WASHINGTON (Reuters) – U.S. House of Representatives Speaker Nancy Pelosi on Thursday ramped up her criticism of insurance companies, accusing them of unethical behavior and working to kill a plan to create a new government-run health plan.
“It’s almost immoral what they are doing,” Pelosi said to reporters, referring to insurance companies. “Of course they’ve been immoral all along in how they have treated the people that they insure,” she said, adding, “They are the villains. They have been part of the problem in a major way. They are doing everything in their power to stop a public option from happening.”
oh, but…she’ll still take their money
Pelosi Will Keep “Villains” Campaign Contributions
Blue Dogs Receive Surge In Contributions From Health Industry, Insurance Companies
LOL! Didn’t they say something about ending the lobbying hold on Congress back in 2006 when Dems tookover Congress? Yeah, how’s that working out? Hey, at least it’s Huffington Post reporting it.
Author of “Reparations and America’s 2nd Civil War
Reparations and America’s 2nd Civil War: Malensek, Scott: 9798864028674: Amazon.com: Books
I don’t know why the insurance industry is wasting it’s money on these Dems. It’s like the families of Iranians killed in the protests later being asked to pay for the bullet that murdered their son or daughter.
The latest Democrat call to the “Two Minute Hate”
Apologies to Curt for the double post/spam, but I inadvertently posted the following comment to the wrong thread; so I I’m reposting:
I had a college fraternity brother named Gary. He developed lung cancer. This presented abruptly, as a pericardial effusion (collection of fluid in the sac aroung the heart) in late June. Specimen came to us (I run a specialized cancer testing laboratory); tested “sensitive” to several drugs, including one in particular which has produced durable (as in years) complete remissions in other patients. One problem; Gary had no health insurance. Only Medi-Cal, which, in addition to not paying us anything at all, pays very poorly for oncologist-administered chemotherapy — barely break even to even money losing. Gary’s hospital admission was an emergency. He went to a very good private hospital (Mission Hospital in Mission Viejo). They couldn’t refuse his (emergency) admission. A private oncologist was assigned to his case. They drained the fluid off his heart and Gary felt better than he had in a year (I’m sure that he had been weakened for some time by the fluid on the heart, caused by tumor in the lining for the pericardium (heart sac). I told Gary, while still in the hospital, to be sure to have the hospital social workers who do discharge planning discharge him directly to the care of a designated oncologist (the oncologist responsible for his inpatient consultation). Otherwise, he’d be in the position of being a Medi-Cal patient trying to find a good oncologist in Orange County (good luck with that). So Gary made sure of this. He was discharged on Monday (I think, the 2nd of July) and given an appt with the oncologist on Tuesday (the 3rd). Had Gary had private insurance, he’d for sure have received chemotherapy that very week (Thurs or Friday) and oncologist would have made thousands of dollars. Instead, somehow oncologist found a reason to stall and stall and stall. Predictably, fluiid recurred over the next couple of weeks, while oncologist kept delaying, and, earlier this week, Gary needed another emergency admission. He died this morning, without ever having received treatment.
This is all relevant to the current health care debate. Opponents of a government, Medicare-style plan, scaremonger about “rationing.” What they don’t realize is that rationing goes on all the time. People with good insurance get treatment (including a lot of treatment which they don’t need). People without health insurance get treatment denied. It’s a different form of rationing, perhaps, but it’s rationing, all the same.
Now, it must be said that Gary was irresponsible for not having health insurance, but there was a contributing reason. He was self-employed, with a small printing business (he did all of our printing). He had a pre-existing condition, diabetes, which, by itself, consumes 1/3 of the total health care bill. Individually purchased, private insurance for Gary would have been prohibitively expensive, given his income level (ironically, Gary moonlighted as a contract funeral director — a job which he actually loved, but which paid peanuts — I think about $11 per hour).
Anyway, he died. Avoidable (or, at least, delayable) death. But a very cost effective death for the health care system. Efficient rationing of services.
– Larry Weisenthal/Huntington Beach, CA
Larry,
Very sorry to hear of your friends passing.
I would be curious to know what caused the Oncologist to stall. It makes me wonder how many un-insured patients he was given. Presumably, he needs some paying patients or else why practice.
I am sorry, but if the government can foul up a very simple program such as Cash for Clunkers, how in he world will they administrate a gigantic program? My problem with the whole health care issue is their approach. There is virtually no dialogue with the minority party. I don’t wish to get into the whole, well Bush did it also argument, but can’t they ask for an alternative program for the public to compare? The WSJ published an article about 2 months ago regarding the Tennessee Governor’s successful approach to a slice of uninsured folks. It sounded rational. BTW, he is a Democrat.
Larry, allow me to add my condolences to Tom on the loss of your friend. And it must be particularly hard when most indications are that it was an unnecessary death.
I agree that rationing already exists. However rationing is most prevalent in public health care, or among the non-insured. Why would this be improved by adding even more to the ranks of rationing?
I am struck by your comment:
It is my understanding government only pays 62-75 cents on the dollar for Medicare/Medicaid. The way private practitioners and facilities make up these losses is by transferring costs onto those with private insurance. If the government were the sole “insurer”, what makes you think you’d be able to break even or stay in business?
In fact, you might find yourself as a quasi-government employee, running a private non-profit facility that doesn’t leave you funds (save what the government wants to provide in grants) for state of the art lab equipment and R&D. If you can’t make money, how can your lab be instrumental in medical advances?
My biggest beef with this debacle being labeled “reform” is it does nothing to cut the costs to medical professionals (i.e. a wide battery of CYA expensive tests, tort reform and reducing E&O costs that make up approximately half of their business expense); supplies (i.e. competitive drug pricing); and facilities (needing to pay for expensive state of the art equipment, etal). Instead, they leave these problems that drive up costs, and plan on moving the nation steadily over to government plans that will… just as Medicare/Medicaid…. force medical professionals and facilities to accept less in their payment for services across the board.
