Sorry, but Nancy Pelosi is wrong. We do have a spending problem and the heart of the matter is our inability to control medical costs. Spending on health care now consumes an astonishing 18 percent of our total economic output. Rising Medicare and Medicaid costs are the main drivers of our national debt crisis. Yet health care costs continue to shoot up relentlessly.
It’s not all bad. Americans live longer, healthier lives due to medical innovation. As the population ages, they consume yet more medical care and there’s more that can be done for them. So far, so good.
But our health care system is also plagued by extraordinarily high levels of waste, estimated at 30 percent or $750 billion annually by the Institute of Medicine. Some of it is administration, like the $210 billion spent in processing claims, a number which doesn’t include the enormous amount physicians must spend on claims submission and adjudication.
But even more of the waste is just plain unneeded, ineffective tests and treatments. “Routine” EKGs and blood chemistry tests, back x-rays for uncomplicated back pain and preoperative chest x-rays soak up hundreds of millions of dollars without improving outcomes. Colonoscopies, mammograms and Pap smears are all useful in early diagnosis of cancer but performing them more often than recommended just adds to waste.
This isn’t all harmless either. CT scans cause a statistically significant increase in cancer risk. Colonoscopies rarely — but often enough to be worthy of concern — cause bowel perforations. Unnecessary tests often lead to a cascade of more tests, each with their potential complications.
Much of the least defensible waste is due to “defensive medicine”, the hope of avoiding future liability claims by ordering more tests “to make sure.” It’s impossible to calculate how much malpractice pressure has inflated health care costs because practice standards themselves have changed in response to the litigation threat.
For example, CT scans are routinely used today to evaluate headache patients in ERs, when in the past careful clinical assessment could reliably exclude significant problems. America doesn’t have to lead the world in litigation expense, but politically powerful trial attorneys have been able to stifle most reform so far.
So why is health care plagued with waste while manufacturing and other economic sectors operate efficiently? It’s the way in which health care is bought and sold. Think about it. Where else are purchasing decisions made where neither buyer or seller is much concerned about price and often don’t even know what it is?
It’s even worse than that. Physicians are generally paid more for doing more tests and treatments. Patients don’t value their ability to be cost effective, and other service providers appreciate the referral business. For insured patients, which is most of us, the incentives are to green-light most anything. After all, little or nothing is coming out of their pocket so an insurance “winner” is the one who uses the most resources.
The medical literature abounds with proposed solutions to control health care cost. Electronic medical records, physician payment reforms and managed care (again) have been touted . Increased price transparency and patient education make a lot of sense.
But the key reform would be to assure that patients are responsible for the cost of their own health care decisions. We would all have catastrophic insurance to cover unmanageable expenses but otherwise pay for our care out of a tax-deductible account where we get to keep what’s left.
These Health Savings Accounts have been tried and they work. People take better care of themselves. They appreciate doctors who are cost-efficient and they become more involved in choosing appropriate tests and treatments to achieve the results of value to themselves.
There is one other way. The Obamacare answer to runaway costs is the Independent Payment Advisory Board — 15 unelected bureaucrats who would make one-size-fits-all determinations of who gets what.
That’s our choice. We can have a future of dependence and rationing or we can have freedom to work with our doctor of choice to make better health care decisions. Doing nothing is not an option.
East Valley resident Tom Patterson (pattersontomc@cox.net) is a retired physician and former state senator.
downtownresident posted at 9:18 am on Sat, Feb 23, 2013.
Tom, as usual, blames the poor, sick people for all our woes. Let 'em eat cake, he says, and all will be well.
Don't put any blame on the doctors who have all these tests and people to run them in their office, so they can charge going both ways.
The simple solution is to make sure all uninsured patients pay full charges while insurance companies get sweetheart deals.
Tom, your attitude would be different if you were a poor retiree with no money.
Accuracy posted at 9:39 am on Sat, Feb 23, 2013.
