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  • #61
    Originally posted by Rustybolt
    When you say "evil corporate profiteering" I think you actually mean evil trial lawyers manipulating the system for their own profit. If corporate profits are so evil why is tobacco even being grown in this country?
    I didn't say "evil" corporate profits. Trial lawyers have little to do with it: the reason we have the most expensive health care in the world (we pay around 3 - 5 times the equivalent health care cost of any industrialized nation) is because a trillion dollar healthcare market has embedded itself here, and we (workers and employers alike) have to pay Cigna, United Health Care, Aetna et al's corporate profits for being nothing more than middlemen. In other words, they don't provide any useful service other than billing and accounting, yet they account for the vast majority of the health care cost.

    So, for example, Novartis -- a Swiss Company, is the world's largest pharmaceutical company, and out-spends Pfizer on research, yet the cost of their pharmaceuticals in Switzerland is 2 - 3x lower than the same drugs sold in the States. Yet their revenues are higher than Pfizer's.
    "Twenty years from now you will be more disappointed by the things that you didn't do than by the ones you did."

    Comment


    • #62
      This is a long answer (sorry) -- but we've got to fix half a dozen things to get healthcare right in this country. This isn't a liberal or conservative issue, it's one of our national crises.

      We pay almost twice as much capita on healthcare as the next big spender, but our outcomes (infant mortality, longevity, etc.) are in around 30th place. Here in the US, we're shown the Ferrari and told how wonderful it is. We're paying Ferrari prices, But the nation is riding around in Yugos.

      I'm pretty much dead center politically, voting both sides depending on the candidate. I'd have to say that the Moyers piece Alistair started with is a simply terrific bit of journalism. Watch it, even if you're sure the world is flat. A couple folks said, in effect, they won't even listen to or trust what Moyers' guests say (prominently an ex insurance exec) because they've been told he's a lefty. In this case, that's foolish.

      Medical inflation is 2.5% more each year. The costs will bankrupt us. The health consequences will debilitate us. This is the big "entitlement" issue to fix.

      Folks like Michael Moore blame the insurance companies all of this. As Moyers' sources tell it, the truth is that private insurance companies piss away "only" about 27% of of our health care dollars.

      An insurance company is a sort of glorified money changer, with three functions. 1) collect money. 2) pay medical bills. 3) make sure you're paying for real patient care, not crooks. Lots of enterprises perform similar functions -- the IRS takes and disburses money and chases crooks. A charity collects donations and disburses the money to worthy causes. An efficient organization charges about 3% off the top for this money changing function; and it's about what Medicare charges.

      In contrast, insurance companies take 20% off the top and are always looking for more. The Bill Moyers piece is especially illuminating in this respect. The current system also forces doctors, hospitals, and patients through billing hoops. Complex submissions, denials, re-submittals -- that probably waste another 10-15% of health care dollars. So we spend maybe 30% of health care dollars to do a 3% job of collecting insurance and paying bills. Wanna guess where that extra 27% or so is going?

      Insurance company execs will tell you they are "innovating" and that you don't want some bureaucrat socializing your payments and rationing your care. Here's the truth: an insurance executive never innovated a cure for anything. Their innovations are aimed at increasing the percentage they keep.

      As for rationing, get over it. It has to happen under any system. Look at your insurance policy, there's already probably a $1 million lifetime cap. If you get $500,000 sick your insurance company will often fight to delay or deny the claim. So, here in the States we have a choice. We can have some Wall St. executive ration our care and take 20% off the top. Their motivation is to take more if they can. Or we can have some government bureaucrat ration our care and take 3% off the top. Their motivation is to bumble through the day. Neither situation is ideal, but it's clear who's going to do the better job of screwing medical consumers.

      We also probably want a ban on health care companies contributing to political campaigns. The corruption on both sides of the aisle is staggering -- and it's now playing out in the health care "debate."

      In my mind, having a government option to collect premiums and pay bills is a must have. Single payer could be even more efficient, though harder politically. Insurance companies are right to fear their 20% off the top won't look so good then.

