Another health care thread.

[Marcus Aurelius]

Originally Posted by atlcomedy

Now imagine a scenario where the Dr. or Hospital or whoever had a conversation with his adult children and said, "We understand he is worth approx. $x. His monthly cost of care is about $y. You do the math. Depending on how long this goes on may be difference between you inheriting a nice sum or actually being stuck with some hefty bills when he's gone. And the only thing we are certain of is he isn't getting better."

What if someone had that conversation with the patient himself?

A hell of a thing to suggest.

But you are so correct. Death panel? No need. Talk to the person then to the family.

[Marcus Aurelius]

http://www.youtube.com/watch?v=K7U4E...eature=related
Edward G. Robinson in a role (Soylent Green) where he chose to die and they gave him some Koolaid and a movie. He died for real within days or weeks of the movie. Cancer. And he knew it.

[jdean208]

Originally Posted by pjorourke

Well that works out to over $1,000 per employee per month --about twice your annual premium. You got a pretty good deal there. But the real issue no one is dealing with is how can we as a society afford to pay $1 million for a set of premature twins. That is a lot of money. And even more when the people who have the direct impact on the decisions have no financial stake in the game. I'm sure they are fabulous and a medical miracle. But where do we stop the spending.

Well, PJ, I believe that was my point. No insurance company can stay in business and pay out over twice as much as it is bringing in. The risk needs to be spread in a more equitable manner than is currently the case.

The twins are my grandsons, so I would like to find somewhere else to stop the spending. I can think of several hundreds of suggestions.

JD

[John Bull]

Originally Posted by jdean208

These kinds of costs must be spread across the entire society if we are to sustain this level of excellence in medical care.
JD

It boggles my mind that your answer to your problems is to put your hand in my pocket.

[TexTushHog]

Originally Posted by Rudyard K

I feel like I'm talking with my kids, who figure if they just don't admit it...then no one knows for sure that it is true.

I guess using your thought process, if I just pay a single woman less...because she doesn't have more mouths to feed than her own, then that is OK (and I am not discriminating) if I pay her male counterpart more because he is taking care of a whole family. Yeah, I'm sure that's exactly how you see it.

The insurance company charges one premium for a single employee, male or female. If that male or female employee has dependents, they charge a higher premium because they have more risk. I don't understand what you don't understand about this. Is your insurance structured differently?

Originally Posted by John Bull

What government are you talking about? I've never seen anything approaching efficiency from the boys on Capitol Hill.

Then look at Medicare. Two to three percent administrative costs. The other 98 to 97 percent goes to health care providers. Private insurance between 60 and 70 cents goes to health care providers. Much more efficient in my book.

[DFW5Traveler]

Originally Posted by charlestudor2005

I really hate broad, sweeping statements like this. Not only can you not support broad, sweeping statements, historically it is untrue. The U.S. operated in deficit spending for generations until Bill Clinton left office and left the government in the black. George Bush put us in the red again.

And how did the budget become balanced? The Balanced Budget Act where the prez cut military retirement to 35% from 50% for 20 years of service, cutting medicare payments, oh and lets not forget, cutting taxes. When I began to invest, I just knew that Bill was going to do something good to prepare for the baby boomers for retirement. I made a huge investment in an assisted living company. After the BBA was passed the company was delisted on the stockmarket when they filed bankruptcy, went insolvent withinin a week, and closed 75% of it's homes. I lost everything I had invested. Thanks, Bill!!!

Originally Posted by John Bull

It boggles my mind that your answer to your problems is to put your hand in my pocket.

LOL!!! Laughing but not at your expense, I completely agree.

[TexTushHog]

And CaptainMidnight, I think you are correct about the current bill not doing much to contain costs. I can't because it doesn't attack the underlying cause of the excessive costs -- for profit medicine.

But I think you are dead wrong about " most Americans would strongly prefer that political 'leaders' offer proposals based on realistic projections and honest numbers." They don't want to have that conversation at all and they're not ready to do what has to be done once that conversation is had. And the case of the $900,000 premature twins illustrates just that.

In addition to getting rid of for profit medicine and the unique disincentives for real competition that it causes because of medical provider conflicts of interests, and the almost infinite inelasticity of demand for core health services, we're going to have to talk about some limits on the amount of care that our society can provide to everybody. Whether it's end of life care, or telling a family, we're sorry, you can go get pregnant again, but we're not spending a million bucks on these premature babies, hard and unpopular choices need to be made. And Americans, in my judgment, just aren't ready for that and neither party has done much to prepare them for that conversation. (And in fact, the Republicans have, through equating anything approaching rationing to "death panels, made such a discussion nearly impossible.)