This is a losing proposition, as we see with Medicare, Medicaid and VA all being on the brink of bankruptcy, as well as the model MA health care in the span of three short years since it’s implementation.
Mike’s A has pointed out often that you are noticeably absent in this health care debate. The most I think we’ve gotten from you was back in early April. And in this one you and I do agree that a single payer system is the worst, and a mixture of private/public was optimum… citing Australia and the Scandanavian systems as the model. I think I get the gist of your base beliefs… everyone should have insurance, doctors shouldn’t be greedy for compensation, and cheap drugs is the ticket.
Portability between states is an issue, especially for those who live in the states with the most mandates (MA, NY, NJ among them). But the 14th Amendment allows for states rights, and they decided to mandate insurance care for procedures other states don’t… thereby increasing the costs. So will the feds use the criteria of the state with the highest mandates as their base model? Or the lowest? If the latter, how does that play out with the 14th Amendment rights of the state? That should be an interesting battle, as soon as the states’ realize the feds are trying to usurp them.
Living with a mixture of private/public (on a federal level) is what we’ve been doing for decades now. As I said, the low payout on those public options contributes to the expense increases of the private options. It’s insane to think the cure is to put everyone on the public option. Just where will the operating losses by practitioners and facilities be made up? In forfeiting state of the art equipment? Treating less people?
You praise Australia’s system. It has a population of about 21 mil compared to our 307 mil. Needless to say, these social experiments are less catastrophic, or slower to fail, in small population centers (with the exception of MA, of course…). But all bets are off on just how well Australia will be weathering their own baby boomer onslaught into the system.
Then consider that the population of the US boomers is estimated at 78.2 million alone – almost 4x that of Australia’s entire population – this is one lousy time to *not* fix the cost factors, and instead add even more people to the public system.
It’s my suggestion that before we run willy-nilly into throwing the nation on the irreversible path to a single payer system, that all factors driving up costs first be addressed so we can see just how inexpensive we can make this via the private sector. You made the points of allowing insurers to be able to negotiate their drug prices, eliminating the high rates of unnecessary procedures and surgeries in the past. I fully agree with these. However the latter will not happen without tort reform, as most “preventative” medicine and surgeries are “cover your litigation arse” medical care.
You don’t believe this system will further discourage future medical professionals, who will have little ability to repay their educational costs and make a good living. I believe the way you put it was:
Well, your optimism is to be admired. In reality, what we seem to be short of are the general practitioners, and have an abundance of specialists. Specialty professionals get paid more, so more head into that field. (apparently not all agree with your idea that “it’s not necessarily a job for people who want to make a fortune”) However their higher return also translates to higher medical costs for the patient.
Right now, the average annual pay for a family practitioner is between $118K to $181K for those over 20 years experience. General surgeons average between $246K and $360K annually. Which direction do you expect most to go?
One begins to see Obama’s “big picture”. He wants the nation to pay for college so that he can cap their earning capacity after they are graduated…. whether it be wall street and corporate, or medical profession. It’s easier to accept $150K annually with you’re not saddled with $100K+ of student loans from 8 years med school before even getting to residency status. But this is a catch 22… In order to pay for all this, earning capacity must remain high. You can’t cut income abilities, and expect to continue to pay for all of this… where will the tax revenue come from?
Good comments, Mata/Tom.
Some brief, random responses:
There’s a huge difference between Medicare and Medicaid. Doctors/hospitals make very good money on Medicare. Not as much as they wish, but enough that they voluntarily remain in the program. Doctors and hospitals aren’t forced to take care of Medicare patients; it’s not like Canada. Everyone/anyone is free to opt out. (I am one of a very few number to opt out; it’s a long story which defies concise summary). Virtually all doctors and hospitals remain in the system, however — voluntarily. If they were losing money on Medicare patients, they aren’t forced to participate in Medicare.
Medicaid (in my state — Medi-Cal) is a different story. It’s administered by the states, not by the Federal Govt. State governments are the ones squeezing the doctors, not the Federal govt. The federal government gives grants to the states — it’s not nearly enough. This is the problem of the uninsured being a burden on the system. It’s why groups as diverse as the AMA, ANA, AHA, and even Walmart are supporting the current health care reform efforts — and why it’s being favored by state governments, as well.
The idea that there won’t be doctors left if you drive down their incomes is ludicrous. For all the whining about declining Medicare payments and increased paperwork (the biggest problem for the latter being private insurance and not Medicare), medical school applications have never been more competitive. In every country in the world, medicine is recognized as being a great job, and it attracts the best and the brightest (I’m an anomaly, I guess, based on the esteem which which I’m held on this blog :/ ) There are tons of really smart, dedicated people who are more than willing to take on all the educational debt and enter medicine, despite the declining income. My daughter will start med school at the U of Colorado one year from now; tuition about $55K/year; and she’ll have to borrow all the money. I agree that there’s an “imbalance” between surgery and primary-care, income-wise, but that’s the fault of a health care system which rewards procedures over cognition. In countries with more robust public health care systems, there’s less of a procedure/cognition imbalance.
Biggest problem is that health care is currently 17% of GDP, on the way up to over 30%. Our industries are less competitive and our state governments are broke. People like my friend Gary, who have to buy their own health insurance, are already priced out of the health insurance market, just as many people with good jobs never get to the point where they can afford their own home. As insurance premiums continue to rise by 30% per year, more and more of us are going to find ourselves having to choose between health insurance and other necessities, as in the case of my friend.
I’ll repeat some other stats:
1. The health care plan with the greatest consumer satisfaction is Medicare.
2. The health care plan with the least total cost (taxes + insurance premiums + patient out of pocket payments) is Medicare.