Tom Patterson thinks: “Americans live longer, healthier lives due to medical innovation.”
A new study by the West Virginia University School of Medicine and the Medical University of South Carolina shows that baby boomers are living longer than previous generations . . . but that doesn't mean they're any healthier.
Legal drugs (medical prescriptions) can cause serious and potentially life-threatening side effects and can cause drug addiction. Baby boomers are more likely to have high blood pressure, high cholesterol, diabetes, and have a greater chance of chronic disease and disability.
The trend has caused concern over the rising costs of ObamaCare.
chatmandu002 posted at 9:59 am on Sat, Feb 23, 2013.
Tom,
Your fighting an attitude that believes, "Nothing is unnecessary when my health is on the line", "The government pays if I can't afford it".
Cerulean posted at 1:38 pm on Sat, Feb 23, 2013.
Tom said that, “ CT scans are routinely used today to evaluate headache patients in ERs, when in the past careful clinical assessment could reliably exclude significant problems.”
Why do Emergency Rooms expect physicians to order a CT scan for a headache? Because the hospital can charge $10,000. for a $500. CT scan and no one can sue them for price gouging or for providing unnecessary procedures. The PRICE of a CT scan and the protocol for headache is ENTIRELY up to the hospital.
Mike McClellan posted at 4:15 pm on Sat, Feb 23, 2013.
Hey, Tom, while you're at it, why don't you tell us about how much medical machine companies make, how much variance there are in costs of procedures, the difference between cost to hospitals and costs passed onto patients for the procedures?
So an MRI in one place might cost $2,000 and at a place 60 miles away, $800. But we the patients don't know, because it's charged to our insurance.
There are billions and billions there. But to cut those billions would require some kind of uniformity in charges.
And we know that would be . . . wait for it, wait for it . . . socialism.
And why do some of those hospitals charge $10,000 for a $500 CAT scan as Cerulean notes above?
In part, because hospital absorb some of the costs of the uninsured. Surely you know, Tom , that sending an uninsured to an emergency room as their primary care is more costly than actually insuring them.
But if we insure them, that would be considered by some to be . . . wait for it, wait for it. . . . socialism.
Rich posted at 5:32 pm on Sat, Feb 23, 2013.
Medicine in the US has morphed into "healthcare" an insurance scam based on price gouging, double billing and every other trick in the book, it features every con known to man and has succeeded in doubling the cost over even overtly socialist systems, while still being outperformed by them. Obamacare gives government endorsement to the practice. If you mistake indigestion for a heart attack, they'll relieve you of at least 10K, on top of your insurance for what is essentially misdiagnosis and malpractice. And charge you ten bucks for an aspirin tablet, because the itemized bill goes to the insurance company and they pass it, wink, wink. The answer is to prosecute the "healthcare professionals" and the "insurance professionals" who are running this con game as the bunco artists they are, relieve them of their ill gotten gains, and return medicine to the sphere of personal service where it belongs.
TruthSeeker posted at 6:37 pm on Sat, Feb 23, 2013.
You want to address abuse of the health care system and waste? I have some rich friends who treat their insurance plans like a timeshare. They refuse to take care of themselves by eating nutritional food and exercising. They'd rather take a pill and/or go to the hospital and let insurance pick up the tab. Since they pay high premiums, they feel the insurance company owes them. They say they don't want to give up anything and live life to the fullest. And, of course, we all pay for them with higher costs at the doctor's office, hospitals, and premiums. [angry]
samkat posted at 8:47 pm on Sat, Feb 23, 2013.
Maybe what we need is fewer ER doctors. Tom, are you listening? :-)
Bluepoet posted at 11:42 am on Sun, Feb 24, 2013.
I do think there's some credibility to Tom's point about doctors who are paid to run tests and push pills, instead of being paid for results--you know, like actually curing or mitigating the health problems of their, you know--patients! Wow, what a revolutionary idea!!
