Here is what the Democrats need to do to pass thier bill

Re: Here is what the Democrats need to do to pass thier bill

PostBy: stockingfull On: Mon Jan 25, 2010 8:47 pm

Mike, I don't see where you factored the cost efficiencies of keeping people healthy in your simple extrapolation.

Are you saying it'll be no cheaper, per capita, when a big chunk of the acute care now being rendered to the uninsured is supplanted by insurance and preventative care?
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: jpete On: Mon Jan 25, 2010 8:50 pm

stockingfull wrote:Mike, I don't see where you factored the cost efficiencies of keeping people healthy in your simple extrapolation.

Are you saying it'll be no cheaper, per capita, when a big chunk of the acute care now being rendered to the uninsured is supplanted by insurance and preventative care?


Who says certain people will use regular doctors offices(if they can get in) vs. emergency rooms?
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: stockingfull On: Mon Jan 25, 2010 9:04 pm

jpete wrote:
stockingfull wrote:Mike, I don't see where you factored the cost efficiencies of keeping people healthy in your simple extrapolation.

Are you saying it'll be no cheaper, per capita, when a big chunk of the acute care now being rendered to the uninsured is supplanted by insurance and preventative care?


Who says certain people will use regular doctors offices(if they can get in) vs. emergency rooms?

I do. If they're covered in the doc's office and not in the ER.

Just like you do because that's the way your insurance works....

The reason the uninsured go the ER is that's the only place where they can get care.
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: rberq On: Mon Jan 25, 2010 9:33 pm

jpete wrote:
rberq wrote:On capitalism: You say the benefits are split among those that produced the product. That is the theory, but... When Chinese labor built the railroads in this country, were the profits split equitably among those who did the work? No, the profits went largely to those who owned the assets

Should rewards be proportional to risks? Who took the risk, the laborer or the capitalist? And I'm talking about the REAL capitalists, like Henry Ford and Harvey Firestone.

Who took the risks? That's an excellent question, Jeff. Conventional wisdom says that the investor takes the risk and deserves the reward. Another school of study says the real titans -- Rockefeller, Carnegie, Trump -- bet mostly on sure things. In a nutshell, they are both smarter and better informed than you and me. They recognize an opportunity we would overlook, they study it, they do the numbers, they think of the contingencies, and if it looks overwhelmingly favorable they go for it. They don't just bet the farm on a whim; by the time they commit, it is pretty much a sure thing.

Should they get such huge rewards for what, in the end, is being smart and imaginative? That takes a deeper philosopher than me to judge. But it is not "risk" they are being rewarded for.
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: mikeandgerry On: Mon Jan 25, 2010 9:34 pm

stockingfull wrote:Mike, I don't see where you factored the cost efficiencies of keeping people healthy in your simple extrapolation.

Are you saying it'll be no cheaper, per capita, when a big chunk of the acute care now being rendered to the uninsured is supplanted by insurance and preventative care?


There are no big chunks to be had. Here's what the NEJM had to say:

http://content.nejm.org/cgi/content/full/358/7/661

Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not. Careful analysis of the costs and benefits of specific interventions, rather than broad generalizations, is critical. Such analysis could identify not only cost-saving preventive measures but also preventive measures that deliver substantial health benefits relative to their net costs; this analysis could also identify treatments that are cost-saving or highly efficient (i.e., cost-effective).
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: Poconoeagle On: Mon Jan 25, 2010 9:47 pm

yada , yada, yada.......

pass health care bill...??? so reading this thread its frustrating worrying what will really take place but a bit of reality hit today, went to moms for coffee while pumping extreme water out of sisters basement and mom says "how much you think my blood tests cost last week"?

mom gets weekly blood draw for coumidin levels..

this test they took 3 small vials for different test different diagonois issue. osteo porossis

knee replacement diabetes....

i say how much ma a grand??? she says....NO... higher......ok 15 hun????


how bout eight thousand bucks!!!!!! WTF????? medicare???? u gotta be #%^$ing me...

yeah a new bill gonna fix this issue??? doubt it :( :( :(
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: tvb On: Mon Jan 25, 2010 9:52 pm

Thing is, not passing HCR won't change that inflated billing either.