      In the best of worlds a few new innovaters will emerge, who get the transaction costs down to 2% or so (e.g. like credit card processing, which must also fight fraud) and then add extra value and fraud protections so they can charge maybe 5% off the top and keep 1% -- still a huge number in a trillions of millions of dollars healthcare industry.

      I think PayPal is a pretty lousy anti-customer company. But, then compare them to insurance companies. Paypal manages to collect money from people they don't know, pay it to other people, handle disputes, deal with fraud, and provide value added services like automating almost all the rest of a transaction (notifications, shipping, follow up). They charge a few percent and make a profit doing this with even tiny transactions (compared to the mega dollar flows of medicine). You might argue that PayPal sucks, but many insurance companies suck just as much -- and charge 10 times as much for essentially the same services. Imagine what a really good company could do in the medical payments space.

      We should also streamline and somewhat standardize billing so that doctors and other providers have only one set of procedures to follow rather than different hoops to jump through for different bill payers. If you want to write to your congressman, tell him you want a government option in direct competition with private insurance companies.

      Getting medical records right can also offer savings IF we get the privacy issues right.

      Next we add half the lawyers suing doctors to the unemployment lines. Their impact in terms of higher insurance premiums for doctors and having doctors prescribe unnecessary tests may add maybe another 5% to health care costs. Some sort of reform really should be simple.

      A larger target, perhaps as large as the billions given to insurance companies, is the inefficiency of the health care itself. I had an experience several years ago of visiting an emergency room (pulled a string, attached to a nail thirty feet away, nail enters back of hand). Basically they did everything in triplicate, but never quite right. It's the opposite of manufacturing where you try to do things just once, and get them 99.999% right on the first try.

      Since then I've looked at every doctor encounter from a quality and productivity standpoint -- and am convinced there's 20% savings easily to be had. Right now, we don't even have incentives in place to spur operational excellence. In particular, patients need to be able to assess the quality of their care more easily and directly.

      It's also amazing to me that no one from either party is addressing the issue of personal responsibility in any meaningful way. IMO, if a disease or accident strikes through bad luck, that person deserves a full share of whatever care our society can afford and beyond that what they personally can afford. But when someone rides a motorcylcle without a helmet, or gains 200 pounds through sheer inertia, smokes two packs of cigarettes a day, or considers meth a recreational drug, then it isn't so clear we should foot the bills for their brain drains, diabetes meds, lung transplant, etc.

      The issues of health care for illegals, deadbeats, and prisoners, and the like also fit in here somewhere.

      The basic claim is that government-run medical care is already going to freeloaders, while hard-working citizens will get socialized and rationed care with some evil bureaucrat denying them their share. It's a little confusing why bureaucrats would want to do this, since most illegals and prisoners have no money or votes to buy the affections of bureaucrats. Still, there have been well publicized instances of idiocy.

      The illegals question can and should be solved outside the medical question. Once we figure out who we want as citizens and who we don't, the problem with unfunded emergency room care should go away.

      The deadbeats and prisoners deal is may be equal in complexity to healthcare. Just why is it that such a huge percentage of our population is sucking value from the country rather than adding to it? In any case, health care for prisoners whether miserable or improved is probably only a 1% factor in the bigger picture. Personally, it's hard for me to believe that prisoners are routinely getting the best medical care. But, hey, if it's an option and I need a heart bypass, maybe I can just shoot someone in the face or steal billions from someone's savings as my last resort?

      Finally, there's also the issue of healthcare innovation. A male born in 1900 had a life expectancy of 45 years. For a boy born today it's more like 75 (and heading down for the first time in a century, due to diabesity). Those extra 30 years of life span came more from clean water, draining swamps, sanitary sewers, safer jobs, better diets, and refrigerated rather than spoiled food than pure medicine. Even today there are many forms of healthcare innovation, not necessarily all of them from pills in a bottle.

      Pharmaceutical execs like to talk about how they need to be free to innovate. But as with the insurance companies, that's just part of the story. First, the typical pharmaceutical company now spends more on advertising and stimulating demand (as if we needed to stimulate demand for a cure for cancer) than on R&D. The average brilliant medical researcher is happy as a clam with a new lab, the admiration of colleagues, and maybe $250K a year in salary. The average pharmaceutical executive, on the other hand, wants $250 million to a billion or so for hiring that researcher and ad agency. Don't even get me started about such issues as not negotiating prices to be as good as, say, Canada. It's another case where the fundamental motivations and outcomes are cockeyed.

