The skinny on healthcare, who is lying?

[Corn.Bot]

Maybe appropos, maybe tasteless, not necessarily an opinion, but definitely a Freudian slip of a speaker's tongue. A few minutes ago heard the words "health care reform" as, and I swear it was said this way, "wealth care reform."

Yup.

[elganned]

Don't go leaping to far-fetched conclusions, there, ghettopalmetto. I wish I did have millions to invest here and there; I could self-insure and skip the whole process. [[Which brings up another point: if you're rich and can self-insure, can you opt out of the process? Or will it be like SS and Medicare--you're in, period. Just a digression...)

I don't mind paying for health insurance, any more than I mind paying for auto insurance. I'm too old and too clever to go without either if I can help it. I'm assuming you don't mind, either, by your comments.

But the world doesn't consist of only folks like you and me; there are a lot of people who figure they'll take the risk, just as there are lots of folks who risk it without auto insurance.

My point is, at least with auto insurance you have to prove it at least once a year [[registration renewal). That's no guarantee that they'll keep it longer than a day, but at least there's a mechanism to check on it periodically. Also, you have to produce your proof-of-insurance anytime you're stopped on the street or highway.

What would the mechanism be to check on whether or not people have health insurance? It could be required to produce it upon applying for service at a clinic, doc's office, or the ER, but will they arrest you after treatment? Or maybe you would have to send in a copy with your tax return every year, but there are lots of people who don't file.

Failing those methods, just how will they enforce it? And even if you have to buy it once a year or so to "prove" you have it, what prevents you canceling it the day after, like some do with auto insurance?

The SS# doesn't work as an analogy, since you do it once only, it doesn't cost anything, and there are several benefits to having one as opposed to a health insurance policy which has a penalty attached, that being the cost of the premiums.

[Sstashmoo]

Quote: "Provide your support. When the no fault legislation passed, premiums went down,"

Exactly the opposite of what I remember happening and everyone complaining about at the time. But, if you have a webpage written by some 22 year old, that says the opposite, keep believing that.

How will they enforce it? Simple as someone else hinted your SS#. Could easily be a line item on your income tax return. Go to chart X and see how much you should be paying for healthcare, enter on line 34b, subtract from 34a, this is how much you'll owe or get back etc. Don't think the insurance companies aren't frothing at the mouth for something like this.

They won't have to haggle with you about rates when they can simply take a politician to the booby bar. Better open your minds.

[ccbatson]

Don't forget the reason the costs are rapidly rising...the lack of market forces. Medicare pays XXX and private insurers must fall in line within reason to compete for providers. IOW, if a private insurer [[A) says they pay YYY and this is 30% of Medicare, then providers are apt to say no thanks, I will not participate. Insurer B then comes in at 50%, etc, until a deal is struck [[which so happens to be within 20 percent of Medicare).

[elganned]

Excuse me, Cc, but what you describe is exactly what "market forces" look like--except that it's the wrong market. In your scenario the doctors are the consumers, and the insurance companies are vying for their business. In other words currently the "market forces" act in the doctor's interests, rather than the patient's interests.

I wonder if you would sing a different tune if the patient was the consumer and the doctor had to negotiate prices to attract business.

And let's not forget that doctors can choose whether or not to accept an insurance coverage. If they insurer doesn't pay enough, the doc can always say, "Sorry, I don't accept Conglomerate Health Services insurance."

If health insurance is going to be mandatory, then accepting whatever insurance you have should also be mandatory.

[elganned]

A thought just struck me: following your scenario, the easy way to cut health-care expense would be to cut Medicare payments to providers in half. Simple and easy. Is that what you are advocating?

[ccbatson]

It isn't market forces if the biggest player is the government.

I would love to have patient/doctor negotiation of prices...part of my practice is structured that way and it is a great improvement for both parties.

[Sstashmoo]

Quote: "part of my practice is structured that way"

Good for you. Seriously.

[elganned]

It isn't market forces if the biggest player is the government.

The government playing doesn't negate its being a market so long as payment is set by people negotiating. It ceases to be a market only if payment is set by ukase rather than negotiation. You really should brush up on the meaning of words--or is this one that you've "redefined", as you are wont?

I would love to have patient/doctor negotiation of prices...part of my practice is structured that way and it is a great improvement for both parties.

Do your patients know what other doctors are charging for comparable service?

[mjs]

Quote: "Provide your support. When the no fault legislation passed, premiums went down,"

Exactly the opposite of what I remember happening and everyone complaining about at the time. But, if you have a webpage written by some 22 year old, that says the opposite, keep believing that.

Either that or a law class on auto insurance, the ICLE manual on Michigan No Fault, and discussions with attorneys that do nothing other than insurance cases including those that frequently bad mouth insurance companies. Yeah, the public's memory and understanding of the details of government actions and its consequences has always impressed me. Sarcasm.

[mjs]

The government playing doesn't negate its being a market so long as payment is set by people negotiating.

Couldn't agree more. So, when did medicare payments to doctors become negotiable? Can a doctor or hospital even say they won't accept medicare patients the way they can say they won't accept patients from certain HMO's? Batson?