Bluepoet posted at 11:51 am on Sun, Feb 24, 2013.
Of course, Tom is wrong about just about everything else, in his article. Pre-tax accounts are fine, for people who are already healthy, or for yearly physicals, and the like. For the chronically ill? Not so much...
On the other hand, administrative costs and the thievery involved there? Yeah, that's pretty much the root of the problem, aside from the equally shady insurance practices...
Mike McClellan posted at 1:46 pm on Sun, Feb 24, 2013.
What Rich and others are talking about here can be found in a seven-month investigation of the health care industry in TIME this week --
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/
What you will find is that we spend more on health care than the next six top-spending countries -- combined. And we get less bang for the buck.
Hospitals, especially non-profits, are making nice profits through something called a Chargemaster, a list of charges for each procedure, aspirin, surgeon's gown, etc.
Unsurprisingly, the charges have no connection to costs. Quick example: Some hospitals will charge up to $30 for the surgeon's gown, when they cost about $6 each.
And medical implants cost patients up to 150% more than what the hospitals pay for them.
And instead of technology making medicine more affordable, in many cases, it's making it less expensive.
Despite some -- in my view, anyway -- exaggerations, the TIME article is an eye-opener. And puts in dispute some of what good old Tom spouts off here.
bobunf posted at 8:49 pm on Sun, Feb 24, 2013.
The Japanese have a much older population than the U.S. - 22% of its people are over 65, compared to 13% in the U.S.
The Japanese spend 37% what the U.S. spends per capita - that works out to an excess U.S. expenditure of about $1.4 Trillion per year.
The Japanese live four years longer than the average American.
Similar comparisons can be made for numerous other developed countries including Germany, Italy, Greece, Sweden, Spain, Austria, Belgium, Portugal, Finland, France, Switzerland, the United Kingdom, Denmark, Norway,
Canada, the Netherlands, Luxembourg, Malta and Australia.
They are all older, spend less money, and their people live longer than in the U.S.
They all have universal health care, but not the U.S.
Rich posted at 9:43 pm on Sun, Feb 24, 2013.
And the Japanese smoke more than we do. In fact only Greeks smoke more. And the Greeks outlive us. Mass ignorance is more damaging to your health than about anything. Health is a personal issue, treated any other way it will kill you.
mnjcpa posted at 8:09 am on Mon, Feb 25, 2013.
When you treat - for free - millions of illegal citizens and pile a government juggernaut like Obamacare on top of it what else do you expect?
bobunf posted at 9:37 am on Mon, Feb 25, 2013.
I expect some improvement in our absolutely dismal health outcomes, which predate Obama and Obamcare by many decades.
Countries with higher life expectancies at birth than the US:
1980 16
1992 19
2000 22
2009 29
Countries with lower infant mortality rates than the US:
1960-62 12
1970-72 14
1980-82 17
1986-88 19
1990 23
2000 27
2009 29
In France and Finland, for instance, your baby is twice as likely to live as in America.
bobunf posted at 9:39 am on Mon, Feb 25, 2013.
Every other developed country in the world has better health outcomes and spends a fraction of what we spend on health care. We have a lot to learn from these people.
Ideological or racist aversion to Obama will not save your child's life.
bobunf posted at 9:49 am on Mon, Feb 25, 2013.
Speaking of children, how on Earth can Americans put up with this:
Excess US Mortality
AGE MALES FEMALES
Under 1 42% 42%
1 to 2 27% 18%
2 to 3 32% 30%
3 to 4 28% 23%
4 to 5 31% 23%
5 to 6 32% 32%
Not only is your baby much more likely to die in the US, even your five year old is 32% more likely to die.
bobunf posted at 9:59 am on Mon, Feb 25, 2013.
By the way mnjcpa, the "millions of illegal"s actually improve our health outcomes. These are mostly young males pre-selected for good health. it's reflected in the mortality rates for Latinos compared to Whites:
The US Census Bureau 2010 projections for life expectancy at birth in years:
White non-Hispanic males 76.4
Hispanic males 78.4
Difference Hispanic males live two years longer than White non-Hispanic males.