I get blood work done every four months for a metabolic issue I have and the the lab bills the insurance company close to $2000. United Health Care then pays the lab about 1/10 to 1/15 of it. I wouldn't expect any of it that to change with HCR.
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: mikeandgerry On: Mon Jan 25, 2010 9:55 pm

stockingfull wrote:Mike, I don't see where you factored the cost efficiencies of keeping people healthy in your simple extrapolation.

Are you saying it'll be no cheaper, per capita, when a big chunk of the acute care now being rendered to the uninsured is supplanted by insurance and preventative care?


Actually, I think I will have to revise my cost estimate upward after reading this:

http://liberalvaluesblog.com/2009/08/10 ... tive-care/

Providing preventive care will cost more than it will save in cases where the individual patient was not going to develop one of the diseases for which preventive care is being provided. In some cases successful preventive medicine might even increase costs further, such as if a person were to live many years longer and consume additional health care resources. In such cases preventive care provides a real benefit and should be paid for, but not because of cost savings.
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: Poconoeagle On: Mon Jan 25, 2010 10:03 pm

tvb wrote:Thing is, not passing HCR won't change that inflated billing either.

I get blood work done every four months for a metabolic issue I have and the the lab bills the insurance company close to $2000. United Health Care then pays the lab about 1/10 to 1/15 of it. I wouldn't expect any of it that to change with HCR.



somethings gonna pop!! somewhere. With my 93 yr old aunt and next door my 92 yr old other aunt and mom and dad with health issues i could bring ya to tears with insane health care bills

and in the grand scheme of it most of the extreme hi stuff is bullshit 6 grand sleep study???

come on the chick didnt watch her correctly and had to do another one a month later!!!!

nother six grand....PLEASE....... if i misdiagonoised bone surgery dr's benz he didnt give a crap and CERTAINLY didnt EXPECT to pay for another comprehensive computer/fuel injection analasis.... god forbid...... :shock:
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: jpete On: Mon Jan 25, 2010 10:10 pm

stockingfull wrote:
jpete wrote:
stockingfull wrote:Mike, I don't see where you factored the cost efficiencies of keeping people healthy in your simple extrapolation.

Are you saying it'll be no cheaper, per capita, when a big chunk of the acute care now being rendered to the uninsured is supplanted by insurance and preventative care?


Who says certain people will use regular doctors offices(if they can get in) vs. emergency rooms?

I do. If they're covered in the doc's office and not in the ER.

Just like you do because that's the way your insurance works....

The reason the uninsured go the ER is that's the only place where they can get care.


Other than a $50 co pay for ER visits, what about insurance PREVENTS me from using the ER as a PCP?

I have a $25 copay at my regular doctor so if I don't do that often, the ER might be cheaper for me.

You THINK people who use the ER with go to a doctor's office. Are your assumptions ALWAY correct? What happens if you're wrong?
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: jpete On: Mon Jan 25, 2010 10:18 pm

rberq wrote:
jpete wrote:
rberq wrote:On capitalism: You say the benefits are split among those that produced the product. That is the theory, but... When Chinese labor built the railroads in this country, were the profits split equitably among those who did the work? No, the profits went largely to those who owned the assets

Should rewards be proportional to risks? Who took the risk, the laborer or the capitalist? And I'm talking about the REAL capitalists, like Henry Ford and Harvey Firestone.

Who took the risks? That's an excellent question, Jeff. Conventional wisdom says that the investor takes the risk and deserves the reward. Another school of study says the real titans -- Rockefeller, Carnegie, Trump -- bet mostly on sure things. In a nutshell, they are both smarter and better informed than you and me. They recognize an opportunity we would overlook, they study it, they do the numbers, they think of the contingencies, and if it looks overwhelmingly favorable they go for it. They don't just bet the farm on a whim; by the time they commit, it is pretty much a sure thing.