As the insurance spokesperson pointed out in today's AP article, "Any time an entity can be both a player on the field and the referee there can't be fair competition." It especially pointed when the same article tells how Pelosi already wants to handicap the non-government competition by levying a $6.7 billion annual fee on them to subsidize the government plan. I guess when they speak of competing with private insurers they're technically not promising they will compete fairly. http://news.yahoo.com/s/ap/20091015/..._care_overhaul

[Sstashmoo]

Quote: "Either that or a law class on auto insurance, the ICLE manual on Michigan No Fault, and discussions with attorneys that do nothing other than insurance cases including those that frequently bad mouth insu"

Blah.. Tell those people they don't know shit from Shinola, ok?

[ccbatson]

As with HMO's it is all or nothing...either a provider agrees to participate for all subscribers, or none. Some private insurers [[BCBS) will allow this to occur whereby the patient pays the Physician up front, submits a claim, and the insurer reimburses the patient the amount that they agree to pay for the services provided. Obviously, Medicare has no such provision.

[elganned]

Cc, you still haven't commented on my observation that, according to you, all we have to do to bring healthcare costs down is to cut Medicare payments in half. [[This should be good...)

[Sstashmoo]

It is really weird how some post on here discussing an era they obviously did not live through and take a stance 180 degrees out and argue it. A little common sense reasoning would douse their argument. Let's see, the state mandates associated with hefty fines that every driver must buy insurance, so the insurance companies, one of the true evils of the planet, decides to chop their rates? Never did or going to happen.

[elganned]

Ssatashmoo, now you're just looking silly and petulant.

Mjs doesn't speak from personal anecdotal material, I'll wager, and I'm sure could post some hard numbers to back up the argument.

If the stats show your assumption is incorrect, it's time to jettison the assumption rather than say the stats are all wrong just because you remember it differently.

[ccbatson]

Elganned...if you buy a house, pay religiously via a mortgage for 15 years, never missing a payment...what do you expect in return? Ownership of the home THAT YOU ARE PAYING FOR?? If someone told you that they were going to confiscate 1/3rd of your house without giving you anything in exchange and increase your mortgage payment...would you think that was a good idea even if it reduced the mortgage payments of everyone making less money than you but buying homes larger and newer than yours?

That should thoroughly answer your question about Medicare.

[Sstashmoo]

Quote: "Mjs doesn't speak from personal anecdotal material"

It's beginning to look like anecdotal knowledge is superceding conventional "wisdom" and "statistics". Since the revision mills are apparently working over time. Same as this F'head that wrote a webpage talking [[lying) about VietNam era US soldiers not being disrespected. It's folklore and urban myth he claims. I call it a total waste of server space.

[elganned]

Quote: "Mjs doesn't speak from personal anecdotal material"

It's beginning to look like anecdotal knowledge is superceding conventional "wisdom" and "statistics".

?? This makes less sense than your original post. Or are you unaware that "conventional wisdom" is anecdotal?

Since the revision mills are apparently working over time. Same as this F'head that wrote a webpage talking [[lying) about VietNam era US soldiers not being disrespected. It's folklore and urban myth he claims. I call it a total waste of server space.

I agree with you about that, but it's irrelevant to this discussion.

[elganned]

Elganned...if you buy a house, pay religiously via a mortgage for 15 years, never missing a payment...what do you expect in return? Ownership of the home THAT YOU ARE PAYING FOR?? If someone told you that they were going to confiscate 1/3rd of your house without giving you anything in exchange and increase your mortgage payment...would you think that was a good idea even if it reduced the mortgage payments of everyone making less money than you but buying homes larger and newer than yours?

That should thoroughly answer your question about Medicare.

Actually, it answers nothing. Your scenario might have some applicability and/or validity were we discussing real estate--but we're not.

Your position is that healthcare costs can't come down because providers negotiate reimbursements with insurers that are within 20% of what Medicare pays. This sets up a direct correlation function which gives us a simple mechanism to lower healthcare costs, by lowering Medicare reimbursements.

Since rates negotiated between providers and insurers are always within 20% of Medicare, when Medicare payments go down, other payment rates also go down. QED.

[Sstashmoo]

"conventional wisdom" should be "contemporary wisdom"

[ccbatson]

It is an analogy Elganned. Hard to believe that you could miss that, however, now you can go back and rethink the scenario with that in mind.....Sheesh.

[elganned]

I understood you were attempting an analogy, and it might have been effective except for the fact that it bears no reasonable relationship to the question; purchasing real estate involves a contract between a buyer and a seller, whereby the buyer pays over time and when the mortgage is discharged takes ownership of the property. I cannot, for the life of me, find any correlation between that transaction and Medicare, in any context whatsoever.

So your analogy failed. Care to try a different one?

[ccbatson]

Taxpayers pay into Medicare with the obligation of the service to be paid for from the government....NOW do you get it?

[elganned]

So if we cut Medicare payments, that would be good for the taxpayer AND lower the cost of healthcare. That would be doubly beneficial, right?

I still don't see your point--if you have one.