White non-Hispanic Females 81.1
Hispanic Females 83.7
Difference Hispanic females live two and half years longer than White non-Hispanic females.
bobunf posted at 10:00 am on Mon, Feb 25, 2013.
Hispanics have significantly better health outcomes (in spite of lower incomes and relatively restricted access to health care) than the US national averages. The phenomenon has been known for decades and is referred to as the “Hispanic Paradox.”
Hispanics who immigrate to the United States are healthier than the average American. Sick Latinos sometimes return to their place of origin. Perhaps it has something to do with higher rates of breast feeding, supportive extended family structures or other cultural characteristics? Lower rates of tobacco use among Hispanics?
Whatever the reason, Hispanics, and especially the illegals, make US health outcomes better. And they cost practically nothing - in spite of vitriolic mythology to the contrary.
mnjcpa posted at 11:18 am on Mon, Feb 25, 2013.
Seriously bobunf?
My point had nothing to do with Hispanics having better health outcomes. Reread my comments. It have everything to do with managing the problem wrong.
You can't possibly expect to burden a private sector business (healthcare) with millions of people that are here illegally, and get benefits for free, and then pile a government bureaucracy on top of it and expect it to be efficient or first class.
You have to start at the root of the problem and unfortunately both 1) flood of illegals in to the American system without any semblance of securing our borders or dealing with the problem well AND 2) letting the government manage our healthcare system.
Until those root problems go away, healthcare will continue to decline in to what you see in socialist countries.
bobunf posted at 4:16 pm on Mon, Feb 25, 2013.
mnjcpa, could you name one socialist country in which healthcare outcomes have declined?
Undocumented people constitute less than 4% of the population, are far younger, far healthier and cost far less per capita than the average American; 13% of whom are over 65. Note that 13 is more than 4.
According to the US Department of Human Services National Health Expenditure Data, total personal health care per capita spending in the United States for 2004 by age group was:
> For ages 0-18 $2,650
> 19 to 64 $4,511
> And 65 and over $14,797.
Mike McClellan posted at 4:42 pm on Mon, Feb 25, 2013.
Actually, mnjcpa, the two government-managed health care systems now -- Medicare and Medicaid -- actually drive costs down.
Read the TIME article.
Rich posted at 8:39 pm on Mon, Feb 25, 2013.
Mike, you've got to be the most gullible man alive. Of course it does. Do you even understand numbers? Like words, they say what the compiler of them wants them to say. It is easier to lie with numbers than words. I've written for Time/Life, it's one of their priorities that your numbers lie correctly, of course the Times is the same way. About the best experience I have ever had with publishers was Rupert Murdoch, at the Village Voice, though my wife, who also writes rather liked Jann Wenner. The problem is that you allowed criminals to take a corner on a market, and the government condones their extortion. Nothing good can result from it.
bobunf posted at 10:52 pm on Mon, Feb 25, 2013.
The good that has resulted from our health system is that in the last 50 years life expectancy at birth has increased from 69.8 years to 78.1 years. More than 8 years of added life for 300 million people. That is an incredible accomplishment - a miracle comparable to the invention of antibiotics.
Infant mortality has declined from 26 per 1,000 live births to slightly over 6. That is 20 babies who are alive; 20 horrendous tragedies that American mothers and fathers do not have to endure. A miracle unlike any other.
bobunf posted at 10:53 pm on Mon, Feb 25, 2013.
Our health outcomes have not kept pace with that of other developed countries; they could be much better; nonetheless those outcomes are unimaginable blessings.
If this is criminals who have enabled 300 million people to live 8 years longer and 80,000 babies to survive, let us have more of them. Rich, your vitriol is neither becoming nor helpful.
Mike McClellan posted at 6:59 am on Tue, Feb 26, 2013.
