And the Health Insurance Debate Rages On

GreenDreams, of course private insurers have policies for what's covered and what's not. It's written into the contracts people sign. The case-by-case decisions start when people when people dispute the policies. The government has to have a similar appeals process, and it will be every bit as expensive as the private sector's.

You haven't missed the angry-villager dynamic in play here, have you? The Michael Moores of the world are aghast that the insurance companies have policies like this...beyond which treatment you need *will not be covered!* This is proof of the fundamental wickedness of the profit-minded insurance companies. How can you imagine that the government will be able to install a similar set of policies without facing a similar mob wielding torches and pitchforks?

We pay 3X as much for care that leaves us dead last in infant mortality, cancer, heart disease, diabetes, longevity and other measurable OUTCOMES of treatment

That's a patently false statement.

We don't lag in cancer survival (though this study shows that there's room for improvement in the US, particularly in certain states/regions and among minorities- but even with those negative factors we still don't lag generally as compared to other countries.) We're so far from dead last, it's absurd to claim that.

I'm not aware of any stats on comparing heart disease survival except a very limited focus one involving a few countries (Scandinavian, I believe) that have lower mortality rates in the immediate aftermath of a myocardial infarction. This could well be due to differences in severity of the disease itself based on lifestyle and genetic factors, though. If you have other stats showing across the board that the US survival rates for cardiovascular disease lag behind other countries, do share.

I've already debunked the longevity claim (that disparity goes away when you factor out violent or accidental deaths, which are not related to quality of healthcare delivery in any way,) and the infant mortality claim (that's due to differing standards for registering live births- we count em all, others do not.)

There are definitely things we can learn from other healthcare delivery models, and there are some narrower stats where we really do lag, as this article points out. But please stick to facts instead of propaganda. We do spend a lot more, and that has to change- but your claims about massive inferiority of our results is just not borne out in fact.

the annualized cost of medicare includes fraud, as does the cost of private insurance. even counting the fraud, medicare is a better deal. and many physicians prefer medicare because they know what it pays, for which procedures, which are allowed, and it is less costly for them to administer than the reticent insurers. physicians' offices pay the cost of paperwork on both private and government insurance, and they add it to their costs, so the private, or government insurer pays. there is no hidden cost in either case, and the paperwork cost would be a wash except private insurers have departments that fight against paying for their "customer's" care.

CStanley, there's no disparity in what I said. Lowering costs by deciding what procedures are or aren't covered does not require a decision on each patient to pay or deny payment. Procedure A is covered, or not, for diagnosis code B. Those decisions need be made only once, not per patient. And private insurers use the codes developed by the government, just as medicare does. Hence they actually are the beneficiaries of government spending, not the victims of it. Even with the government covering the full cost of developing the rules, private insurance is much more costly.

But we're talking in circles about comparatively trivial savings. If 80% of costs are on 20% of patients, and mostly in the last few months of life, it is THERE that we must save money. That's the toughest part of the debate, but it's sexier for you to passionately defend companies while trashing government. Government paid and controlled systems outperform globally, and to deny it is just disingenuous. We pay 3X as much for care that leaves us dead last in infant mortality, cancer, heart disease, diabetes, longevity and other measurable OUTCOMES of treatment. Governments can and do perform better globally at providing health care outcomes than our profit-driven model. You can deny it all you want, but you can't provide a single example in which a profit-driven system provides better OUTCOMES, regardless of cost.

Wouldn't the problem be the people who refuse to give them those resources?

Yes- that's why I think it's a sham to claim that Medicare operates efficiently with 3% administrative costs. Those costs SHOULD be higher if they're unable to weed out fraudulent applications- then we wouldn't need the money on the back end to investigate the fraud. That's not to say I condone politicians who protect the perpetrators- it should be prosecuted and if GOP are refusing to do so they are wrong.

CStanley: true, depending on the rules of a government-run insurance plan. If it competed honestly, negotiating prices with suppliers who were free to walk away, it wouldn't undermine private insurance companies. Unless it genuinely out-competed them, and there's little danger of that.