      Imagine how much stronger this country would be if we spent less on health care, but were the world's healthiest and most vigorous people. If you want to make progress on that, now's the time to hold both Democratic and Republican politicians to account.

      Comment


      • #63
        Yes we do need to hold Republicans and Democrats accountable.

        However more importantly we need to address this one problem at a time and make changes where needed over a period of time.

        The worst thing we can do is sign off on this idiotic plan being forced down our throats.

        We first need to tackle two problems first.Medical tort against hospitals,doctors and drug companies,end the litigation lottery.We have become a nation of people who expect a happy outcome no matter what and we also expect all drugs to have zero side effects.We must once again be willing to accept some risk.

        Next illegal aliens and dead beats.We constantly hear ourselves being compared to the rest of the industrialized nation.Problem is we aren't like them and never will be.Not in culture,not in demographics and not in thinking.No system anywhere can survive if 12million non-payers are dumped into it.

        Insurance reform would be next,allow people to buy outside they're state and only the coverage they need.

        See what those changes do before knee jerking into the abyss.Somehow we managed to get along fine in this country for most of our history.We need to look at what has changed since then and correct it.

        And I still say I will not participate in any system unless the Congress and the President are forced to use the same one.
        Last edited by wierdscience; 07-19-2009, 03:42 PM.
        I just need one more tool,just one!

        Comment


        • #64
          Originally posted by lazlo
          I didn't say "evil" corporate profits. Trial lawyers have little to do with it: the reason we have the most expensive health care in the world (we pay around 3 - 5 times the equivalent health care cost of any industrialized nation) is because a trillion dollar healthcare market has embedded itself here, and we (workers and employers alike) have to pay Cigna, United Health Care, Aetna et al's corporate profits for being nothing more than middlemen. In other words, they don't provide any useful service other than billing and accounting, yet they account for the vast majority of the health care cost.

          So, for example, Novartis -- a Swiss Company, is the world's largest pharmaceutical company, and out-spends Pfizer on research, yet the cost of their pharmaceuticals in Switzerland is 2 - 3x lower than the same drugs sold in the States. Yet their revenues are higher than Pfizer's.



          We also pay for the research and experimentation that the rest of the industrialized world either can't or refuses to do.
          Yes it's expensive-thanks to trial lawyers- but I can trael to 4 hospitals and nemerous clinics within a tem minutes drive and not have to wait for care.

          Comment


          • #65
            Weirdscience -- we'd probably agree on the list of things to fix, but not the priority.

            I'd put insurance reform first -- it's costing us 15-20% of health care dollars.

            Tort reform costs a couple percent in terms of actual judgements, but maybe as much as 5-10% in CYA health care. I think there's a good bill, yet to be written, that simultaneously makes frivolous lawsuits less lucrative AND moves us toward fuller disclosure of doctor and hospital outcomes. We keep better statistics on baseball players then we do medical practitioners. So, one bill gives doctors something they deserve (less stupid lawsuits) and gives the public something it deserves (the information needed to be an informed consumer).

            Illegals are likely not even a 5% of costs problem. First, less than that % of the population is illegal. Second, they are less likely to consume health care. But more to the point, this issue belongs outside of the medical discussion. Once we figure out who we want in this country -- and who we don't -- the problem goes away. The place to fix this (and other issues, like educational entitlement) is in immigration policy.

            "Deadbeats" is a harder problem. I do believe we should be held accountable for our lifestyles and behaviors and there are ways to see that our best and costliest medical care goes to value-adding citizens rather than, say, chronically criminal meth addicts. We manage to do that fairly well in some cases, say kidney transplants. We haven't figured it out yet for the system as a whole.

            I do like the idea that any insurance program for citizens should be good enough for our elected officials.