No, Rich, I'm the SECOND most gullible man alive . . .
mnjcpa posted at 8:36 am on Tue, Feb 26, 2013.
No Mike, you win the prize for clouded thinking. And the sad part is you don't even get that you're thinking is skewed because of the propaganda you take in.
From healthcare to education to whatever else you lockstep liberals want to regulate you're all in to have a government monstrosity regulate it. NOTHING comes out well when that happens.
To suggest that Medicare and Medicaid are great examples of a business run well is a laugh out loud joke. That's as funny as we need the Dept. of Education (and it's bloated budget) to have an exceptional education system.
Mike McClellan posted at 8:59 am on Tue, Feb 26, 2013.
Don't put words in my mouth, mnjcpa . . . I didn't say that either is a "great example of a business run well."
I just noted that those programs drive hospital costs down, simply because both refuse to honor the "chargemaster" scam of hospitals, and reimburse them based on cost and not what the "chargemaster" puts on non-Medicare/Medicaid patients.
Again, read the article before you comment on what the contents of the article are. Be different from Rich, who doesn't need to read something to know what it says.
mnjcpa posted at 10:01 am on Tue, Feb 26, 2013.
I didn't Mike. First, I don't read the Times because it's just another liberal rag that's about to bite the dust due to lack of profitability. Secondly, they promote the Obama propaganda. And finally, ANYTIME the US government is managing the problem it's easy to know that it's mismanaged.
You said Medicare and Medicaid drive costs down reporting from the Times article. So the way you stated that supposed `fact` suggests you believe it. Hardly a stretch Mike, nor is it putting words in your mouth - try critical reasoning. I know you believe that these programs drive costs down. The sad part is you believe it.
The ONLY way to solve the healthcare problems the US is completely reverse course and NOT involve another government bureaucracy. The waste in hospitals is well documented. In Mexico, if you don't have the money to pay for medical services - you don't get it, period. But hey, come to the US illegally no less and you get it for free!
But you don't solve the problem when you've got the government managing the problem. Need I mention the Dept. of Education again?
mnjcpa posted at 10:43 am on Tue, Feb 26, 2013.
Latest reports from CBO is that Obamacare is going to add $6.2 TRILLION to the national debt.
I recall the Times was part of Obama's propaganda machine pushing the message that OC wasn't going to add any costs to those making less than $200k a year. Right.
Just another fabricated lie coming from the Obama administration that the majority of the country bought.
LiveInGilbert posted at 12:52 pm on Tue, Feb 26, 2013.
Wow - look to be a lot of "experts" in healthcare on the topic today. For those that haven't worked in the industry or dealt with the entities involved that drive the market, both Medicaid and Medicare, while not models of efficiency and with a lot more work to be done to eliminate fraud (that is fraud by providers - hint, part of the problem) and waste, absolutely have and continue to drive down healthcare costs. .
VofReason posted at 12:53 pm on Tue, Feb 26, 2013.
Yes Medicare and Medicaid are the most efficient providers of Healthcare coverage, just like the post office is the most efficient way to get a letter mailed. Here is a question, isn't healthcare at it's essense a personal exercise for the majority of people? Again, for the majority of people, if you eat right, avoid smoking, excess drinking and exercise, you will likely get a cold every now and again up until age catches up with you. It isn't becuase Doctors in other countries are any smarter or came up with the magic potion to make people healthier. The key to living healthy is not spending a lot of time in a Doctors office or Hospital- no?
LiveInGilbert posted at 12:58 pm on Tue, Feb 26, 2013.
History has shown that in healthcare it taken the Fed government mandates/ payment programs/processes to drive reimbursement through pay for performance (which includes a myriad of objective quality measures and patient satisfaction scores) and implementing other programs like Accountable Care Organizations and Bundled Payments, which encourage providing only appropriate, needed care and multiple facets of the healthcare system to work together to manage patient's care.
