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Health care milestone US reform kicks in

#1 User is online   PassedOut 

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Posted 2010-September-23, 12:19

Some of the benefits of health care reform in the US are starting six weeks before the mid-term elections, and Obama is calling attention to that.

For Many, Health Care Relief Begins Today

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The amount of vulnerability that was out there was horrendous, Mr. Obama on Wednesday told a gathering of people chosen to illustrate the laws new provisions. He said he concluded that weve just got to give people some basic peace of mind.

Mr. Obama also responded to Republican Congressional leaders who have campaigned on a threat to repeal the act. I want them to look you in the eye, he told his audience, and explain their opposition to a law that is projected to cover 32 million uninsured and reduce the deficit by $143 billion over 10 years.

Nothing this big goes in completely cleanly, but the executive branch is certainly doing a lot better than congress on moving this along. Here is a quick assessment by Yale professor Jacob Hacker: The Health of Reform

I would quibble with some of the grades: some are a bit too high, in my opinion, particularly in controlling costs. That has to be the next big, aggressive push. But, all in all, a clear summary of where we are now.
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#2 User is offline   kenberg 

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Posted 2010-September-23, 12:45

I was thinking of you this morning while reading the paper. Here is an op-ed piece from the Wash Post. The author is the head of kaiser so he no doubt has some biases, but who hasn't.


http://www.washingtonpost.com/wp-dyn/conte...0092204604.html


For a chart you need to go to
http://www.washingtonpost.com/wp-dyn/conte...ST2010092205602

One of the parts of this is that when people who say they are angry about health care are asked for details they are just generally angry.


Anyway, I think it would be very useful to pin down some facts. There is often some general unfocused anger but this time the tea partiers are really going off the deep end.

And yes, getting costs under control is vital. I just had a very minor thing done for 700+ bucks, all paid for by insurance. I am glad I don't have to pay it but the amount defies any common sense.
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#3 User is offline   luke warm 

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Posted 2010-September-23, 15:51

for group plans, it only affects those that are on a calendar enrollment year... for those on a fiscal year, it kicks in 7/1/11
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#4 User is offline   Rodney26 

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Posted 2010-September-23, 16:06

I think you just look people in the eye and tell them the CBO projection is absurd, and they will believe it. You don't need to be a brain surgeon to understand that insuring 32 million more people can't result in the government spending less money without other significant consequences.

American voters understand better than ever there is no free lunch and are going to work hard to get those out of office who insist otherwise (on both sides). No more wars without paying for them, Ponzi pension schemes or tooth fairy style funding for comprehensive health insurance.
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#5 User is offline   jdonn 

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Posted 2010-September-23, 16:22

Rodney26, on Sep 23 2010, 05:06 PM, said:

I think you just look people in the eye and tell them the CBO projection is absurd, and they will believe it. You don't need to be a brain surgeon to understand that insuring 32 million more people can't result in the government spending less money without other significant consequences.

American voters understand better than ever there is no free lunch and are going to work hard to get those out of office who insist otherwise (on both sides). No more wars without paying for them, Ponzi pension schemes or tooth fairy style funding for comprehensive health insurance.

Obviously the savings come from other parts of the bill, not from insuring 32 million more people. And obviously government spending is not the only part of the deficit. But you don't need to be as smart as a brain surgeon, or even the average American voter, to know when an argument is made so deceptively and unfairly that it should be completely ignored.

I do agree with you that the CBO projection needs to be taken with a particularly large grain of salt (because making such a prediction is such a difficult task, not because it's inherently absurd). But it's the only fair objective measure we have and should be taken infinitely more seriously than the random claims of politicians that health care reform will explode the deficit or such. I have no problem with Obama quoting CBO projections, as both sides do any time it suits them.
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#6 User is offline   neilkaz 

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Posted 2010-September-23, 17:20

Rodney26, on Sep 23 2010, 05:06 PM, said:

I think you just look people in the eye and tell them the CBO projection is absurd, and they will believe it. You don't need to be a brain surgeon to understand that insuring 32 million more people can't result in the government spending less money without other significant consequences.

American voters understand better than ever there is no free lunch and are going to work hard to get those out of office who insist otherwise (on both sides). No more wars without paying for them, Ponzi pension schemes or tooth fairy style funding for comprehensive health insurance.

This will be proven in the upcoming elections in November and these elections are the reasons some politicians won't even mention any support for health reform now.
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#7 User is offline   Winstonm 

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Posted 2010-September-23, 20:19

I think it is ridiculous to believe that the health insurance companies will simply roll over and take it - they won't. Already I have heard that certain policies are simply being removed from being offered instead of having to comply with the new legislation.