            Comment


            • #66
              bama is smarter than W, but he's just a different flavor of the same machine, as are nearly all of them. I have absolutely no faith in any of them to do right by the people. Oh, I believe they will pass some health care "reform", but if you think you will be better off, then dream on. Anything they do or don't will gurantee that you and I pay more and get less. To make health care right would require that the status quo is burned to the ground and start it up again from scratch, and that just ain't going to happen. It's all a ponzi scheme folks. Make it complex and it's harder to see the core reality, but it's definitely nothing more than a colossal scam. Wake up.
              You can see through it, but are you brave enough to solve it? Perhaps I am not. Obama, in addition to being smarter, is less directly evil, but he is still a bollard on the road to the Era of Infinite Light.

              Do not be decieved by fear of entitlement, indeed, under the Internationale Council no person illegally within the bounds of an administrative region shall suffer, but the cause of their intrusion shall be made null. Yet they will be removed and be punished for their intrusion.

              I see no reason for rationing; when scientific agriculture (in a more natural form than todays) and efficient production methods are applied, all things-medical care, food, shelter, and goods will be in easy excess, and the extra labor applied to the thousands of great projects that will drive Humanity into the stars. Nor should your worry that the system may be usurped by those who are lazy; jobs will be found for them, and their life shall become a state of horrid simplicity if they do not pay.

              This is the blazing perfection of a well-engineered system. People will not be forced to work or assigned to jobs like draft animals, but they will not be able to soak. People with an excess of children, for example, might receive day care and people who are unemployed will receive education benefits, and job search priority. The Labor Shortage will be carefully maintained.


              I't won't be the war that right-wingers predict they will win with their automatic weapons, nor the election of a new candidate. When the time is right, instead, we will pull the carpet from beneath the feet of the conventionalists as it was nearly a century ago. Then, without bloodshed or insurrection, the Donkey and Elephant will pass to the world governed by the winged angel of international social community.


              Those who see the receivers of wellfare as consisting of cheats and fools, cannot imagine that the system could be engineered to be cheat and fool resistant.

              Those who reject the social contract and prefer to play by the (nonexistent) rules of "rugged individualism" and supposed natural justice can pursue the solitary and wretched life that awaits them in the backwaters of the world. There, the vanguards of the International Council will ensure that their children have a right to choose the benefits-and the labor- of the social world.

              "become more productive or die???"
              For that, you will be left out of the Society. You yourself may become unproductive one day. We will reward productivity- incomes vary by one order of magnitude based on productivity, with education for increased productivity available.

              Long Live the Republic, the Community, and Humanity!

              Comment


              • #67
                ya got me goin

                A friend of the family lost a mother to the European health care system. She wasn’t sick enough to treat (beginning stages of cancer) so they (the doctors) sent her home. Then when she went back she was too sick to treat so they gave her hospice care until she died: Great system.

                My son got sick (stomach flu) a few months back and passed out. He was taken to the hospital and checked out; one of the tests they ran was an MRI. When he passed out he hit the floor hard enough to cause bleeding in the brain. Had he been in the European system I would have lost my son. As it was because the hospitals’ are afraid of being sued so they run more tests than the European hospitals (Btw, the doctors in the European system do not have a choice in the treatment, it is prescribed by legislation.) The doctor that treated my son had just come back from an exchange program with teaching hospitals. That is how I know what the difference in treatment is.

                As for law suits, yes there are tones (like the European spelling?) here as compared to Europe. I have seen the cost of insurance drive doctors out of private practice (one of our doctors gave up after insurance premiums’ reached $250,000). In Europe malpractice suits are almost un-heard of.

                Is it the insurance companies? No they need to stay in business after being sued for every thing, (if a baby is bruised or the parents think it is bruised at birth the doctor has to defend him/her self against a law suit, and yes it does happen).

                Is it the lawyers that want to make a quick buck? Didn’t John Edwards become a millionaire from just one law suit? That was millions that came out of the healthcare/medical insurance system.

                The real culprit of our medical dilemma is us. Everyone that sues or dodges out on a bill or lets it happen.

                Single payer system, what one thing does the government do well and not charges an arm and leg for? Will it still stop the law suits? Or will it just take my son from me.

                I will stick with what we have now and work for tort reform!

                Comment


                • #68
                  Originally posted by huntinguy
                  . . . because the hospitals’ are afraid of being sued so they run more tests than the European hospitals . . .