LiveInGilbert posted at 1:00 pm on Tue, Feb 26, 2013.
That is the only time that the rest of the healthcare market takes notice and follows suit. Healthcare economics are not like any other industry in the economy - and like it our not the insurance companies, big pharma, etc don't move on their own volition. Our healthcare system are not an Obama, Republican or Democrat problem - it's a national problem that had it's start decades ago predating most of those in Washington now - expect maybe John McCain, he's been around a long time ... but that's for another comment.
LiveInGilbert posted at 1:05 pm on Tue, Feb 26, 2013.
Voice - you must have been doing something else and not reading - I said they weren't the model of efficiency but they are at least as efficient as the big insurers and HMOs and they actually seek ways to drive down overall costs. What the other insurers do is find ways to drive down their costs, reduce care for patients, reduce payments to providers and maximize profits. You are correct - for the majority of Americans the single most important influence on their health is them - what they eat, how they exercise, etc - and not seeking a magic pill or treatment at the doctor's office or the hospital.
LiveInGilbert posted at 1:07 pm on Tue, Feb 26, 2013.
And my previous 2 comments prior to resonding to Voice are inverted - they definitely don't make sense the order they are in and the "spam" function is making posting today more difficult than it needs to be!
Mike McClellan posted at 1:08 pm on Tue, Feb 26, 2013.
So, mjncpa, the article's not in the Times but in TIME. Of course, that probably doesn't make a difference to you.
But what to make of the author's criticism of Obama's approach to healthcare reform? Should I dismiss the writer's points because it comes in TIME magazine?
So I'm confused . . . when he talks of medicare and caid keeping hospital costs down, that's just liberal drivel. But when he criticizes Obama's approach to reform, that, too, is liberal drivel?
mnjcpa posted at 2:02 pm on Tue, Feb 26, 2013.
You should be confused Mike, because I never discussed the author's position of healthcare reform.
What I did discuss was agreeing with Rich of your view of the Time article and my position that ANY involvement by the government to manage what should be a private business will be a boondoggle, taxpayer funded waste.
Mike McClellan posted at 4:54 pm on Tue, Feb 26, 2013.
Sure. Of course. Without reading the article, you and Rich already have given your carefully-considered evaluation of it.
One hopes your work as a cpa doesn't include divining numbers.
Rich posted at 8:41 pm on Tue, Feb 26, 2013.
He's a very good reporter, Mike, but you get a lot of 'shadings' in any article in main stream media, it is a bit of ensemble art and though he tried, he did not scratch the surface of numerous problems including the whole of governmental bureaucracy, and the tail to teeth aspect of billing and coding. Yes, Mike, I not only read the article, I talked to the editor of it. You jump to conclusions, in fact if it was a physical activity you'd be close to the most physically fit man in America. Once again you cherry pick one aspect of one thing, totally out of context and hang everything on it. Critical thinking at its best, what you taught the kiddies.
mnjcpa posted at 8:49 pm on Tue, Feb 26, 2013.
Mike, Clearly editing was not one of your strong points teaching government English. If you had bothered to track our comments, you would find that Rich's comment was in regards to his experience in communications. Neither one of us were making a case with the author, but in your comments to the article. Try to keep up...
bobunf posted at 12:13 am on Wed, Feb 27, 2013.
The reduction in mortality rates in the last 50 years for 1,2,3, 4, 5, 6, 7 and 8 year olds did not come about as a result of eating right, avoiding smoking and excess drinking and regular exercise.
The reduction in infant mortality (80,000 alive this year and every year; babies who would have died in the 1960s) also did not result from those suggested causes. Suggestions also known as blaming the victim and whistling past the graveyard.
It is not possible to imagine how one could ascribe the reduction in mortality rates for every age cohort and for both sexes to such suggestions.
Every other developed country in the world has something akin to Medicare from ages 0 to 120. Every other developed country spend a fraction of what we spend. Every other developed country has better health outcomes than the US by miles.