No, the Medicare bureaucracy is not the victim here, the American taxpayer is. And if the administrators of Medicare don't have adequate manpower and resources to prevent fraudulent claims from being paid out, then they are part of the problem.

Wouldn't the problem be the people who refuse to give them those resources? In Missouri the Republican party proposed a bill to increase penalties for patients who defrauded Medicaid. When the Democrats proposed an addition that would also go after the businesses who committed fraud the Republicans refused to do it. Ths is a perfect example of their mindset. Screw the peasants, protect the wealthy.

Re the pricing discussion: both private insurance and Medicare's negotiated pricing have that same effect of raising the costs for the uninsured, Medicare even more so because it sets the pricest lower than the private market does in most cases.

That's why it makes no sense when people say, "Fine, let's not adopt a nationalized UHC system but instead let people voluntarily choose coverage under a government run plan, while others can continue with their traditional coverage." That's not a sustainable situation because as govt begins feeling the pinch of rising costs, it's plan will continue to dictate low pricing which will then be subsidized by higher negotiated payments to the private insurance companies. So that approach makes no sense at all- you're not allowing some individuals to opt out of the government run program, not really- because they're going to pay for it one way or another. As soon as this becomes apparent, everyone will begin abandoning their private plans. We might as well skip the charade and go straight to universally mandated govt run insurance.

So private hospitals committing fraud are the reason that Medicare is the problem? That's like blaming the victim for the crime, isn't it?

No, the Medicare bureaucracy is not the victim here, the American taxpayer is. And if the administrators of Medicare don't have adequate manpower and resources to prevent fraudulent claims from being paid out, then they are part of the problem.

Hemm, a little early in the morning to be hitting the conspiracy theory bong, isn't it?

If doctors lose money on medicare patients, of course they'll want to stop taking them. That doesn't require any collusion, it's just common sense.

Granted price caps stabilize prices, but they don't drive down the supplier's costs. You can cap what a doctor can charge for a treatment, but that doesn't make his rent any lower or his malpractice insurance payments any cheaper. His staff still has to manage the same paperwork--or more--and will still expect to be paid. So he's either going to stop giving the unprofitable treatment or shift the costs around by charging more for something else.

A doctor friend of mine reports that some of his medicare patients cover only 10% of the costs of treating them. He has to charge other patients more to make up the difference. And he's not part of a cartel.

Dr_J
If the government sets the price at something "reasonable and customary," an efficient provider who might have charged less than that will naturally raise their prices and pocket the difference as profit. Lo, costs go up.

Medicare prices are always lower that what hospitals and doctors want to charge. That's why many private hospitals and practices quit taking medicare patients. The cartel is a collusion between hospitals and doctors and insurance companies, just like the oil companies and the refineries. Medicare placing a basement on prices doesn't increase prices, it attempts to stabilize them.

CS

So private hospitals committing fraud are the reason that Medicare is the problem? That's like blaming the victim for the crime, isn't it?

Greendreams, you are contradicting yourself. In paragraph 2 you assert that healthcare costs have risen largely because of increased usage of healthcare for costly end of life procedures, and that we'll need to curtail that.

Then in paragraph 3 you state that there's a problem with insurance companies spending money on denying claims. You can't square that circle- if you believe that certain procedures must be denied, there has to be a cost in arbitrating when that happens.

Also, Medicare also denies claims, but it relies on the administrative staff of the physicians offices to deal with this- so the idea that their administrative costs are so low is mostly smoke and mirrors.

And finally, I don't know how you can seriously claim that Medicare prevents fraud. This article about a bust last year in Houston estimates that the annual national cost of fraudulent Medicare payouts is $11 billion.

Profit is the least of the problems with health care, and one of the main hopes for improvement.

The problem is not that the cats in the health care industry are too fat, it's that there are too many of them. Too many clerks pushing paperwork that should have been computerized a decade ago, too many administrators jumping through government-held regulatory hoops, too many doctors doing needless tests, too many lawyers trying to squeeze blood out of other people's turnips.