The Obama administration was elected on a tidal wave of change and had a chance for single payer system - but Rahm Emmanuel intervened and screwed it up in order to coddle to the health insurance giants so as to gain what amounts to kickbacks to political parties in the form of donations.

The U.S. Supreme Court has ruled that corporations can donate as much as they want to whomever they want.

And someone actually believes any of this will be good for the citizenry?
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#8 User is online   PassedOut 

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Posted 2010-September-23, 21:06

When the US pays twice as much per capita than other nations to receive poorer medical care, it is clear that enough money is already in the system to give every single US citizen good medical care.

But it is true that it is a very difficult task politically to redirect that waste into positive outcomes. It will take a constant effort. But at least now the health care system is getting some adult supervision, so the mechanisms to redirect the waste are being established. That was a necessary first step.

Necessary, but as everyone has noted, far from sufficient.
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#9 User is offline   benlessard 

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Posted 2010-September-24, 00:59

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When the US pays twice as much per capita than other nations to receive poorer medical care, it is clear that enough money is already in the system to give every single US citizen good medical care

Pure nonsense. Cost is 95% driven by supply-demand so insurance for everybody will increase cost per capita. Better management might reduce some cost but I seriously doubt you will find somebody who think gouvernment management/regulations will do better than private sector. Ill believe in the tooth fairy before ill believe that price will go down when demand go up.

Im canadian and even if our system compared to yours is a success, its in reality a big failure.

The cost per capita difference between US and Canada is mainly due to..

1-Lower salaries for everybody working in health system. Many nurses are going to work in Switzerland and elsewhere. For doctors its worse and for specialist its a joke.
2-Population is clearly in better health than American (better nutrition, more physical activities, less stress, better environment) This is fairly obvious for every canadians that make a trip to USA. Also where i live (in Montreal) when we compare the health of immigrants from Asia vs Africa/Haiti and its clear for me that Afro-American are probably an extra burden for Usa.
3- Less high end service in Canada. All the top surgeon, top researcher etc work elsewhere where they can make 5 times more money and pay a lot less income tax.
4 Public funds --If you calculate public fund that endup in reducing health care indirectly you ll get a different picture.

Our Universities are mostly public funded, so getting MD an getting a lower income is more tolerable.

Same thing for immigration, we get immigrants with Md degres and other health care workers, because even if the salaries are lower/more income overall its a good deal for them because they get more security and more benefits for raising a family.

Many indirect services are paid with publics funds so less pressure for insurance for MD/hospital.

More governement prevention, regulations (tax on smoking products) etc.
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#10 User is offline   helene_t 

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Posted 2010-September-24, 02:46

benlessard, on Sep 24 2010, 07:59 AM, said:

I seriously doubt you will find somebody who think gouvernment management/regulations will do better than private sector.

Lol, what you mean to say is just that you don't believe that.

Anyway, the US health sector remains in private hands so it is irrelevant.
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#11 User is offline   rbforster 

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Posted 2010-September-24, 03:27

helene_t, on Sep 24 2010, 03:46 AM, said:

benlessard, on Sep 24 2010, 07:59 AM, said:

I seriously doubt you will find somebody who think gouvernment management/regulations will do better than private sector.

Lol, what you mean to say is just that you don't believe that.

Anyway, the US health sector remains in private hands so it is irrelevant.

Just IMHO I don't think they'll do a better job, but I can't imagine anyone believing the govt can do the job cheaper. Medicaid is something 10-20% fraud/waste, and what makes you think this will be any better? Look at how trying to offer universal healthcare has done to the MA budget and you'll see it's a financial disaster even if you think it's a worthy goal.
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#12 User is offline   helene_t 

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Posted 2010-September-24, 03:41

Well, the highly privatized US health sector is extremely inefficient compared to most developed countries with more gvt involvement. I am not saying this proves anything. Just saying that it is an absurd statement that "nobody" believes that gvt can do certain things in the health sector more efficiently than the private sector.

FWIW I personally prefer gvt to offer health insurance to everybody, as long as we are talking about countries with reasonably functioning governments. To what extent gvt should also be involved in the carrying out the health services I am not so sure. As a patient I prefer the British system with government-employed GPs to the Dutch/Danish systems with private GPs financed by public insurance (Denmark) or heavily regulated private or semi-private insurance (Netherlands) but that's just based on my own experience. I think it must be tremendously difficult to do research on the relative efficiency on various systems, too many factors with unknown effect that differ between countries.

