ObamaCare

[Sstashmoo]

I can't understand why people are incapable of simple math.

When someone goes to a doctor and runs up a bill and doesn't pay. Here is what happens. The Doctor "expenses this out" "writes it off as a loss" thereby offsetting his or her tax liability. That will omit that much tax owed on other income. The Government operates on tax money received. If they don't get it one place, they get it somewhere else. So you can plainly see, we are already paying for "Government funded" healthcare and not getting it. Think about it. No free lunches, costs are constant.

[Lorax]

Democrat=liberal.

Republican=fascist.

[ccbatson]

Would you please put a copy of Webster's Dictionary on your Christmas list this year Lorax?

[ccbatson]

Doctors do not get write offs for accounts receivable. It is either a loss plain and simple, or you send it to collections and get 10-20 cents on the dollar.

[Zacha341]

[Compelling Article]

Despite President Obama's good intentions, his deviations from truth-telling compromise his credibility.

http://www.nationaljournal.com/njmag...ngargument.php

by Stuart Taylor Jr.

Saturday, Sept. 26, 2009

President Obama is rightly concerned that our health care system leaves many Americans without insurance when they need it most and is hugely inefficient, with costs soaring toward crisis proportions unless something changes.

Few of Obama's Republican critics have signed on to any credible plan of their own to address these inexorably growing problems. Some have reneged on earlier support for mandating that individuals buy insurance. And many hurl demagogic accusations that the president would usher in "death panels" and overheated alarums [["You lie!") about peripheral issues such as whether illegal immigrants or abortion-seekers would benefit.

As for voters, most seem satisfied with their own health care -- still the world's best in important ways -- and unwilling either to pay more to help less fortunate people or make even small sacrifices to control costs. They also seem oblivious to the real problem underlying the "death panel" demagogy, which is the unavoidable need to hold down the 30 percent of Medicare spending that goes to sometimes-unwanted, often-not-very-beneficial treatments for chronically ill patients in the last two years of life.

So it would be unrealistic to expect complete candor from any president about the costs and risks of extending health insurance to 30 million more Americans. If Obama can meet the truthfulness test applied by Huckleberry Finn to his creator Mark Twain -- "There was things which he stretched, but mainly he told the truth" -- that would be good enough for me.

But can he? Despite Obama's good intentions, I can't help thinking that the deviations from truth-telling identified by various critics go to the heart of his plan, compromise his credibility, and could accelerate health-cost inflation with ruinous consequences for the economy. Examples:

* "The problem of rising costs." The centerpiece of Obama's advocacy has been that "my plan" will "slow the growth of health care costs," now nearly 17 percent of gross domestic product and racing higher. But his plan would quite clearly increase costs dramatically, which is why he is proposing so many new taxes, "fees," and other levies.

Mandating health insurance [[or Medicaid) for 30 million more people will cost hundreds of billions of dollars. Requiring insurers to accept people with costly-to-treat pre-existing conditions will cost billions more.

These particular costs are justifiable, in my view. But they are surely costs. And they are not sustainable in the long run unless they are offset by savings far more serious than Congress is likely to adopt on Medicare [[see below) or anything else.

While Obama and Senate Finance Committee Chairman Max Baucus, D-Mont., have proposed significant steps to restrain the growth of health care costs, to their credit, it would probably require much more focused public advocacy to persuade Congress to make fundamental changes in the single biggest driver of the waste and inefficiency that feeds health care inflation. That is the fee-for-service system, under which doctors make more money if they do as many marginally beneficial and arguably unneeded procedures and tests as possible.

Nor has the president made more than a token effort [[by proposing to tax "Cadillac" insurance policies) to give consumers a stake in holding down costs. People who would decline to pay out of pocket for many tests, treatments, and drugs almost always consent to them when insurance picks up the tab. And insurance plans often cover such wasteful costs. Because of a decades-old tax subsidy, employer-provided insurance covers not only the necessary, unexpectedly large costs that consumers cannot afford -- the traditional reason for buying insurance -- but also many not-so-necessary tests, procedures, and drugs.

The bill proposed by Baucus, which Obama backs except on some details, would diminish consumers' already weak incentives to hold down costs by requiring insurers to reduce co-payments and deductibles.