Moral: Carping about criminals, personal responsibility and government inefficiency leads to millions of Americans dying every year. Learn from your betters.
mnjcpa posted at 7:44 am on Wed, Feb 27, 2013.
bobunf - it's not the carping about criminals, personal responsibility, and government inefficiency that's the problem. It's putting people in office like Obama that continue exacerbating the problem by thinking they can govern the problem.
In Mexico, if you're sick and you can't pay for hospital services, you don't get it. Period. What other countries offer an improvement over the United States? Canada? Great Britain? Yes, right. Socialized medicine. That's exactly where were headed and why people from Canada come to the US to get healthcare because of the substandard care in their own country.
The ONLY problem we have is financing people's healthcare for free administered by a government bureaucracy. Eliminate those two problems and our healthcare system can be fixed.
VofReason posted at 1:25 pm on Wed, Feb 27, 2013.
This is good LIG, maybe you can explain why the Government is then the lowest reimburser of services? You are aware that MCR and MCD pay providers the lowest amount for the services that they give to people. Listen to the Healthcare community when every year Medicare threatens to lower the boom on Doctor's reimbursement. Many MDs have and will drop Medicare patients all together if it ever goes through. Here is something, instead of trying to assume that the Government knows what it is doing in Healthcare, why didn't Obamacare center on creating competition over state lines for Insurance policies. Remember the rule about competition creating efficiency? Never heard let the Government do it to creat efficiency for anything- have you?
Mike McClellan posted at 4:47 pm on Wed, Feb 27, 2013.
VofR, you are right on the button about competition over state lines. Good point.
And since we're ripping Obama, how about tort reform? While malpractice and malpractice insurance is a relatively small piece of the health care pie, there are huge costs associated with the threat of malpractice, so doctors often ask for redundant testing or needless tests just to CYA. How about giving doctors "safe harbor" if they've performed the norm in care and a patient still suffers or dies?
Rich posted at 6:52 pm on Wed, Feb 27, 2013.
"How about giving doctors "safe harbor" if they've performed the norm in care and a patient still suffers or dies?"
Medicine is a personal service, it is only worth something when performed on a unique individual; therefore, it is malpractice once you can find or establish a 'norm.' The assembly line theory of 'health care' has destroyed medicine in this country already taking it from the most advanced care to the bottom of developed nations and the cost to double what it should be. All in pursuit of your 'norm.'
LiveInGilbert posted at 6:25 pm on Thu, Feb 28, 2013.
VOR - I actually agree that competition over state lines could have been a positive thing - just one I don't think has gotten any support by a lot of the steadfast state's rights and interstate commerce folks - especially as it pertains to healthcare. Mike is on target with tort reform - unfortunately I think Obama cowed to the political pressure that the lawyers bring to bear on not only the White House but also the Congress as a whole - tort reform inclusion would have weighted this down with no chance of passing.
LiveInGilbert posted at 6:29 pm on Thu, Feb 28, 2013.
At the end of the day I view this really as a beginning of a reform effort - not an end state. Pieces will be added and subtracted to the legislation and it will hopefully morph to meet the needs of the citizens - a more efficient healthcare system that controls costs, provides high quality care and does more than just treats illness and injury - the system incentivizes and works to prevent disease and keep people healthy. Funny thing about economics - when you pay people to do more things, then they tend to do it as it is in their best economic interest. And in healthcare those people that control demand are often those that reap the financial benefits.
mnjcpa posted at 7:28 pm on Thu, Feb 28, 2013.
What you're describing LiveInGilbert is exactly how the tax code has become a ridiculous mess. Does it bother you at all that the Obamacare is estimated to add a minimum of $7 trillion to our national debt - and that's before it's fully implemented? The government has no business in healthcare.
Rich posted at 8:33 pm on Thu, Feb 28, 2013.