That's the supply side. On the demand side we're blessed with millions of people stridently demanding that other people pay their medical bills. They're eager to demonize insurance companies for not paying enough bills enthusiastically enough, no matter what their contract says. And they certainly don't want to hear about market reforms that might control costs and enable them to pay the bills themselves.

This is one broken system.

ironic comment, casualobserver. "Defensive medicine" raises costs precisely because the premiums on malpractice INSURANCE keep going up.

healthcare costs are up for many reasons, not the least of which is that we use increasingly sophisticated end of life procedures and treat previously fatal conditions. The solution to higher costs is not to continue to reward insurance companies, nor is it some kind of abstract "controlling costs" or "increasing efficiency". Some gains can be made by increasing prevention and allowing medications to be purchased on the global market. But let's face it, the hard fact is that in order to lower costs substantially, we need to limit the amount we are willing to spend on hopeless cases.

And we need to kick profit out of healthcare. Insurance companies do the opposite of what we pay them to do, which is to pay medical bills. A huge part of their payroll is in claims DENIAL departments, while Medicare pays nothing to deny claims. The cost of actually preventing fraud (which Medicare does) is much less than nitpicking every single claim in an attempt not to pay it.

But let me play conservative for a moment (though you all know better). LET THE MARKET DECIDE. I hereby offer to pay my share of the added cost of including me in Medicare. If they'll sell it to me, I'll buy it. Let the insurance companies compete with that. If they can't, they don't deserve to be in business. Here's another proposal. When insurers come begging for a government bailout, buy them. That's how businesses raise money in the private sector. By selling stock.

Way back up the thread you had a poster named Dave Schuler comment. I recall from prior years that Schuler is quite versed in the whole healthcare issue and he hardly resembles a conservative.

I believe he will support me on the statement that US healthcare costs have spiraled out of control most largely due to the costs of defensive medicine.

How that falls at the feet of insurance companies is patently counterintuitive........after all, aren't they the ones constantly denying treatments??

HemmD: "So when government medicare sets the price it will pay for a particular service, this increases cost how?"

If the government sets the price at something "reasonable and customary," an efficient provider who might have charged less than that will naturally raise their prices and pocket the difference as profit. Lo, costs go up.

On the other hand, if the mandated price is too low, providers won't get more efficient, they'll stop providing that service. If you require them to keep providing it, they still won't get more efficient. They'll skimp on quality, or they'll shift the costs somewhere else.

"Private enterprise in a free market, not so much."

Well, duh. Health care is the most heavily regulated industry we have.

CS

I agree.

The problem with health care debates is that one must always start with the political positions commonly held. If we can agree that both sides have ideas that can be incorporated to create the best solution instead of the politically appealing solution, headway could begin.

This may well be my biggest concern. The moneyed interests distort the political debate so that no solution is ever found. I believe that may be their very intention. If nothing changes, they guarantee their profits and the politicians guarantee their PAC money.

I believe that both government and business must modify their efforts or the U S will certainly go bankrupt. Rhetoric has to be the first casualty of the health care crisis.

I just believe we need to agree that government must have a part in regulating the health care market just as it has in other cases.

Of course- but it oughtn't intervene in the wrong direction, to make costs go up by protecting the profiteering that comes from the cartel situation.

I don't think the 'cartel' can be completely broken, but it could certainly be managed more effectively by increasing the supply of treating professionals (more medical school graduates as well as a loosening of restrictions on what can be done by PAs and nurses for wellness care) and by changing the rules for CONs for new medtech facilities (currently anyone who wants to open a new imaging center, for instance, has to prove need as well as proving that they will have no regional competition- gee, that's a great way to keep costs down, eh?)

It's certainly not the total answer, but I'd suggest that these are going to be important things to address regardless of whether our system remains mostly privatized or we go to a single payer or UHC system. In fact, if this side of things isn't addressed, the supply issue is likely to be far worse when we dump a whole lot of new patients into the system; primary care is already underserved and that's the very part of our healthcare system that's going to see drastic increases in demand with UHC.

Dr_J also mentioned the costs of practicing protective medicine (doing extra testing is the physician form of CYA, and it's very costly), so that's another area where the govt needs to get out of the way more (an example of govt intervention that works to drive costs UP, not down as we need.)

