyday. Those who use the ER to seek narcotics should lose rights to governmental funds.
6) Lower regulation...and you lower our need for staff which = lower overall costs.

Demand the government fix it's current systems before taking over others. Medicaid, medicare and most VA hospitals are broken...and broken badly.

The fact is free markets lower costs and improve services. Lets just fix what we have.


Most of that is what Obama said last night.  My main gripe is that an inordinate amount the health care dollar is spent on the administrative side of things.  Let's get the patient care we're already paying for.


I absolutely agree.  There is a crushing amount of red tape...all set up to "protect the public".
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« Reply #8 on: Sep 10, 2009 at 19:00 »

I'm gonna have to get the sis to post on this.  She & my dad are independent pharmacists, and what the insurance companies do to them is criminal.  Such as the $30K in retroactively denied claims they just got noticed on.

I don't know enough about all this stuff to effectively argue, but I know that competition among insurance companies and pharmaceutical companies most certainly has not driven down costs.
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Finnegans Wake
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« Reply #9 on: Sep 10, 2009 at 19:22 »

I'm gonna have to get the sis to post on this.  She & my dad are independent pharmacists, and what the insurance companies do to them is criminal.  Such as the $30K in retroactively denied claims they just got noticed on.

I don't know enough about all this stuff to effectively argue, but I know that competition among insurance companies and pharmaceutical companies most certainly has not driven down costs.

And that's where one set of rules, streamlined, in the form of single payer, would reduce admin costs and this kind of confusion.  (BTW, nice stress for your father, in the other news, eh?  Related?)

We can have private providers, a public administrator, spend more than other countries to ensure better care, but lower current costs due to inefficiencies in the system.  'Cept that 'Bama punted.
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