What you are missing is rather simple. It is a personal service, person to person, doctor to patient. Once you add insurance, and then government, it deteriorates into healthcare, and unless you stop it, into your demise.
LiveInGilbert posted at 8:23 am on Fri, Mar 1, 2013.
So Rich - your proposition is to get rid of insurance and government? While at it's most basic form I would agree with you healthcare is a personal service between doctor and patient - and that insurance companies add no value to the process - I don't think the healthcare system, like most other major industries that have the potential to harm citizens without some form of regulatory oversight, survives and provides the needed, quality care without some form of government oversight and participation. And economically - without Stark and other anti-kickback statutes I can assure you the economics don't work - see my comment on the economics of healthcare previously.
LiveInGilbert posted at 8:26 am on Fri, Mar 1, 2013.
mnjcpa - not sure where you get your facts or math from but I and the CBO would disagree with your 7 trillion dollar comment. The CBO estimated that the Obamacare provisions to expand health insurance coverage will cost about $1.165 trillion over the next ten years, after taking into consideration $455 billion worth of penalty payments, taxes, and other effects on tax revenue and outlays. This doesn’t take into account Medicare savings (potentially hundreds of billions of dollars) and the like, only how much the coverage provisions will cost. While the net cost of the coverage provisions remains the same as the prior CBO report, there have been revisions in regards to how many people will be covered over the next ten years.
After the new revisions, CBO estimates about 12 million more people will be covered by Medicaid and 26 million more by those who buy insurance in the new exchanges. Seven million people will lose their employer-based insurance as businesses prefer to pay a fine than their employees’ health insurance, but overall, 27 million more people will be insured over the next ten years
Rich posted at 4:11 pm on Fri, Mar 1, 2013.
" I don't think the healthcare system, like most other major industries that have the potential to harm citizens without some form of regulatory oversight, survives and provides the needed, quality care without some form of government oversight and participation."
I do. Government participation is just incompetent meddling looking for power over citizens. It raises the cost, hikes up the danger and becomes, in and of itself, a killer. Our government is far and away too corrupt to be handed this kind of power and we are only placing ourselves in jeopardy allowing it. Government regulation has long past the point of diminishing returns, and makes most everything it touches more dangerous. Government has had too much power for too long and is incurably corrupt, as power corrupts.
mnjcpa posted at 8:44 pm on Fri, Mar 1, 2013.
LiveinGilbert - I don't have anything to add to Rich's comments, and in particular his last post.
Rich is right. Nothing the government touches is run efficiently or cost effectively. And if you really believe you can add 27 million more people to the rolls of healthcare with the government managing it and it NOT become a disaster then you've been seriously taking in too much Obama propaganda.
LiveInGilbert posted at 5:25 pm on Tue, Mar 5, 2013.
Guess it's good we live in a free country defended by our military - part of the government you both have such disdain for - to freely express our opinions and be able to vote on them. Our government surely isn't perfect and has much room for improvement - but it's a helluva lot better than most.
frank66 posted at 1:28 pm on Thu, Mar 14, 2013.
"We would all have catastrophic insurance to cover unmanageable expenses but otherwise pay for our care out of a tax-deductible account where we get to keep what’s left."
Why do we need ANY form of mandatory and conscripted "health savings account"? Why can't I be trusted to make my own decisions on what I spend my money on? The government is TERRIBLE at saving and investing money, as history proves. So why should I trust they won't waste my money away, like the have with the non existent, so called "social security trust fund", which is filled with hundreds of billions of dollars of worthless government IOUs???
Insurance is for catastrophic instances, and is the voluntary collective pooling of risk. So yes, this type of health insurance actually qualifies as insurance. But otherwise, eliminate most all 3rd party payments, and allowing individuals and their doctors to negotiate on service and payments directly. You don't use car insurance to pay for regular maintenance, and most non-accident repairs, so why do we think health insurance should be different? And stop stealing money from the current workers to pay for those who retired without appropriate savings. It's still theft.