One final note is that really, even without changing a thing we could all affect costs if we price shop as though we're paying directly. I realize that's not going to happen on a scale that would bring overall costs down, but really it's a shame that we've reached this point simply because we're like the guy on an expense account who eats steak every night because he can.

HemmD, no actually the perfect answer is you live the way you wish and allow me to do the same.

No, I am not a "righty". I am dyed in the wool libertarian.

I'll even let you smoke pot, marry a member of the same sex and allow you to believe you evolved from a frog. Just don't send me any of your bills.

Dr_J
"But the insurance companies are a distraction, because the bigger problem is providers. If it was you having to pay the doctor for the treatment you get, you'd ask a lot more questions than you probably do about how much it costs and what benefit you'll get." and the rest

So when government medicare sets the price it will pay for a particular service, this increases cost how?

Insurance ultimately doesn't care how much something costs, they just pass it on along with a nice profit increase. The health care cartel functions like oil producers and refineries. Oil sets the price, and the refineries just add their part. There is no competition here, nor is their any in health care. Collusion for a common profit? Of course.
Private enterprise in a free market, not so much.

CO

What your perfect answer for the rightys

Let everything go along like it is now and bankrupt the country. I think I saw that in your Budget yesterday.

CS

Even though I don't put the aegis for the ills of our health care system on government, that is exactly where this conversation needs to start. If you have a privater sector solution to the cartel, go.

May I suggest we start with any economic market that provides a necessary product (food, oil, power, etc.) where the government has not had to intervene? This is not meant as a challenge, I just believe we need to agree that government must have a part in regulating the health care market just as it has in other cases.

CO, that is a good answer. Insurance is the wrong financial instrument for most health care anyway, since you're definitely going to face some bills over your lifetime. A savings account makes much more sense.

Is your contention that government has no business in breaking that strangle-hold?

The question of whether it has the 'business' to do so if the manner in which you propose for it to do so is doomed to fail.

If you want to talk about undoing the many ways in which government promotes the cartel of supply, that would be a fine discussion to have.

I've got the perfect answer for the lefties........do not use these corrupt insurance company middlemen sucking you dry.........doctors and hospitals will still take personal checks.

The way to promote competition is to shorten the distance between the consumer of health care and the payer.

You consume the services of a health insurer, but you don't really shop for them, normally your employer does. So the insurance companies' real customer is businesses, not you. And that shows.

But the insurance companies are a distraction, because the bigger problem is providers. If it was you having to pay the doctor for the treatment you get, you'd ask a lot more questions than you probably do about how much it costs and what benefit you'll get.

Health care providers cannot answer these questions today, so not by coincidence the true answers are "too much" and "not enough." But if the people paying their salaries started asking, they'd learn how pretty quick.

CS
So your agree that our current health care system is not competitive? That
"it functions in a system with highly inelastic demand and a near cartel situation of supply.)"

I would submit that the profit margin is indeed a motivator for a cartel. That's my point. As a cartel, just like OPEC, the price is not controlled by anything but the caveat of those that rule. I wish to break that cartel's blind obedience to profit.

Is your contention that government has no business in breaking that strangle-hold?

Also, could you send me the link that sites that European counties don't count births like we do. I believe you, I just can't find any evidence that this is so.
"Babies don't count as 'dying' if they were never counted as 'born' to begin with"

So you're saying the way to make health care costs go down is to foster more competition between them? Great, I agree. That's quite the opposite of making the government run the market.

Exactly. I was thinking this after our previous exchange, Hemm....

Simplistically, the 'efficiency' that you want to see from the business side is a function of profit motive + competition.

The part that's missing in the current system is the competition part. Taking away the profit motive isn't going to then cause efficiency to magically reappear.

Hemm, our founders didn't exactly stop there, they established a system of checks and balances. So what is the check on the govt authority with these GSE type enterprises? Has anyone in our government yet been held accountable for the fiascos in the housing GSE's? The last time we tried to implement a moral imperative that way, it was when both parties decided that there was a moral obligation to increase the number of homeowners in the country. That went well, didn't it?