3. The health care plan which is associated with the fewest personal medical bankruptcies is Medicare.
4. No health care plan has produced better health care outcomes than Medicare.
5. Medicare would be even better if the GOP would support eliminating the prohibition of Medicare negotiating with pharmaceutical companies on prescription drug costs.
– Larry Weisenthal/Huntington Beach, CA
And let me add to the list that Medicare is virtually bankrupt. So if you’re trying to control health care costs, and this system, which pays out less to medical facilities and professionals than private insurers do, is bankrupt from inefficiency, just what’s your point with this shopping list of smiley faces? It doesn’t matter if the POTUS himself adores the public option… it still isn’t fiscally sustainable.
All the above is a US senior citizen, happy with a gold plate medical policy that covers almost everything, and little from out of pocket. But I’ll say two things here… most I know on Medicare also have umbrella plans that cover what medicare doesn’t. Absolutely nothing here, save #5, that has to do with cutting the costs that drive up health care. And while you’re at bashing the GOP on that issue, you might want to have a chat with your own party that clamped down on competition by increasing drug patent rights to 12 years. There’s no dearth of idiots in the halls of Congress… either side of the aisle.
Secondly, our seniors are a generation that has been paying into the government system and retirement benefits held out for their entire working lives. Just what has a 21-35 year old paid in? Frankly, I wish they had not withheld all that cash from me all my working life, and I could have used it better….
Lastly, I didn’t say there wouldn’t be doctors left. There will always be those who go in that direction. And speaking of ludicrous, nor can you use today’s applications… in a free market era… as what applications would be like under O’healthcare and single payer systems. Students entering med school today are still looking ahead at a free market income return. Until the sheeeeet hits the fan, we won’t know how many will still go in that direction, nor how many will fill the more needed tasks of the lower paid GPs vs specialists.
We are in agreement that the costs for insurance need to be brought down. We are in complete disagreement that a public option, which does absolutely NOTHING to reduce waste in healthcare, fills that bill. It will, instead, destroy healthcare as we know it.
Where does Medicare rank in terms of fraud and graft?
My guess is that there is a reason those issues weren’t included on the “peachy” list that Larry posted.
A major step in the right direction for this whole health care thing would be tort reform.
Another major step would be the implementation of “loser pays”. That would reduce dramatically the frivolous complaints that are filed.
Finally, why not allow small businesses, within the same business type/size, the option of banding together to form a larger buying group?
The restrictions on where people can purchase insurance plans are outrageous. Open up the market. Let the ‘invisible hand’ do its’ job.
Another Democrat gets and earfull….
They’re in summer recess. Time to give them a piece of your mind !!!!
Aye, Larry’s shopping list was from the perspective of the patient – happy to have most items paid for without reaching into his or her wallet. Again, I cannot stress more… this isn’t “free” government coverage. These seniors have been paying for this “privilege” since 1965 with our FICA taxes and changes to the SS laws. With over forty years of pay in, I’m certainly not going to suggest we do away with it, as it’s my (and any other rapidly approaching boomer) money down the drain. I often feel this way with SS. Frankly, I want my money back. They absconded it for over 40 years… and now, when it comes to being doled back out in dribbles… it’s bankrupt.
In that same vein, I certainly resent the idea that Medicare gets expanded to the 20-30 year olds who are only vested approx 4-15 years in what is already a financial loser. I assure you, the feds have more of my tax dollars than they do of theirs. I’ve paid for this coverage over and over and still am shy of qualifying for it at my age. Now they want to pass it out like Halloween candy.
Larry’s list was *also* not a mantra of Medicare fiscal efficiency… which is, of course, the entire reason we need reform. Creating a government policy and massive/inefficient bureaucracy is not going to cure that problem. If we can’t sustain Medicare by paying pennies on the dollar, then what makes these blithering idiots think we can expand it – in the era of massive baby boomers coming of “care” age – and it will be all right?
And BTW, Larry…. you say:
I’m not going to pass judgment on your own decision to “opt out” of Medicare patients. I understand it may most certainly be a matter of financial survival. Quite frankly, you’re not alone as many more private practitioners are opting out because of the low reimbursement rates and increased costs of paperwork and red tape. And yes, as a former Southern Cal girl, I am well aware that MediCal is not a fed, but state program. And I’m not clueless to the difference between Medicare and Medicaid as you seem to believe. But they are both federal programs, so I bring them both into play as examples of financial loser.
But I’m not specifically addressing the state run programs, although I’m sure you’re aware of the pickle MediCal is in, as well as the rest of your state.
But let’s go back to your statement which I bolded above. You are only half correct. Doctors are notoriously under reimbursed… thus the exodus. Hospitals “make very good money”?? That’s a stretch. By comparison to the primary caregivers, hospitals and specialists do get a better return. But profitable?
However the devil in the details nuance does bring into play that payback to doctors and payback to hospitals are two completely different critters. Is it a money maker being a Medicare hospital? No. Can some afford the break even or loss by being a Medicare facility (and thereby forcing doctors who practice there to also do the same…)? Yes… but ONLY by making up their loss on other services. And in fact, as Klein points out, Medicare reimbursement to hospitals is totally dependent upon their other financial services. ala are they profitable via other than Medicare services? In which case, they are under reimbursed. A “non-efficient” hospital is reimbursed more than an “efficient” hospital (efficiency meaning financial health based on private care income).
Which begs the question, what happens when there is not “private care” income and only public care income? Who’s going to make up for the losses?
Ezra Klein had an interesting article in WaPo at the beginning of the month about just this argument.
But first, let’s get rid of the argument that Medicare is profitable, if not “as profitable as they’d like”… the impression Larry left us with. And that might easily be portrayed via Ezra’s accompanying graph:
First disclaimer: the source data for Ezra’s above graph are not provided, tho Ezra is using much of Glenn M. Hackbarth’s testimony March 2009 in front of the House Ways and Means Committee for other fodder.