[Marcus Aurelius]

I've noticed over many years in various Doctor's offices and health centers the Pharmaceutical representative. Always young people. Used to be only women. Hot hot hotties in mini skirted business suites. Now you see guys as well but they are straight off of GQ as well. When they hit 30 do they get whacked? I never see an old one or even middle age. Never have. Never saw an unattractive one either. Not important just curious.

[charlestudor2005]

Originally Posted by Marcus Aurelius

I've noticed over many years in various Doctor's offices and health centers the Pharmaceutical representative. Always young people. Used to be only women. Hot hot hotties in mini skirted business suites. Now you see guys as well but they are straight off of GQ as well. When they hit 30 do they get whacked? I never see an old one or even middle age. Never have. Never saw an unattractive one either. Not important just curious.

Prostitutes of a different kind????

[atlcomedy]

Originally Posted by TexTushHog

Whether it's end of life care, or telling a family, we're sorry, you can go get pregnant again, but we're not spending a million bucks on these premature babies, hard and unpopular choices need to be made. .)

Not the elimination of for profit medicine, but the above....tough conversations & unpopular choices...well, TTH, I think this may be the first thing we agree on in months...but this is so neccessary.

And, Jdean, the reason I personalized my real life story about my loved one's death is everyone (most?) of us have a real life story about loved ones that cost a fortune in care. Every high cost premie has parents, grandparents, aunts, uncles, etc. I'm not asserting here where the line needs to be drawn, but we need to start the conversation....

[jdean208]

Originally Posted by John Bull

It boggles my mind that your answer to your problems is to put your hand in my pocket.

And the Parthenon Marbles? The Egyptian ObelisK? The Benin Bronzes? The looting of Abyssinia? Half the contents of the British Museum? There is little room in the pockets of the British Empire for a hand!

John Bull is the symbol of the British common man, for whom I have endless respect. They showed the world how to make a universal health care system work. I do not for a moment believe you speak for them.

[DFW5Traveler]

Originally Posted by TexTushHog

...But I think you are dead wrong about " most Americans would strongly prefer that political 'leaders' offer proposals based on realistic projections and honest numbers." They don't want to have that conversation at all and they're not ready to do what has to be done once that conversation is had. And the case of the $900,000 premature twins illustrates just that....

I think that is a key point why there is opposition to the current plans. If they, the political leaders, don't want to have the discussion why is it being ramrodded through the process?

The proposed Slaughter Rule IS NOT an up or down vote on a bill that will fundamentally alter everyones way of life. Some of us American people want to know realistic projections and honest numbers. I've seen the polls and they, the American people, are overwhelmingly opposed to the bill in it's current form. Yes, they want reform, but not in this fashion. I even saw a poll today that suggested ~47% of medical professionals will leave the medical industry if it's passed. I know several people that were med students. They have changed their majors based on the idea of overhauling HC in the US. If that last poll is acurate, what is the govt going to do to balance the doctor/patient ratios?

[Texas Contrarian]

Originally Posted by TexTushHog

And CaptainMidnight, I think you are correct about the current bill not doing much to contain costs. I can't because it doesn't attack the underlying cause of the excessive costs -- for profit medicine.

But I think you are dead wrong about " most Americans would strongly prefer that political 'leaders' offer proposals based on realistic projections and honest numbers." They don't want to have that conversation at all and they're not ready to do what has to be done once that conversation is had.

To your first point, I don't think for profit medicine per se is the primary driver of excessive costs -- rather, it's the structure of the system in which consumers of health care services have no relevant information concerning the market for those services, and no incentive to control them. Consider what a mess we'd have if auto insurance covered everything related to the ownership and maintenance of a car -- even oil changes and tire repairs. Instead of paying $29 or so for an oil change at a quick-lube joint, you might have to shell out two or three times that, just to pay for all the overhead arising from the insurance claim and paperwork processes. And no telling what fixing a flat would cost!

That comparison points up the ridiculousness of our current system. It's about the furthest thing imaginable from a functioning market.