Hemm: "Health care costs go up because there is no competition between these companies any more than there is any competition among oil companies."

So you're saying the way to make health care costs go down is to foster more competition between them? Great, I agree. That's quite the opposite of making the government run the market.

Dr_J
We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.

If that's not a moral imperative, maybe you direct me to the correct link that explains our government's justification. Where I agree that the past 8 years have certainly caused me to question just what our government is good at, it doesn't change our goals as a people.

Hemm, you're not going to get any "moral imperative" out of government. You'll get a new set of bureaucratic policies and hoops to jump through. Just as corporations try to maximize profits, government bureaucrats try to minimize any appearance of impropriety that might lead to an investigation. For example, they'll waste huge amounts of taxpayers' money to avoid the appearance of wasting taxpayers' money.

You're citing data, and you're making claims, but the two don't line up. Suppose those top 7 insurers made 0 profit, that would make health care $12.6B cheaper. Compare that to the $700B the CBO says gets spent on unnecessary tests, and it gets painfully obvious that insurance companies are a small part of the story.

And I'm not sure if you caught it or not, but your CNN link about infant mortality proves nothing. Babies don't count as 'dying' if they were never counted as 'born' to begin with. That's the problem with the stats.

No, you misunderstand. I'm not claiming that healthcare functions as a market system- it doesn't, and that's why the profit motivator doesn't work to control costs in that situation (my comment was about profit motivation in general, not as it functions in a system with highly inelastic demand and a near cartel situation of supply.)

I was just pointing out that if you lack that motivator, you have to replace it with something if you're going to improve the status quo. And I don't see that happening in any way, shape, or form with a govt run system (see Dr_J's comment about our legacy of government procurement of $640 toilet seats.)

Could the government catch more? sure, but that's not a reasonable rebuttal to this argument.
OK, now I'm really confused. How it is not a reasonable rebuttal to your argument that government oversight would fix the problem to mention that government oversight hasn't worked effectively to date to do so? You are the one talking about the wasted funds which don't go toward actual healthcare provision- so if you're not arguing that the government would need to 'catch' that, then what are you saying?

CS
The top 7 "for profit" health insurers made a combined $12.6 billion in 2007-- an increase of 170.2% from 2003. The same year, the average CEO compensation package for these health insurance companies was $14.3 million. Pay packages ranged from $3.7 million to $25.8 million.

What explanation for these profit increases do you attribute to market factors.

Health care costs go up because there is no competition between these companies any more than there is any competition among oil companies. Somebody raises rates, every body raises rates. We no ,longer have gas wars at the pump, and we never have a cost war in health care. Private enterprise shows its best qualities when there is real competition.
Medicare and medicaid fraud is a direct product of private corporations. Its not patients who commit the fraud, it's the private hospitals and insurance companies that do. I've sent links on this before.

Could the government catch more? sure, but that's not a reasonable rebuttal to this argument.

I believe a Government/business joint system of health care may be the ultimate solution. From business, we get efficiency (Maybe), from government we get a moral imperative to provide good health to everyone as much as is possible.
Just as I challenged Jim S on this, I'd also challenge you to think of the models we currently have for those kinds of public private partnerships. Fannie and Freddie, the USPS, Amtrak.

Do those represent the best of private and public systems, or as I'd submit, the worst features of both? It seems to me that when we create these hybrids we generally end up with all of the greed but without a check on cost constraints (because the government till is always open.)

Hemm, the profit motive itself serves as a check on waste and fraud too- and I see little evidence that a bureaucracy has alternative motivation to do any better at keeping costs down. That's actually a very convincing argument I've seen about the low overhead cost of Medicaid- that this is actually probably a bug, not a feature to some extent. If they'd spend more on oversight, they'd reduce the massive fraud (or look at it in reverse- we can't address the fraud and waste without increasing the overhead costs.)

When the government doesn't even use the authority it already has to provide oversight, on what evidence can we assume that giving it more authority will help?