* Slashing Medicare's waste and fraud. Obama has vowed to save "hundreds of billions in waste and fraud" from Medicare -- without affecting benefits. This is a fantasy discredited by the countless broken promises of other politicians over the decades to do the same and by Obama's own failure to offer credible specifics.

While Medicare includes plenty of waste, much of it is inextricably intertwined with the benefits that Obama promises not to cut. The Congressional Budget Office has confirmed that the Baucus bill's $130 billion in cuts [[over 10 years) to Medicare's managed-care plans would reduce benefits. Some benefits probably should be cut as insufficiently cost-effective. But that doesn't make them "waste and fraud."

* Preventive care saves money? Obama has suggested that requiring insurance companies "to cover, with no extra charge, routine checkups and preventive care" will cut costs. The opposite is probably true. Although judicious expansion of preventive care makes sense, the savings from early detection of some medical problems will be exceeded by the overall cost of requiring insurers to cover tests and marginally beneficial [[as well as necessary) preventive care.

My daily statin pill seems sort of necessary [[to me, at least) because it may extend my life by keeping my cholesterol down. But it costs my insurer over $2 a day and lessens my incentive to cut cholesterol by changing my diet. Justified costs are still costs: The longer statins keep me alive, the more my other medical problems will cost my insurer and eventually Medicare.

* "Absolutely not a tax increase." That was Obama's response when asked by ABC News about what Baucus calls the "excise tax" of as much as $3,800 a year [[since lowered to $1,900) on families who defy his bill's mandate to buy comprehensive health insurance.

The mandate itself is a kind of tax. CBO projected that by 2016, the original Baucus bill would require an individual earning $32,400 a year to pay $4,100 in premiums before getting any subsidy, plus an average $1,500 in deductibles and co-payments. [[The much cheaper catastrophic coverage that many people would prefer would not satisfy the mandate.) Baucus has been scrambling to lower these premiums by raising subsidies. But the only ways to get the money are to raise other mandated premiums or taxes, make more Medicare cuts, or incur bigger deficits.

So much for Obama's campaign pledge that "no family making less than $250,000 will see their taxes increase." Maybe it's a good idea to require young, healthy people to buy more-costly insurance than they want or need and then use their premiums to subsidize older, sicker people. But it's deceptive to pretend that this is not a tax.

Maybe it's a good idea to require young, healthy people to buy costly insurance. But it's deceptive to pretend that this is not a tax.

Consumers would also end up paying the original Baucus bill's 35 percent excise tax on insurance companies that offer Cadillac policies valued at $8,000 [[now $8,750) for individuals or $21,000 [[now $23,000) for families -- an estimated $215 billion over 10 years -- and more than $50 billion in fees on medical devices, lab tests, and prescription drugs. Plus $27 billion in taxes on employers who don't provide health insurance.

* Deficits won't increase? Obama vowed in his September 9 speech, "I will not sign a plan that adds one dime to our deficits -- either now or in the future." The good news is that this should force Congress to produce a plan that at least looks deficit-neutral.

The bad news -- apart from the illusory nature of the promised cuts in Medicare waste and fraud -- is that Obama added an escape hatch. His plan "requires us to come forward with more spending cuts if the savings we promised don't materialize." But when they don't, the "required" cuts probably won't materialize either. That's because nothing can force Congress to deliver any future savings that it "requires" now.

Not to mention the fact that the tax revenues mentioned above would be available to reduce the government's alarmingly gargantuan non-health-care deficits if they weren't spent on Obama's health care plan.

* "Nothing in this plan will require you or your employer to change the coverage or the doctor you have." That's literally true, but misleading. The excise tax and other costs imposed on employer-provided insurance would certainly spur many employers to reduce the coverage they pay for.

* Bashing insurance companies. Obama has been borderline deceptive in beating up on insurance companies that "dropped [people's] coverage when they get sick," "won't pay the full cost of care," and "deny you coverage because of a pre-existing condition." As he must know, health insurers -- whose profits are far from huge compared with other industry sectors -- engage in the latter two practices because current law gives them strong incentives to hold down their costs [[and the nation's). Take away those incentives, and costs will go up.

As for dropping people when they are sick, some abuses no doubt exist. But it's telling that even in the worst two examples that Obama could find, he garbled the facts of one case and glossed over the other patient's possible concealment of relevant information in applying for coverage, as detailed by Scott Harrington in a September 14 Wall Street Journal op-ed.