John Mackey (CEO of Whole Foods) pointed out a good way around this. Simply stated, you combine incentivized wellness programs and HSAs with high-deductible catastrophic event insurance:

http://online.wsj.com/article/SB1000...072865070.html

As for your second point, likely you are right -- at least in the sense that we've created a monster in the form of an entitlement-expecting culture by promising everyone they can have ice cream now and broccoli later (or maybe broccoli never!) We saw that with campaign claims that no one whose income was below $250K would be asked to pay higher taxes, despite massive new spending initiatives.

But I still don't think promoters of the bill are serving anyone's interests (not even their own) by making such patently dishonest cost claims. Only those suffereing from stupefying levels of ignorance and innumeracy believe them.

As I said in another thread: If I were to try to drum up investor interest in a hedge fund or private equity partnership by rolling out such phony numbers, I would fear being indicted and arrested.

[TexTushHog]

Originally Posted by DFW5Traveler

I've seen the polls and they, the American people, are overwhelmingly opposed to the bill in it's current form.

You must be watching the MSM, the most conservative and lazy organization in our society. They couldn't scratch their ass if they had a hand full of fishhooks.

The public, especially the Democrats and Independents, are not against this bill. Properly polled, it has a broad majority of support.

Look at this quote from a news story (from someone who isn't lazy and conservative) on the very recent McClatchy/Ipsos poll.

Comes now (Feb. 26-28) a McClatchy/Ipsos poll of 1,076 people that on first glance offers rocks to sling at Obama. The lead question asks, “As of right now, do you favor or oppose the health care reform proposals presently being discussed?” Forty-one percent said they favored them, 47 percent said they were opposed, and the rest said they were unsure. Those are numbers the Republican leaders could work with.

But the pollsters went a step further, asking those opposed – 509 people in all – if they were against the proposals because they “don’t go far enough to reform health care” or because they go too far. Thirty-seven percent said it was because the proposals don’t go far enough. Thus – are you ready for this? – the addition of an obvious, simple follow-up question completely turns the tables. The overall numbers switch to 59 percent in favor of health care reform, 30 percent against. Putting aside those with no opinion, it becomes 66 percent in favor of health care reform, 34 percent against. Some would call that a consensus, or these days, a super majority.

http://www.niemanwatchdog.org/index....groundid=00435

See also: http://www.pollingreport.com/health.htm
The lazy will only see 41/47 against the bill. But when you ask the next question, why are you against it, over a third 37%, said they are against it because it doesn't go far enough in it's changes. They are like me -- they want either single payer or at least the public option. So you add those back into your initial group, 59 percent favor health care reform at least as significant as this bill. Throw out the no opinion folks, and it gets even stronger -- 66 percent in favor.

You also overlook one important issue. Democrats want a bill passed badly. Independent are split almost down the middle, but prefer this bill by a narrow margin. It's the Republicans who don't want it and they're not going to vote for Obama or Democratic Congressional candidates in any event. Fuck them, they don't count in the political calculus of what to do. They're going to vote against anything Obama or the Democrats do and their voters will vote against Democratic candidates no matter what. They lost the election and elections have consequences. Can you imagine Bush worrying about what the other side thought? Hell no, he'd just go do what he was elected to do -- fuck the Democrats.

CaptianMidnight, you oil change analogy is flawed. That might work for routine medical care. Getting checked out when you have a cold. A once a year physical, etc. And there is very effective cost competition for those sorts of medical services. What is driving costs are the low to zero elasticity of demand services like an acquaintance of mine experienced last week. He'd been having chest pains for a few days and his wife talked him into going to the doc. They rushed him from the doc's office to the hospital and he was having quadruple bypass within two or three hours of leaving the doc office.

That's the sort of procedures that are driving costs and the competition model doesn't work there. There is no time to shop, no time to move from place to place, you do what they say, and you pay what they pay and you don't ask questions, at least not before the fact. Same with critical care after a big accident, a heart attack, a stroke, premature kids, end of life care, etc. All the big cost drivers.

[pjorourke]

Originally Posted by TexTushHog

Then look at Medicare. Two to three percent administrative costs. The other 98 to 97 percent goes to health care providers. Private insurance between 60 and 70 cents goes to health care providers. Much more efficient in my book.

There is a huge difference between efficiency and effectiveness. Fraud easily adds 5-10% so you are about back in the same place. And a more typical Medical Loss Ratio in an insurer is in the range of 80-85%.

Now if you want to cut costs, distribution costs are about 5-7% (read sales commissions) which are income to someone else. But then you are taking on a lobby almost as tough as the trial lawyers.