But what you can see is not unexpected. The only trick here is what is real “cost”, as how much of the service provided was waste (which STILL isn’t addressed on O’healthcare). Thus the “break even” line on which this graph is built is based on a system fraught with fraud, waste and the added costs of bureaucratic red tape.
Private insurers pay overall, allowing for profit. Medicare and Medicaid have been taking a dumb as the demands on the system with an aging population hit… not to mention the increased litigation for medical claims.
BTW… do notice that with a “public option”, no one can sue the government program for malpractice unless they have the bucks to go into federal court. I guess that’s a form of “tort reform”, eh? Reform that’s called “no recourse”. But I digress…
No, Virginia. There is no Santa Clause, and being a Medicare facility or doctor is not a money making proposition.
Another graph about whether Medicare is profitable… no. But addresses the difference in reimbursement between “efficient” and “non-efficient” hospitals.
But there is a reason for a hospital capitulating to Medicare service losses… and it’s called federal grants. Or, better explained as Congress holds hospitals hostage to medicare participation, using grant money as the ransom.
Larry
I am sorry to hear about your friend. But to say that he did not get insurance because he had a pre-existing condition of diabetes is ridiculous. He would have been covered for the condition he died of and everything else and after 255 days he would have been covered for diabetes. You did not say what stage his diabetic condition was in. If his diabetes was controlled by medicine or insulin the only costs he would have incurred was doctor visits, blood tests and testing supplies which I grant are expensive but he had to pay for these things without insurance so why not have it.
About medicare going bankrupt. I find it hard to believe that 3.2% of the salaries of everybody in this country with no limits or cut off amount cannot keep medicare afloat. That is 1.6% employee and 1.6% employer. And medicare is not free. Some $90.00 is cut from every recipient’s social security check. Add to that $165.50 Blue Cross supplement and I, myself, am paying %255.00 a month for health care. And as for medicare reimburing doctors, I get notices of how much they pay and how much Blue Cross pays. In my estimation medicare pays doctors 20% less than they bill and medicare refuses to pay for extra blood tests as if doctors keeping an eye on patients’ conditions don’t reqiure blood tests several times a year for serious conditions. I have read the doctors are no longer taking new medicare patients. What is going to happen when the boomers enter medicare and they can’t find a doctor to treat them?
You say there will be no shortage of doctors is this health care bill passes. Obama and congress have admitted their sources for this “perfect” system is UK and Canada. Did you not read about muslim doctors in UK trying to blow up Heathrow? UK has an acute shortage of British doctors. Most are leaving and doctors from third world countries are taking their places. The same thing will happen here. Oh, they will be required to take tests but when they fail to pass them these tests will be dumbed down until they can pass them.
Think about this. If medicare is scheduled to go bankrupt within 50 years after its start in 1965 and being run by the government what makes you or anybody else have any hope for this public health system not going bankrupt sometime in the future? It was in the news in the last day or so about a huge ring of criminals bilking the system and about 42 people arrested. Graft is the problem and until that is addressed it would just be carried over into this public system. Tort reform would bering the cost of health down but the democrats are in bed with the trial lawyers and that will never happen.
I have had several surgeries in the past few years and according to the medicare notices I get medicare does not pay the hospitals anywher close to what they bill and deny several procedures.
My post before the one above is evidently caught in spam.
Mata, the above is a very misleading statement. Medicare is going bust for the same reason that American health care in general is going bust. Monstrous inflation in medical costs, vastly outpacing inflation in the rest of the economy. So, yes, Medicare costs a lot more than it was projected to cost, but not because of government inefficiency. Simply because of medical inflation.
But here’s the relevant statistic, which Mata does not address:
In terms of the TOTAL cost of providing health care, i.e. TAXES + INSURANCE PREMIUMS + OUT OF POCKET PAYMENTS, Medicare wins the prize for cost effectiveness, hands down.
You can pay taxes or you can pay insurance premiums. It so happens that your taxes buy more health care than do your insurance premiums.
Once again, patient sastisfaction is higher with Medicare than for private insurance and there is a significantly lower rate of personal bankruptcy for medical costs of equivalent conditions.
Once again, Medicare controls costs by offering to pay providers less than they’d like to be paid. But providers don’t lose money by providing care to Medicare patients. Those that do lose money, drop out of the program. But there are plenty of providers who do participate. Including the best hospitals and the some of the best physicians in the country. In fact, Medicare patients have a vastly greater choice of providers and hospitals than do patients with any of the major health care plans.
Providers bellyache, because they don’t make as much money as they’d like to make. But they still make enough money to make their continued participation in Medicare worthwhile. And the overall quality of care provided to Medicare beneficiaries remains unsurpassed.
I challenge this statement. None of the 5 health care proposals under consideration and debate is anything at all like the British system, much less the Canadian system, in which it is ILLEGAL to provide private medical care outside of the government-administered system. In contrast, in the case of Medicare (and in the case of all the 5 proposals under consideration), physicians are perfectly free to work outside of the government-administered system (me being a case in point), and patients are perfectly free to seek care outside any proposed public system.
By the way, the most admired Canadian Prime Minister in history is Lester Pearson, the father of the Canadian health care system (which no one other than Dennis Kucinich is promoting). And fewer than 10% of Canadians would agree to junking their system in favor of a US-style system.
The best health care systems are those in the Scandinavian countries, Germany, and Australia, in which there are co-existing public and private systems. The private systems are less expensive than those in the USA, as the public system does, indeed, provide competition. But the private systems do manage to continue operating and operating profitably.