My experience from working at various government institutions in various countries, both health care and other sectors, suggests that the government is actually able to run hospitals very efficiently compared to the mess they make of the civil service in general. Now this doesn't really answer the question about gvt vs private health care as I have no experience from working for private healt care providers. But I can sorta understand why a government-run hospital works reasonably well. The people who work there have health care as a calling, they don't need a strong profit motive to do their job. This is contrary to many parts of the civil service where the lack of a profit motive makes civil servant walk around like beheaded chickens. It can be difficult to spot a common goal of the workers in a gvt dpt that goes deeper than manipulating the politicians to finance a more expensive staff canteen.

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Look at how trying to offer universal healthcare has done to the MA budget and you'll see it's a financial disaster even if you think it's a worthy goal.

Sure. Or look at Hawaii and reach the opposite conclusion.
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#13 User is offline   kenberg 

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Posted 2010-September-24, 06:29

As Novemebr approaches, people will be deciding on how things are going. I may want to expand this topic beyond health care but if so I will start another thread. So here it is health care.

I put a lot of stock in personal experience. One needs to check back to see if it is generally applicable but still, it's a good place to start.

My experiences with the health care system suggest two things:
1. Administratively it is bizarre.
2. In delivering care it is quite good, but this is for those of us with access to good insurance.

The bizarre part might be called a pre-existing condition. At 71 I am still having good luck with my health but I did have a kidney stone last year. They needed to go inside and zap it. There was a bill that wasn't right and my wife, who has far more patience than I have, called. They acknowledged the error, it involved improper coordination of medicare and my supplemental insurance, and they promised to straighten it out. This was back last November. No subsequent bill. She called a couple of times to ask, but to no effect. Maybe they will send a bill. Maybe they won't. Maybe it was all paid for. Maybe we have been reported to some credit agency as deadbeats. Who knows? This sort of thing is far more common than it should be. I don't know if the Obama bill has helped with this, but the problem has been with us for a long time. Criticize Obama for not solving the complexity issue perhaps, but he did not create it.

As to effectiveness, I am very satisfied and grateful for the treatment I got with the stone. It hurt like hell and they took care of it. The guy who did the zapping is now my urologist, replacing the bozo I was seeing before. Which is another issue. There are some very good doctors out there. There are also some that maybe should take up a different profession. We moved four years ago and it has taken a bit of time and effort to get to our now rather satisfactory situation.


I was hoping that the health bill might address some of the confusion in health care. I also hope it does not screw up effective medical delivery. If it costs me a little cash to have a sick kid from a poor family treated for his illness, I don't mind. I very much believe the system is not at all cost effective and I would like to see that dealt with.

I will try to assess as accurately as I can whether the health bill is good for America. I do not plan on doing a Ph.D. thesis on the topic but I hope to approach the question seriously. The correct answer is not at all clear to me.
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#14 User is offline   benlessard 

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Posted 2010-September-24, 06:39

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Well, the highly privatized US health sector is extremely inefficient compared to most developed countries with more gvt involvement.
Says who ? For profits hospital make around 5% profits years after years while non-profits do ok while canadian hospital run in red years after years. The condition for working in US hospital are much better than anything you see in Quebec (and probably Canada too) and the waiting is nowhere near what is happening in Canada. Managing an hospital here is a nightmare and the worse is to come since we are losing personnel (less income, twice the income tax) and the population keep growing older. Every canadian i know that had to go in a US hospital is fully satisfied and impressed by the care they have gotten vs what they would get in Canada.

As far is i know for middle and upper class the services are better in the US than in Canada, I dont rely too much on satisfaction poll since its easy to be satisfied when its free and easy to be pissed off when you pay. Of course the price is way too high, but its no mystery, everytime you have customers that dont pay from their pocket price go up artificially. Pharmaceutical is the best example since by law there force to sell to the govnt at a discount vs the "free market price" so they raise their real price above optimum selling prices (they make less money with regular sales but make more profits on medicare medicaid (captive customers). When US medecine is cheaper in Canada then in US you know there is a swindle.


There is a extras cost for us health care system vs canada. Overweight people, pharmaceutical companies, ambulance chasers, heavy lobbying. When you let the greed of the freemarket plunder public fund with the governement that disable free enterprise and competition its always get ugly really fast.
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#15 User is online   PassedOut 

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Posted 2010-September-24, 07:36

benlessard, on Sep 24 2010, 07:39 AM, said:

Of course the price is way too high, but its no mystery, everytime you have customers that dont pay from their pocket price go up artificially.

And this is a big problem in the US, which the healthcare reform aims to fix.

A substantial pool of uninsured (and underinsured) people in the US obtain medical care in emergency rooms, paid for by the rest of us who do pay for insurance. And this emergency room care costs much more than if those folks were already included in the healthcare system. Whatever their personal circumstances, these folks are essentially freeloaders and need to be integrated into, and paying into, the healthcare system.