                  I will stick with what we have now and work for tort reform!
                  Medical care is a pretty emotional issue for all of us, especially when we've seen our kids at risk. In this case, I'm trying to understand your idea of how we go from #30 or so in the world in health care outcomes to the best.

                  First, it's good that we have all the lawyers suing the hospitals, because that meant your son got an MRI?

                  Then, the main thing to fix is tort reform?

                  Tort reform is needed, but it's a smaller issue compared to the profiteering of middlemen and the screwed up incentives and productivity throughout the system.

                  In an ideal system, MRI's would be so cheap (more like a half hour's worth of CNC machining time) a father wouldn't hesitate to pay for them. The capital equipment cost and skills required are about the same, but our system manages to make an hour of MRI time 20x or so the cost.

                  Comment


                  • #69
                    Originally posted by PeteM
                    Weirdscience -- we'd probably agree on the list of things to fix, but not the priority.

                    I'd put insurance reform first -- it's costing us 15-20% of health care dollars.

                    Tort reform costs a couple percent in terms of actual judgements, but maybe as much as 5-10% in CYA health care. I think there's a good bill, yet to be written, that simultaneously makes frivolous lawsuits less lucrative AND moves us toward fuller disclosure of doctor and hospital outcomes. We keep better statistics on baseball players then we do medical practitioners. So, one bill gives doctors something they deserve (less stupid lawsuits) and gives the public something it deserves (the information needed to be an informed consumer).

                    Illegals are likely not even a 5% of costs problem. First, less than that % of the population is illegal. Second, they are less likely to consume health care. But more to the point, this issue belongs outside of the medical discussion. Once we figure out who we want in this country -- and who we don't -- the problem goes away. The place to fix this (and other issues, like educational entitlement) is in immigration policy.

                    "Deadbeats" is a harder problem. I do believe we should be held accountable for our lifestyles and behaviors and there are ways to see that our best and costliest medical care goes to value-adding citizens rather than, say, chronically criminal meth addicts. We manage to do that fairly well in some cases, say kidney transplants. We haven't figured it out yet for the system as a whole.

                    I do like the idea that any insurance program for citizens should be good enough for our elected officials.
                    The first two problems I mentioned are directly related to the cost of health care.My cousin is a doctor,has been for years,never a single claim on his malpractice insurance and it's nearly $60,000/year now,hospitals pay even more.It's also gotten to the point now where nurses are being sued.The Tort lottery must be closed.Loser pays law would eliminate a lot of it,many insurance companies simply pay out settlements rather than fight a case in court.If they had a mechanism to recoup they're legal expenditures they might be more inclined to fight.IIRC there is a similar system to Loser pays in Canada.

                    My brother is an ER supervising nurse in a town of 65,000.In that town there are quite a few industries that use illegal labor.He says 40% of the people they see are illegal.Everything from a head cold to a gunshot comes in.They offer cancer treatment and cardiac surgery,all of it FOC to walk ins.It's free for them because his hospital receives federal funds and falls under the Hill-Burton act.It costs his hospital millions a month and this is just one of 4,000 facilities nation wide that provide services under Hill-Burton.Those federal funds pay for capital improvements,new equipment etc,but not the day to day facility costs.Some of those are picked up by The states medicaid system and the rest are charged off to paying customers.

                    The problem got so bad here and the feds refused to do anything about our medical system was running a $95m/year deficit which violates the state constitution.The state senate recently passed and the governor signed into law a fine of $10,000 per employee for any business found hiring illegals.Finally the numbers are coming down even in the criminal system.I have nothing against anyone coming here to make a better life for themselves,just don't do it at my expense.It's an insult to those who immigrate here legally to let all these folks just land here willy-nilly and use the country for an ATM machine.

                    Oh and we do need insurance portability and shopability.When I went looking for a policy last year I had a very difficult time finding what I wanted.I more or less was given a choice of what was availible in my state.I finally found what I wanted,but it would have been cheaper if I was one state over.
                    Last edited by wierdscience; 07-19-2009, 10:23 PM.
                    I just need one more tool,just one!

                    Comment

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