– Larry Weisenthal/Huntington Beach, CA
Larry, INRE your comments:
Projecting actual costs for public care seems to be a chronic problem… i.e. MA, TN, etal. No to mention they not only shortchange the figures, they also seem to ignore the aging population that is changing over rapidly to health care they have been paying into since 1965 atop the private insurance we need in the meantime. In other words, all of us… some more than others… have been paying out both ends. And *still* it’s bankrupt.
I have no argument with you that it’s bankrupt for rising costs, Larry. My point is that virtually no where in the House/Senate/Obama plans, save central records (which may be a privacy risk) is any remedy for the rising costs. As I’ve said repeatedly, this is my problem with the “reform” that is no reform at all.
You’re talking gold plate insurance coverage… where the patient pays nothing. Very convenient, but also a contributor to the rising costs of coverage. Not to mention the state mandates that also add to the cost for misc procedures from cosmetic surgeries to acupuncture and chiropractic (the latter of which I am a HUGE fan of).
Were the simple visits to doctors for preventative and basic check ups not padded with additional red tape accounting costs for insurance (and covered via tax exempt health care accounts), and insurance confined to the catastrophic insurance, we might have a chance. Oh yes, eliminate the middle man of mandatory primary visits just to *get* to a specialist, and get rid of the frivolous law suits that drive up costs and E&O insurance, and… you get the drift.
I repeat, since 1965, we have all been doing both (if you have private health insurance). FICA is your Medicare for the future. Your payments for private insurance are for your current under senior age. We have been paying twice. And frankly, my FICA hasn’t returned twat since I’ve been paying in.
INRE the statement you challenge about the models being the UK and Canada… that’s not my statement, but from BarbaraS. So I shall leave her to respond herself. I agree with you that that is an incorrect statement. The model for the current BS running thru Congress is Romney/Kennedy’s MA health care system. And that is a model in financial straights, cutting off coverage to 30,000 legal green card holders in order to stay a’float after only three years. They have had to “ration” because they are broke. Again, because no one actually addresses what genuinely drives health care costs up.
All in all, I agree with you, Larry, that a combo private/public system that actually reduces the waste, bureaucracy, and unneeded procedures done for litigation protection is a good plan. Unfortunately, that doesn’t resemble any plan in the halls of Congress today.
Mata, I guarantee you that your graph/chart, purporting to show that doctors and hospitals lose money on Medicare is cooked data. It’s not credible. Medicine is too much work to do and not get paid for it. I know lots of docs who don’t participate in Medi-Cal. I don’t know anyone, other than plastic surgeons and other esoteric practices (such as my own) who don’t participate in Medicare. If/when Medicare ever stops being profitable, doctors will leave it in droves. We are nowhere near that point now.
You don’t sue government programs and you don’t sue health insurance companies for malpractice; you sue providers. Medicare providers get sued by Medicare patients every day and the lawsuits do not have to take place in Federal court.
In terms of suing to get compensated for denied claims, it’s much easier/cheaper for a patient or provider to appeal to and/or sue Medicare than it is for a comparable problem with a strictly private insurance company.
Vastly less in the way of pre-authorization headaches; vastly more flexible with regard to paying for off-label indications of expensive prescription drugs, etc. Vastly greater choice in providers and hospitals. Vastly cheaper overall (including all costs: taxes, insurance premiums, out of pocket payments, and “fraud”). Fewer personal banckruptcies for non-reimbursed health care costs. Greater consumer satisfaction.
Examined from any angle you choose, Medicare is the best major health care program in America.
– Larry Weisenthal/Huntington Beach, CA
Larry, as I said with my disclaimer, Klein does not disclose the source of his data. But reading his article, it is a combination of Medicare payouts to both doctors (lower) and facilities (some at cost or above/below) averaged out via the March testimony of the chair of the MedPac. I’m going to have to give more weight to that chart (from a source who is also pro-public programs, BTW) than I do what doctors and hospitals you personally know. You are most likely very well connected, but your personal contacts dwarf reality in overall perspective.
Facts are, per you, your buds participate in Medicare. But I’ll wager big bucks that they also have private clientele. What they lose in Medicare reimbursement, they make up in private insurance billing.
So why don’t you qualify how many of your friends make their living solely off Medicare patients, and get back to us?
Larry, under O’care, the government *is* the provider/insurer. You’re speaking of malpractice by individual medical professionals and facilities, and not lawsuits based on nonpayment for services rendered. These lawsuits will need to be filed in federal courts.
Disagree respectfully. It is only “the best” from a patient’s POV because of minimal out of pocket expense. Upon the nation, it is a financial albatross around the neck… and only getting heavier daily as the boomers approach cashing in on a system they’ve been paying for since 1965.
Mata, I assure you that this is not true. Simply not true. Tons of docs don’t see Medicaid patients. They all see Medicare patients. Medicare is not only profitable, but it is highly profitable. It’s just not as highly profitable as providers want it to be. And there are tons of providers who’s practice largely consists of Medicare patients. Geriatricians. Cancer doctors. Many cardiologists. Virtually all doctors who live in the butterfly ballot portion of Florida. On and on and on.
Here’s from a Washington Post op-ed. I just now did a Google search on “medicare profitability.” Basically, the writer explains things the same way that I just did:
http://voices.washingtonpost.com/ezra-klein/2009/06/does_medicare_work_by_dictat.html
Your chart and data, Mata, are simply not credible.
What you fail to address is the following:
Given that us aging baby boomers (including you and I) need Medical care, what is the best and most cost effective way to provide it?
What system costs more (TOTAL COST, including TAXES, and INSURANCE PREMIUMS, and OUT OF POCKET EXPENSES, and “FRAUD”)? Purely private health care or government administered Medicare? Answer: Medicare, hands down.
Which system offers greater consumer satisfaction? Medicare
Greatest choice in providers? Medicare. Greatest choice in hospitals? Medicare.
Fewest personal bankruptcies from out of pocket costs? Medicare
Less total cost? Medicare
Unsurpassed quality of care? Medicare
Least delay in receiving tests or surgery or other services because of preauthorization needs? Medicare.