Dr_J

I have never advocated government as the solution to all my problems, nor am I doing so now. I am working from the assumption that the primary tenet of corporations is to maximize profits above all else. The function of government as I see it is performing oversight for that unbridled avarice.
We have laws for people to limit their worst foibles, and we all accept that as a basis of judicial system.

Isn't the lack of oversight what has been a major factor in the Wall Street mess? Corporations have time and again demonstrated that they cannot be trusted to do anything except maximize their profit. The health care industry has spent billions in convincing us we've got it good and that they were entitled to define a necessary market. That is foolish. Their definition contains only a view of profit.

I believe a Government/business joint system of health care may be the ultimate solution. From business, we get efficiency (Maybe), from government we get a moral imperative to provide good health to everyone as much as is possible.

Hemm- the life expectancy numbers are skewed by deaths from accident, suicide, and homocide, which have nothing to do with quality of healthcare. Take that out and the US actually leads. For life expectancy to be a meaningful metric, it has to only involve the factors that are controllable by a good health care system.

And on infant mortality too, the numbers are impossible to interpret because different countries count live births differently (many countries don't register as a live birth any infants who are severely underweight- they're considered the same as stillborn since the mortality is so high.) But in the US we count them- and we have a lot of them, and we save some of them but lose a lot of them too.

HemmD, don't misunderstand my position. I'm in no way defending the deal we're getting from the current system. I'm paying, what, 50% more for health care than I was 10 years ago? Am I 50% healthier? Am I going to live 50% longer? No I'm not, and no I won't.

Where I disagree with you is (a) your assumption that insurance companies are the disease and (b) your faith that government sponsored insurance is the cure.

Dr_J
I don't need to start a private insurance company. Perhaps you can explain why it's such a good deal for the US to spend the most for health care but receive second rate care. I'm quoting the World Health Org, so you may wish to question the source. The rankings are kind of a problem for you otherwise.

Demonstrate your assumptions with facts please.

CS

So the fact that Americans don't live as long as other people with universal health care is a feature, not a bug?
Innovative treatments should prolong and improve life. If we lead in innovation and innovation is good for health, then why are our numbers lower than other countries?

It's not political spin to point out that new born mortality is higher in the US than in other countries. I know you said that these other countries just bury their dead, but a CNN link disproves your assumption.

"American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found."

As for as life expectancy, we're 50th. I'm sure there's a perfectly reasonable explanation. I wouldn't trust the CIA's figures either.

https://www.cia.gov/library/publications/the-wo...

So again, tell me about the good deal we've got going from paying the most for health care.

HemmD, of course insurance companies have overhead; so does government, home of the $640 toilet seat. That 3% overhead number for medicare does not stand under scrutiny. See, for example, http://www.thehealthcareblog.com/the_health_car....

To the extent insurance companies are making a profit, that's not necessarily cause for alarm. Profits of public companies come back to the general public in the form of dividends and capital gains, ie better returns on our retirement savings.

But if you're certain insurance companies are bloated and corrupt, put your money where your mouth is. Round up some like-minded friends and start an insurance company with *your* money rather than mine and that of other taxpayers. You'll start raking in those obscene profits, and you can pay yourself $1million a year salary and still look like Mother Teresa compared to the existing fat-cat bosses.

Not nearly as many times as an 8 or nine-figure compensation package represents, CS.

So if that's the scale that gets your attention, is it safe to infer that you do think it's wrong for the Freddie Mac CEO to have gotten 8 figures?

I am not proposing a system that seeks purposefully to eliminate them, just one where there is an alternative to them that anyone is free to buy into.

But that model of putting for-profits in competition with government subsidized organizations never works. The government ones will never be allowed to fail, so they compete unfairly in the marketplace.

Before you go into that, however, please let me know your rational for the US paying the most for care and receiving such a low ranking in care given. I believe the last time I asked that question, you or someone question The World Health Orgs ranking of the US. That is not an answer.

Questioning the quality of the data that supports your side of the argument, and the politicization of it, is part of the answer whether or not you choose to allow it. In that previous response, I gave several examples of why some of that data and some of the conclusions are indeed questionable, and I don't recall you having a rebuttal to those points, so I'll continue to make that 'exhibit A'.