In the spirit of Huck Finn, we may excuse the last two of the seven Obama lines of argument cited above as mere stretches. But the first five seem both deceptive and dangerous to the nation's economic future.

[Lorax]

Doctors do not get write offs for accounts receivable. It is either a loss plain and simple, or you send it to collections and get 10-20 cents on the dollar.

Well, if it's cutting into their fund for the new Rolls Royce, maybe they should take only paying patients, and those without money can use the public option.

[Lorax]

Would you please put a copy of Webster's Dictionary on your Christmas list this year Lorax?

You could benefit from the same advice, but you'd have to toss out one of the dozens of corporate fascist manifestos that take up so much space.

[Diehard]

Thank you Zacha341 for posting that. It's good to see an even-handed, analytical look at the details and costs, without descending into catchphrases and finger-pointing. If only the whole nation could try thinking that way, we might get somewhere.

[ccbatson]

You realize that I have often posted the valid, dictionary based, definitions for your convenience, don't you Lorax?

[Lorax]

You realize that I have often posted the valid, dictionary based, definitions for your convenience, don't you Lorax?

Actually, it was I who posted the dictionary definitions, not the Wikipedia ones you quoted.

[ccbatson]

Resorting to bold face lying now Lorax? Backed in a corner on the issues I suppose.

[Zacha341]

Far too much of this issue has been rolled off onto partisan favoritism.

We have afoot a proposed precedent [[government sponsored full-out and mandated health care) that will impact use all... It did not "sail" thru in August as it was assumed it would and it should not have. There was much
that needed to be revealed and hopefully something sustainable can occur.

What ever side you're on it's hard to ignore the unsustainability of this proposed plans. Plans that even Conyers says would take many "lawyers" to fully understand. And he was not going to be reading the bill.

BIG government: left OR right = equals a little "you". Less choices, fewer options. More bureaucracy.

Some say why all the hype concern about this...? Look at all the bad stuff Bush did...

Answer: Older citizens [[who are able to see beyond partisan loyalty) know this will have a an impact on them and that the government is over-promising what it can do. Cost and will explode well beyond projected expense and the whole health care delivery system will be altered.

Having buried two parents who both endured government hosted health care [[Medicair and the VA Hospital) and having myself been on Medicaid, varied private insurances, COBRA, and NO insurance, I have strong views on the subject of health care. If you've seen the bureaucracy up close in personal as it already is your less apt to desire more of it.

As we grow older we will all "present" with our own brand of pre-existing conditions. Thus, those so passionate about the Obama health care proposal are older [[the baby boomers -- folks over 45 -- not just the "cane waving" folks at those meetings.)

We may say we don't like "them" or believe they are all conservative wackos --
some are. Yet it cannot be "PROVEN" that all CRITICISM is coming from one only perspective, one world view, one party. Things would be more "tidy" were that true.

Those of us [[especially minorities) who feel we can "sit the whole thing out" will be potentially harmed the most.

Let me blunt for a moment: For example, observing the "supposed" crazy Townhall meetings it was clear in my mind that if the elder suburban communities were this upset behind these proposed initiatives, then what more HELL is headed for black folk in urban communities with even less resources - should not some of the issues an promises not be addressed?

And I have a recent memory my parents and their end-of-life bureaucratic health care issues as a referent.

Like with other politics and the proposed policies therein, rough shod, over-promised "care-for-all" health care initiatives may have the largest impact on the very communities they promise to help.

The poorest communities will be hurt hardest. And their partisan silence will not soften the blow. The inner city elder aunt may endure more problem and paperwork then the elder aunt living in Rochester Hills... yet we were told those Townhouse folks concern[[s) had nothing to do with a broader community.

Just those "conservative" folk.......

Yes, we need some form of health care reform, but an expansion of Medicaid/ Medicair style care is not the answer. Too many obvious contradictions. The proposed plan cannot offer care to more people, with more care options, while at the same time reducing the deficit, and not raising taxes.

Sigh.

Some people just can't face reality, all they see is if a politician has an R or a D after their name.

[Zacha341]

Republican or Democrat - Big Government means little "you". The whos "side" you're own - left vs. right is a side show distraction.