Greatest flexibility in paying for new services and off-label indications of drugs? Medicare.
Ah, but here’s the rub. The Medicare non-payment appeals process is more transparent and, when it gets to the lawsuit stage, Medicare has a nifty, cheap, simple system based on Administrative Law Judges, which are lacking in in the state court system.
e.g. http://www.hhs.gov/omha/
Many a beautiful theory is ruined by an ugly fact. Medicare beneficiaries have fewer complaints about their health care coverage than do patients with purely private health care contracts. Significantly less need to sue in the first place. And, if they do need to sue, it’s easier, faster, cheaper.
– Larry Weisenthal/Huntington Beach, CA
Larry, don’t you find it ironic that you quote/reference a link from Ezra Klein (WaPo economics guy), and it is *HIS* chart (not mine) that you don’t find credible?
As a matter of fact, the very article you that cite is the predecessor to the article I used with the two charts in response to *your* article. Your referenced article led to a response by Shadowfax, a Pacific NW doc who blogs at “Movin’ Meat, who contended that Klein was way wrong on the profitability.
Klein then came out with the article and graphs I used (linked above) in my response to you, Larry… where he says that the private practitioners/doctors do indeed take a loss, but hospitals recoup via “cost”… but that the “cost” baseline is somewhat skewed based on padded prices.
Therefore Klein’s chart is the response to your referenced article and a rebuttal. Weird how that stuff works out, eh? Read the sequence between the boys and you’ll get the gist. Me? Already been there, done that.
INRE this:
First of all, let’s try to stay on the same page, Larry. You keep talking about health care from the patient’s perspective. I’m talking about Medicare from the taxpayers and national economic perspective. Hell… give me everything possible for free, or as little as possible, why wouldn’t I be happy? This is the place from which you continually post over and over. Step outside the box into reality for a bit… like into the world of national fiscal responsibility??
INRE what *I*, as a patient (not a taxpayer) want, Larry… I’ve already paid all my life into Medicare. I most certainly want my benefits that are prepaid, guy. I say again, I have no problems with Medicare from a patient’s level.
However fiscal reality has a problem with Medicare since the low reimbursement and chain of events for care (plus litigation prevention with overtesting, etal) are not cost effective for the nation’s health expense expenditures. You keep confusing the two in your mind…. that is, how we, the patients’ view it vs how we, the taxpayers, view it.
As a taxpayer, there is the efficiency factor and cost to the taxpayer at a loss. And that “loss” part is apparently something we’re going to have to battle about for awhile yet. You still think it’s profitable, but still haven’t told us if any of your doctor friends treat ONLY…. shall I repeat that?… ONLY Medicare patients and no private insured clientele.
I don’t know how often I can repeat this. I have no problems with health care reform for runaway wasteful costs like tort reform, packaging small businesses and individuals into group plans, getting rid of the paperwork bureaucracy that gets in the way of logical care, dealing with different state requirements for covering extraneous procedures, etc.
None of the above are being dealt with in the House or Senate proposals. They are nothing more than a step to single payer coverage that mandates every employer provide health insurance or be fined, and that private insurers must compete against government plans who pay out at a lower rate than the private companies can…. meaning it will only be a matter of time before they are out of business and “Medicare”, running at a loss for the medical industry, will be the only thing left. ala welcome to UK/Canada/US health care.
Now, INRE you reference to the Admin Law Judges… this deserved it’s own response.
Your business is cancer research. Mine is real estate. And let me divert for a moment to give you a perspective you may not have thought about on the Admin Law system. Built into every real estate contract in (perhaps) every state’s contract is a waiver of your right to a jury trial in the event of dispute. It’s called arbitration/mediation. The Admin Law system is built on the same concept.
If you have a Medicare lawsuit, you go thru a similar process and no jury by your peers trial is possible. It is settled in much the same way where an authority hears your oral arguments (or in some cases, as the website says, you don’t even have those…) and makes a decision that is final with limited appeal.
Do you understand that if you have something other than a frivolous case, this limits your legal recourse with a public plan? This is *not* the tort reform I had in mind.
Larry, from your Medicare comment on the Cash for Clunkers thread…. bringing it here for a more complete archive.
Yes… however that is not how the House/Senate plans have health care set up for the future in their bills. Medicare will be replaced by a government run plan, funded by a “trust fund” that they will rob for something else, as they usually do. So if you’re a huge fan of Medicare, you’d better start battling to hang on to that… because it’s going buh bye.
Mata, my reply to # 17 went to spam.
– larry w
Bailed out two for you, Larry…. Mata
Why is it that, somehow, in Norway, Sweden, France, Germany, Australia, etc. there are robust, competing public and private health care systems. Medicare payments are generous, in comparison to government payments to providers in the above countries. So Medicare expenses are higher than are the expenses in these other systems. Yet, somehow, the side by side private systems manage to remain in business in these foreign countries and give health care consumers private options. Are American private sector physicians and hospitals so unable to compete?
It’s all exaggerated scaremongering and misinformation. Just read all the misleading comments on this blog. Wild claims of out of control costs, which are blamed on the government, as opposed to putting the blame where it belongs, on the for-profit health care insurers, on the providers, on the pharmaceutical companies, on the hospitals, and on the explosion of new technologies and drugs.
As I see it, Mata, you are digging in mainly on the narrow issue of whether or not providers actually do lose money by providing services to Medicare beneficiaries. If the providers lose money; they don’t need to participate. If they continue to participate, it’s because they voluntarily choose to do so. They can opt out. If too many opt out, then Medicare will have to increase its reimbursement levels. Medicare is trying to control costs by squeezing providers. If it cuts reimbursements too much, then it won’t have providers. It’s not that different from other forms of mass market economics.