Should they get such huge rewards for what, in the end, is being smart and imaginative? That takes a deeper philosopher than me to judge. But it is not "risk" they are being rewarded for.


Sure it is. Henry Ford built automobiles without an infrastructure of highways and fueling stations. That sounds like a bit of a risk.

Compare that to T. Boone Pickens who wants the government to eminent domain all the property and have the taxpayers build the transmission lines to the windmills he'll build IF he gets a big enough break from the government .

We have such a mixed up idea of what a "capitalist" and "capitalism" is. CEO's are not capitalists. They aren't playing with their money. I would be all in on a pair of two's if I was playing with someone else's chips. :D
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: mikeandgerry On: Mon Jan 25, 2010 10:19 pm

rberq wrote:But it is not "risk" they are being rewarded for.


:shock:
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: tvb On: Mon Jan 25, 2010 10:28 pm

jpete wrote:
Other than a $50 co pay for ER visits, what about insurance PREVENTS me from using the ER as a PCP?

I have a $25 copay at my regular doctor so if I don't do that often, the ER might be cheaper for me.

You THINK people who use the ER with go to a doctor's office. Are your assumptions ALWAY correct? What happens if you're wrong?


Hopefully any co-pays will be significant enough to discourage any abuse. There will definitely need to be an educational program of some type that helps people otherwise too dumb to distinguish between a scratch and wound where you can see the bone.
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: stockingfull On: Mon Jan 25, 2010 10:41 pm

OK, lots of posts to answer.

Most illustrate that costs, even for routine stuff, are bat-sh!t outta control. Which is how the NEJM and Mike's supplemental source seem to conclude that they no longer save enough to cover the acute care they're meant to head off at the pass. (Some here with elephant memories will remember my story of starting an engrg job in 1974 and being offered straight BC/BS or an HMO which included the same coverage for the same (zero) cost -- meaning my wellness care was free.) Which also may be why costs have been spiking the past several years (as tech has overwhelmed the system with "fun" and expensive new tests).

But it does seem like there are two take-aways: (1) preventative care may not save money but it'll increase lifespan, so at least we can catch up with the rest of the civilized world, and (2) as Mike's sources imply, there is plenty of room to improve prevention by culling the "less-efficacious" measures. The latter will be the hard part, since every time somebody suggests cutting back on something -- ANYTHING -- in the universe of stuff docs can order up, the screaming starts. Remember the mammogram story about a month ago?

Plus, let's not forget that Medicare is running at about 3% admin costs, while pvt insurance is skimming off more than 20% on the average. Hartford's a very prosperous town. Ask Joe Lieberman.

To recap, we already spend 1/3 more of our GDP on healthcare than the next most expensive country in the world, bar none. And it's trending worse. So, tough as that may be, if we don't start to confront it, we pretty literally will be working for our medical insurers before long.
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Re: Here is what the Democrats need to do to pass thier bill

PostBy: jpete On: Mon Jan 25, 2010 10:59 pm

tvb wrote:
jpete wrote:
Other than a $50 co pay for ER visits, what about insurance PREVENTS me from using the ER as a PCP?

I have a $25 copay at my regular doctor so if I don't do that often, the ER might be cheaper for me.

You THINK people who use the ER with go to a doctor's office. Are your assumptions ALWAY correct? What happens if you're wrong?


Hopefully any co-pays will be significant enough to discourage any abuse. There will definitely need to be an educational program of some type that helps people otherwise too dumb to distinguish between a scratch and wound where you can see the bone.


My wife is an EMT. Any idea how many people call 911 and then wait for rescue with a suitcase? Just to go to the hospital for a shower and a meal?

How many people know how to fake a condition to get the drugs they want?

And in you and stockings ideal world, it would all be "free" and they would never get turned away.

You CAN'T educate these people. So get ready to pay up suckers. Be careful what you wish for.....
jpete
 
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