In the US today, much of the anger directed at healthcare reform stems from the government's clamping down on that freeloading. You can see that directly in the votes taken on "our right to be freeloaders" by the Virginia legislature and in a Missouri referendum.
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#16 User is offline   phil_20686 

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Posted 2010-September-24, 09:11

IMO the biggest reasons for publicly funded healthcare are the structural savings and benefits.

Here are a couple of examples:
In an NHS hospital there is no bureaucracy related to paying for treatment. The hospital gets a certain amount of money and does the best it can for all its patients. A huge amount of time and energy (and hence money) is saved because no one is sending bills back and forward.

There is no question of a difficulty of obtaining health insurance esp with a pre-existing condition. Nor is there any bureaucracy devoted to calculating risk and premiums.

In a publicly funded system there is a strong incentive not to over treat. Money spent on one patient is money not available to treat another. This means that money is not spent on high value drugs of questionable value. Compare this to the American system, having got health insurance, then when in hospital, for any given treatment the hospital gets a profit, but there is no counter balancing incentive for the patient - as he will not pay anything for the treatment. Thus there is a strong incentive for doctors to offer expensive treatments of questionably medical value. How much money should be spent on a drug that might extend a cancer patients life by 3 months at a cost of 500 000 a month with nasty side effects? I believe this is the largest single factor for why Americans spend so much more on health insurance. You are paying for far more expensive treatments. In Britain the situation is clear, some treatments are deemed not cost effective, and are denied to patients, but everyone gets the same treatments.

This is ultimately a problem with no clear answer. Is it "fair" if those who can afford more comprehensive medical insurance should get better treatment options? Arguments can be made in both directions.

This post has been edited by phil_20686: 2010-September-24, 09:12

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#17 User is offline   jdonn 

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Posted 2010-September-24, 09:27

PassedOut, on Sep 24 2010, 08:36 AM, said:

A substantial pool of uninsured (and underinsured) people in the US obtain medical care in emergency rooms, paid for by the rest of us who do pay for insurance. And this emergency room care costs much more than if those folks were already included in the healthcare system. Whatever their personal circumstances, these folks are essentially freeloaders and need to be integrated into, and paying into, the healthcare system.

Not to mention that they reduce the quality of outcomes of people who make necessary trips to the emergency room, as anyone who has spent 2 or 4 or 6 or 20 hours waiting in one, or who has been put in a bed in the hall, or who has been sent to a different hospital, can tell you.
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Posted 2010-September-24, 11:32

i don't know what the truth is about "A substantial pool of uninsured (and underinsured) people in the US obtain medical care in emergency rooms"

But, granting that it is true for this post - what choices do they have? If they lack choices, can they be freeloaders?

Edit: here is some old (2007) PDF data from the CDC http://tinyurl.com/26pxzbw
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#19 User is offline   luke warm 

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Posted 2010-September-24, 16:20

kenberg, on Sep 24 2010, 07:29 AM, said:

~~Maybe they will send a bill. Maybe they won't. Maybe it was all paid for. Maybe we have been reported to some credit agency as deadbeats. Who knows? ~~

assuming your doctor: 1) takes medicare and 2) is in your other carrier's network, probably it was all paid for... your doctor will only be paid the contracted rate from both medicare and your supplemental... medicare will pay 80% of their fee schedule... the amount that is left will be paid at 80% of your supplemental's fee schedule (max), after deductible... but if the amount paid by medicare totals more than or as much as 80% of your supplemental's fee schedule, there is nothing due

the provider has to accept that payment (if in network) so you'd owe nothing
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#20 User is online   PassedOut 

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Posted 2010-September-24, 17:13

uday, on Sep 24 2010, 12:32 PM, said:

If they lack choices, can they be freeloaders?

No matter what their circumstances, people who rely on others to pay for expensive medical care are freeloaders, in my opinion. I don't know what those steeped in political correctness call it.

So far as I can see (and I'm a conservative businessman), the entire republican campaign this year amounts to, "Hey, Obama is taking away your free lunch." And that has a mighty appeal to many folks, as we see.

A case in point is the scare campaign about "cuts in medicare." At issue are the Medicare Advantage plans that were set up to compete with Medicare. The republican rhetoric at the time was that those plans would demonstrate that private companies could outperform the government insurance program and win in the marketplace.

But to get those companies started on the program, a subsidy was provided, paid for from regular medicare collections, that was supposed to be temporary until the efficiencies took hold.

Of course, those efficiencies never did take hold, and the crying about "cuts in medicare" is about removing those "temporary" free lunch subsidies.
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