– Larry Weisenthal/Huntington Beach, CA
sigh… Larry, read the bills. They are not set up to emulate Australia, Germany or other countries. Just because they are called “medicare” in other countries doesn’t me they are constructively the same. The House/Senate have different mandates demanding every employer provide health insurance (private while they exist, or public) or be fined. They are set up to drive the private insurer out of business.
You call my (and others) digging in the “narrow issues” of fiscal loss “scaremongering and misinformation”, yet this entire bill is supposed to be about savings. And there are ample economists and medical experts that echo my words. I, and those here on FA, are not the lone voices in the desert here.
You are correct that if private providers lose money, they need not participate. Indeed, they will cease to exist and a single payer system… which even you do not support… is all that’s left.
The disinformation is all on your side because you simply refuse to read the bill and it’s specifics, and go on “just words” instead. This is a mentality that our nation cannot afford to tolerate.
The administrative law judge is simply the third step in a 5 step appeals process. The final (5th) step is, indeed, a Federal court (which can be trial by jury). My point is that the Medicare appeals system is easier and much more transparent. The A.L.J. step is independent, easy, cheap, and accessible. There is rarely a need to go all the way to a jury trial. In any event, as I keep saying, overall consumer satisfaction is higher for Medicare than for the private health plans.
With regard to the dark threats of a Canadian style, single payer system, anything is possible, twenty years down the road. But there is absolutely no current support for a system which would grant a Canadian style government monopoly of health care. Zero (outside of Dennis Kucinich).
Let’s talk mandates, since that’s the latest thing you bring up. They have been reasonably effective in Massachussetts.
http://blog.taragana.com/n/massachusetts-home-of-nations-most-ambitious-health-care-law-offers-reform-dos-and-donts-119400/
[aside: I really like it when bloggers and commentators use URL addresses, rather than simply turning a word or phrase into a link; from reading the URL, one gets a good idea of whether or not one wishes to invest the time in jumping to the link; without a listed URL, one has no idea where one will end up, cyberspace-wise]
– Larry Weisenthal/Huntington Beach, CA
@openid.aol.com:
No, not quite.
Barney Frank is one of many who supports single payer. He is also one who admits that this current move regarding health care is just one step on the road toward single payer.
Roll the tape:
Hmmmm….seems even the guy you voted for last November is a single payer proponent.
Roll the tape:
The American People are being purposely deceived in this health care debate.
Roll the tape:
[In the interest of a complete archive and coherent discussion I duplicated this response from the clunkers thread.]
@ Larry
I posted this in The Cash for Clunkers Thread, (sorry again for that Mike).
New York Times, Doctors Opted out of Medicare So I believe you’re mistaken there Larry. Doctor’s don’t seem to be as happy with Medicare as you indicate. I would love to see a system where everyone is covered, doesn’t increase the deficit, doesn’t allow the government to infringe on the people. I read a long report about how great the Israeli plan is, at the behest of Fit fit. It’s not that great. I also read a long report about the plan the Netherlands has. But even the Netherlands agree that they have a problem with too few young people and too many old folks. Plus, as Mata pointed out, we have way more people than either of those countries.
Your friend made a money based decision not to purchase insurance. I too offer my condolences. But people do that everyday. A huge amount of people choose not to purchase life insurance and end up leaving their families with major financial burdens. Do we mandate coverage and reform for that next?
Obamacare explained
That all depends on what you, a more affluent American, would consider “easy, cheap”, doesn’t it? Any litigation, arbitration/mediation procedure entails legal costs that are not “easy, cheap”. Most of the reason people don’t use the judicial appellate process is the sheer costs of continuing the fight. Most judges and prosecutors actually depend on the plaintiff running out of cash before ending the court battles. So when you say there “is rarely a need to go all the way to a jury trial”, much of that may be entirely due to the legal expenses out of pocket by Medicare patients who don’t have the cash to play the litigation game.
Reasonably effective?? Obviously you missed my July 18th post about MA, desperate to become solvent after only three years, denying benefits to 30,000 *legal* green card holding immigrants.
Jacob Goldstein at the Healthcareforall website also disagrees with your notion of “reasonably effective”.
Warner Todd Huston also had an article appearing on PubliusForum that focused on the failure of the MA system… THE model for this plan.
On a segment with Glenn Beck, Sally Pipes of the Pacific Research Institute laid out a few MA facts.
The NY Times’ Kevin Sack reported on their “day of reckoning” in March 2009.
Well, it didn’t take that long since, as I pointed out in my July 18th post, they took the “significant steps to arrest the growth” of spending by denying coverage to the green card holders… the very people that are supposed to benefit from these plans. Kennedy, along with Mitt Romney (one reason I can’t abide him as a conservative candidate) came up with this mess, and it’s fall into financial woes even beat out the fall of the TN health care system, which took more like a decade to get to the breaking point.
As a matter of fact, the only one speaking of the MA health care plan is Romney himself in his July 16th op-ed. I had to gasp at the chutzpah of what he said about that plan, vs reality. He points out that the MA health plans don’t rely on a public option which, as he said, “…. would inevitably lead to massive taxpayer subsidies, to lobbyist-inspired coverage mandates and to the liberals’ dream: a European-style single-payer system.” But here’s the big laugh…
Apparently, Romney has been on the road too long, and is way out of touch with fiscal reality in MA.
One last thing:
Whether you want to “invest the time” in jumping to the link?? I provide links (and generally a summary of info from that link) so that you can read to clarify my summary point further. If you choose not to read the source material, then you are missing the data from which I derive my opinions. But that’s your choice.
However I choose not to put a URL because it breaks the flow of the sentence and the point I wish to make. And you will also find that I generally provide the source in the highlighted link so that you *do* know where you will end up in cyberspace. But I’m sure there are many sites with which you are not familar, and it would behoove you to check them out as you might find them a valuble addition to your bookmarks on particular subjects.