More bureaucracy has never bred efficiency, better service, cost reduction or even cost maintenance. Just more phone numbers to call, more undecipherable paper work that no one can understand, more useless departments with rude people answering the phone with "caynnn I hepp you?" knowing good and well they have not plan to help you. Bad enough when you are calling the city clerks office for some paperwork. Worse when you are trying to get approval for a knee replacement. Or worse.

Republican=fascist.

[ccbatson]

Well said...however, short of anarchy, we must start working with what exists and reform it. Liberals/the Dems are too far gone...only Republicans/conservatives have the potential.

[Lorax]

Republican or Democrat - Big Government means little "you". The whos "side" you're own - left vs. right is a side show distraction.

More bureaucracy has never bred efficiency, better service, cost reduction or even cost maintenance. Just more phone numbers to call, more undecipherable paper work that no one can understand, more useless departments with rude people answering the phone with "caynnn I hepp you?" knowing good and well they have not plan to help you. Bad enough when you are calling the city clerks office for some paperwork. Worse when you are trying to get approval for a knee replacement. Or worse.

And what is the difference between a bloated government bureaucracy and that of a giant corporation? Nothing.

We've tried it the Rethuglican way, now it's time to socialize all medical care on the European model, and then we stand a chance at real reform. There are some things we can learn from Europeans, and need to realize we don't have the best and biggest and brightest in all areas of our society.

[Zacha341]

It's not about being the best or brightest. We need to come up with something even better than the European model. It has problems...

And what is the difference between a bloated government bureaucracy and that of a giant corporation? Nothing.

We've tried it the Rethuglican way, now it's time to socialize all medical care on the European model, and then we stand a chance at real reform. There are some things we can learn from Europeans, and need to realize we don't have the best and biggest and brightest in all areas of our society.

[rb336]

It's not about being the best or brightest. We need to come up with something even better than the European model. It has problems...

there is no "european model" -- there are several different ones

I like the germano-dutch model best so far. single payer, but private companies running it that are strongly regulated in terms of executive pay, administrative expenses, etc., and who must go before review boards when they wish to deny treatment

[Lorax]

I was generalizing by stating "European model", and find the Belgian and Swedish models most to my liking.

Sure European plans have problems, which ones don't? Any of them are better than what we don't have now.

[rb336]

and, more importantly, the euros [[and canadians) are constantly improving their systems' deficiencies

[ccbatson]

Improving, or backpedalling in order to avoid complete collapse?

[Lorax]

Improving, or backpedalling in order to avoid complete collapse?

No dangers of collapse, sorry to disappoint you.

Only improvements that actually deliver health care efficiently as opposed to this country. Don't forget, I've been in two hospitals in Europe, and had superb care- and no bill.

[ccbatson]

You realize that these improvements, if they are that, are all reversals away from socialization.

One example is the elimination of salary caps. Why? Doctors would work up until they hit the cap, and then take the rest of the year off. Fewer available Doctors accelerated the limited supply ramping up the rationing and lengthening wait list time.

[Lorax]

Or perhpas an opportunity for a younger crop of doctors coming up to take over, which is the real issue, since the average age of physicians is growing exponentially in Europe, and here in Florida at an alarming rate.

[elganned]

One example is the elimination of salary caps. Why? Doctors would work up until they hit the cap, and then take the rest of the year off. Fewer available Doctors accelerated the limited supply ramping up the rationing and lengthening wait list time.

You assume that the doctors in question would be independent contractors still receiving "pay per service"; they just perform as many services in as short a time as they can and once they reach their max they relax. Kinda like piece-rate at the mill.

However, if they were true salaried workers, not independent contractors, and paid per time periond and not paid by the "piece" [[procedure, visit, whatever), then they would have to show up every day in order to get a paycheck.

That's how the rest of the business world goes about things, and it's worked for private enterprise for centuries.

It's all in the intitial assumption, isn't it?

[rb336]

You assume that the doctors in question would be independent contractors still receiving "pay per service"; they just perform as many services in as short a time as they can and once they reach their max they relax. Kinda like piece-rate at the mill.

However, if they were true salaried workers, not independent contractors, and paid per time periond and not paid by the "piece" [[procedure, visit, whatever), then they would have to show up every day in order to get a paycheck.

That's how the rest of the business world goes about things, and it's worked for private enterprise for centuries.

It's all in the intitial assumption, isn't it?

the salaried part is also how the nations top medical centers work - and they are also the most efficient models