The second part of the answer to why we pay so much is that at least part of that is the profit that motivates innovation. It's my sincere belief that we'll sacrifice innovation for global health care if we go to a non profit motivated system. I don't necessarily think that's all bad- I've said elsewhere that we are kidding ourselves if we think we're on a sustainable course to continue increasing both longevity and quality of life ad infinitum. But I do think that people also kid themselves if they think that the same level of medical advances is going to continue without the profits that are currently attainable.

No, I just don't trust the proposals that have all of the government money going to the for-profit corporations. I am not proposing a system that seeks purposefully to eliminate them, just one where there is an alternative to them that anyone is free to buy into.

"How many times greater is $800,000 than the average mail carrier's salary?". Not nearly as many times as an 8 or nine-figure compensation package represents, CS. For something as large as the USPS I think it's reasonable and I imagine many people on "my side" of this kind of argument do as well. Is the USPS having problems? Yes. Tell me who isn't having problems nowadays. I simply meant that the ties to the government are similar.

I just don't trust a proposal where that money goes to the for-profits. I think too much would go to their bloated administrative overhead.
Our stalemate in a nutshell. You don't trust ANY proposal that retains a profit motivation, and I don't trust any proposal that eliminates it in favor of centralized government authority to ration the resources.

a corporation like the USPS created.
I find it astounding that you think this helps support your case, given the conditions of USPS right now. In fact it's ironic because it's an example of what I think will happen if we change to that kind of construct for healthcare; the USPS is now proposing, among other things, that they ration our access to mail delivery service in order to bring costs down. And meanwhile the CEO is making something like $800 grand, without a peep from the populists in Congress who rail against exec. compensation being too high. How many times greater is $800,000 than the average mail carrier's salary?

Dr_J

Well, for starters:
http://www.huffingtonpost.com/donald-cohen/why-...
Quotes from article.
Private insurance overhead and profits eat up 20% and more of health care premiums while Medicare overhead (and no profit) is closer to 3%. ...

t's no wonder, though, that the Health Insurers are frantically trying to head off competing with a public plan. Private insurance overhead and profits eat up 20% and more of health care premiums while Medicare overhead (and no profit) is closer to 3%. There is big money to be made in health insurance. The top 7 "for profit" health insurers made a combined $12.6 billion in 2007-- an increase of 170.2% from 2003. The same year, the average CEO compensation package for these health insurance companies was $14.3 million. Pay packages ranged from $3.7 million to $25.8 million.

Redistribution of wealth is to CEO s is not a model I'd care to continue.

CS

I was referring to the link you sent me when you and I first discussed health care. (sorry, I don't have those links on this computer.) The study was from the English Doctor who had analyzed the increase in hospital administration and decrease in actual beds.
Here is the US, the hospital staffing to management ration is higher. You may remember that my wife is an RN in a local major hospital. Much of the administration staff is dedicated to getting pre-approval and and contesting denied claims. If as the article above states that 20% of premiums goes to admin. I don't believe I'm stretching the truth when I figure in 10% for the hospital's side of the insurance game.
If you have problems for my reasoning, fine, call it 20% of health care premiums.

Before you go into that, however, please let me know your rational for the US paying the most for care and receiving such a low ranking in care given. I believe the last time I asked that question, you or someone question The World Health Orgs ranking of the US. That is not an answer.

Actually, CS, I've always felt that a program that utilized a sliding fee scale was what we needed. I just don't trust a proposal where that money goes to the for-profits. I think too much would go to their bloated administrative overhead. Blue Cross used to be a network of not-for-profits. Most of them have converted to for-profit corporations. If the private sector can't create a nationwide non-profit or network of smaller non-profits then I'd like to see something along the lines of a corporation like the USPS created.

30% of your private health insurance dollar goes to people who don't know medicine and don't interact with patients except to disallow payments.

Cite reference, please. I've seen estimates of TOTAL administrative costs around 13% (and some of those costs aren't going to people who don't interact with patients.)