As for me? I almost always check out the links so I can further understand where the commenter is coming from… even when they are Huffpo.
Larry:
(emphasis added)
Response: The taxes collected are from the WHOLE of the taxpayers, not just taxes paid by the Medicare subscribers. The total revenues collected and costs per Medicare subscriber are greater than or equal to those paid by private insurers. If Medicare was open to everyone, there would be more recipients than premium payers. Reimbursements would then go below costs or there will be rationing.
Mata:
That’s 62-75% of that BILLED, not 62-75% of actual costs, certainly not of marginal costs. We still have some semblance of a free market. If Medicare wasn’t profitable, providers would opt out of the system. They are not forced into it.
Eventually, there will be single-payer in this country, not because the liberals push for it or manipulate for it. Rather, it will be because of the lack of vision of the free-marketeers and the private sector.
Sure, the liberals have unrealistic expectations of free health care by right with no or small deductibles, copays and out-of-pocket maximums covering everything available to everyone regardless of willingness to pay. But conservatives, libertarians, free-marketeers and private insurers regard the health care issue as a nuisance issue, favor the status quo hoping the issue will just go away.
Instead of offering realistic workable alternatives of their own, they concentrate on attacking proposals put forth by the liberals. Yet there are very real problems with health care in the U.S., not the least of which is the inability to provide any protection against rises in insurance premiums if a person acquires a medical condition while covered by a health insurance policy. So that even if a person takes self-responsibility and willingly pays for health insurance, one can be priced out of insurance protection due to the “Spiral of Death” of health policies if one acquires a health condition. See http://en.wikipedia.org/wiki/Death_spiral_(insurance) If one acquires a condition while working for an employer, then one may become uninsurable as well.
Unless, free-marketeers or the private sector can offer workable solutions to very real problems, there WILL eventually be some kind of government-run health insurance, most probably single-payer in the long term. In any competition of ideas or solutions to real problems, the one who offers the positive solution has the advantage. If one party offers solutions, even if badly flawed, and the other merely attacks the proposed solutions, the one who offers solutions will win.
If single-payer in all of its ugliness ever comes to the U.S., the conservatives, libertarians, free-marketeers and the private sector will have no one to blame but themselves — for lack of vision and failure to offer a workable alternative.
@ Bruce D
See New York Time article in post 27, providers are opting out.
House Republicans Offer Healthcare Alternative Of course their alternative might not be a “realistic workable alternative” in your opinion, what it is in my opinion is what healthcare reform should be. Keep what works, fix what’s broken. Also, the republican plan offers something no liberal plan out there offers, which should be essential to any reform; TORT REFORM! Funny how the left seems to leave that out, huh?
Bruce D, we agree on most of your comments, but I still have to disagree with you (and Larry) about Medicare being “profitable”.
First, as both Aqua and I pointed out with the NYTs article, more and more providers *are* opting out as the annual Medicare cuts continue. I also backed that up with national data on another thread via an ABC news article at the beginning of July.
You can also add to that a MA hospital lodging a lawsuit against the state of MA, the model for this healthcare plan in many ways, for them having to eat most of the expense of care for the poor because of Romney care. If Obama care comes around, we won’t have that ability of legal recourse, because Congress cannot be sued… only members of the Executive branch.
As I said, show me a hospital and/or medical practitioner who’s business is supported *solely* by Medicare patients – and hasn’t been sued for attempted fraud in Medicare reimbursement – and I might admit that Medicare *may* have the possibility of being profitable. But I’d have to look and see if he (or the hospital) is cost shifting some of their overhead costs to services or product elsewhere… ala selling some product out of the office aside from practicing medicine, making cash off an in-house acupuncturist tenant, etc.
I will again point to my comment #10, with the chart from WaPo’s Ezra Klein to point out that Medicare barely pays cost, and most often come in below. This is why there is cost shifting in the industry, making up the (perceived or real) profits on the private insurer.
As I mentioned to Larry – who dissed this chart as bogus based on his personal group of acquaintances instead of national figures of payments to practitioners and hospitals – Ezra doesn’t cite the origin of this charge, but his article and figures are based upon Ways and Means Committee testimony of Glenn Hackbarth, the chairman of MedPAC, this past March.
I have since, however, found a source with a chart of similar data in a 2003 abstract on cost shifting and medicare by Jason S. Lee, Robert A. Berenson, Rick Mayes, and Anne K. Gauthier. That differentlyl formatted chart (on page 3 of the PDF) reflects the same data, but only up to 2000 instead of thru 2008, as the graph above extends. I have far more faith in this reflection of payment, as it relates to “cost”, than I do Larry’s personal poll among his peers.
Klein may be saying the same thing you are trying to say… ala it all depends on what you consider “cost” as the baseline.
Cost shifting is, however, an economic reality. It does require that a service provider (ala hospital or doctor) have relative market power (little competition) for it to work. When you are one of only a few community hospitals (they aren’t on every corner like a Starbucks…), you do enjoy a certain amount of market power to shift the Medicare payment losses onto the private insurer.
However some HMOs refuse the attempts at higher payments anyway. This means the hospitals… who may already be trying to charge top dollar to the private insurers… continually go into the financial arrears with the Medicare payment shortgage.
Doctor have less power for cost shifting because there is more competition. If they try to increase their costs to the private insurers, they can always run down the block to another GP who may not shift costs quite as much. But I’ll wager the private insurer pays considerably more for the same services and treatment as the government pays out for the Medicare patient.
And therein lies your incorrect reasoning to your correct outcome of a single payer system. There is no “lack of vision” by American entrepreneurs or indeed, we would not have become that nation that we are rapidly becoming a shadow of under this one party regime. However all the vision in the universe cannot compete against a government who uses the taxpayers to undercut the private competition in payout.