Yes, HemmD, show me the economic data that shows insurance companies are hoarding enormous pots of gold that we can simply redistribute through reforms. Sure, a ton of money goes on administrative costs, but there's a reason for those costs, you can't simply wish them away.

Oh I agree with those who don't trust in federal regulations needlessly limited private insurance. It's worked so well with WS, how could holy private enterprise be doubted. yes, that is snark.

30% of your private health insurance dollar goes to people who don't know medicine and don't interact with patients except to disallow payments. The greatest increase of costs year over year are generated by management. Perhaps it would be different if the US ranked in the top twenty for health care effectiveness.

Perhaps the right should make their arguments based upon the economic data and not blind allegiance to ideology. I mean why should we pay top dollar for third rate care?

Jim, I'd submit that plans like this would have solved the problem that you encountered far better than any of the proposed single payer or nationalized systems would. (Similarly there are all kinds of proposals out there for small businesses to pool together and get greater bargaining power, and for people to be able to purchase insurance across state lines.)

So, you can either argue against strawman conservatives who you believe are sticking their heads up their rears and ignoring the dysfunctions of the private healthcare system (in this case, the obvious problem created by having employer based coverage subsidized by individual insureds since the employers have greater buying power) or you can acknowledge that some people have sought government interventions which seek to make the market function in health care purchasing.

That’s right, the same highly profitable insurance companies that have caused the price of health care to spiral out of control

Insurance costs amount to, at most, one third of total costs (at least according to the study in the JAMA). Our costs in the United States are three times per capita what they are in our closest competitor. 30% is not 300%.

Given that disparity what is your justification for asserting that insurance companies are the sole or even primary cause of high costs?

I support going to a single payer system but I think we need to have realistic expectations of what it will achieve which is to drive down total healthcare costs at most 20%. That's not enough to bring universal healthcare within the affordable range without other reforms.

The cost of medicare is growing faster than the economy and has unfunded obligation into the trillions. So the solution is to lay off a million or more people in healthcare, expand care by 50 million people while maintain open borders and unlimited immigartion, and plan of covering everything.

I doubt if there is enough money to pay for all of this. Besides, many people purchase supplemental Medicare insurance to fund things that it does not pay. There will end up with many procudres that are not covered, the government will set the reimbursement rates below costs (see normal baby deliveries for medicaid, and people will by stuck facing the problem of paying a lot more to fund everything or rationing care.

The idea that things get cheaper and easier when the government pays for everything is foolish.

Dr_J, allow me to present some anecdotal evidence. At one point I paid for my own insurance. I did this for almost 10 years. During that time neither my wife nor I had any major or even moderate expenses. Yet every single year our insurance expenses went up at a rate faster than medical inflation. I paid attention. There were no exceptions. The same has been true of what they do to my current employer. In addition both Medicaid and Medicare do not waste as much money in administrative overhead as the private corporations do. But of course if there's one thing I know, it's that there is in fact no way to convince conservatives that the free market won't solve it all.

I'm with Bridget and Ron. The whole deal of paying absurdly high health insurance premiums every month and still having to deal with a semi-competent bureaucracy that seems to hope if they make actual coverage a big enough pia you'll get tired and pay what the insurance is supposed to cover, well... please, bring the single payer system on. It's no mystery why most people, including doctors, want it.

Dear Bridget, consider the reservations of those who aren't embracing single payer. The bloat in the health care industry isn't confined to insurers, it's an epidemic raging throughout the system. We're paying too much for doctors, hospitals, equipment manufacturers, construction workers--and they're paying too much to comply with all the regulations government imposes on them, which arguably cost more lives than lack of health insurance.

Please convince me that single payer will drive efficiency and lower costs into the system. It's easy enough for the government impose price caps, but that just shifts costs elsewhere. Where and when has the government driven meaningful efficiency improvements into anything, much less anything as complex as health care?

Amen
Any reform that doesn't get rid of the parasitic insurance companies is no improvement at all. They contribute nothing to health care and in fact frequently get in the way but are rewared with up to 30% of each health care dollar. See: http://www.newshoggers.com/blog/2009/03/health-...