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1. In a true market economy, there are limited barriers to the entry of new vendors.
Reality: When I went to medical school, at the University of Michigan, in the early 1970s, there were 225 students in each entry class. Today, there are 170, and this is representative of what has happened on a nation-wide basis. In the late 70s/early 80s, organized medicine feared a “doctor glut” and admissions slots were drastically scaled back, again, on a nation-wide basis. There are enormous barriers to entry, among them, a single “B” in organic chemistry – virtually. Never have medical school admissions been more competitive. There is no way to increase the supply of doctors which will not take 15 years (much easier to cut back admissions than to increase admissions and medical training averages 9 years — 4 years of med school/5 years of residency ), save for dramatically easing the restrictions on immigration of foreign medical graduates.
2. In a true market economy, the “buyers” understand what they are buying.
Reality: 80% of people love their health insurance. Why?, because their employers pay for it and because they are happy to get free pap smears and mammograms and ER visits and payment for many costs of prescription drugs. But this is all small potatoes stuff; people don’t even need health insurance for this stuff, anymore than they need insurance to purchase food or pay for automobile and home repairs. You need health insurance when you come down with acute leukemia or Steve Jobs style liver cancer. Only then do you realize how inadequate most health insurance is. The prior authorizations (not required by Medicare, by the way) drive you and your doctors crazy. Private insurance often won’t pay for cutting edge (“off label”) indications of new drugs (Medicare more often does). You can’t go to an out of state cancer center (with Medicare, you can). You have a lifetime limit of benefits (often as low as $1 million), which can and does run out, long before the end (Medicare doesn’t have such a limit).
The rest of the story, I’m sure that you know. The current system rewards doing procedures — providing treatment, doing diagnostic tests, doing surgery, with much of this being entirely unnecessary and running up costs. Many conservative bloggers have grotesquely misrepresented Dr. Emmanuel’s JAMA article, comparing US and foreign health care systems. It has been stated that “over-utilization” is on account of more upscale facilities, creature comfort wise. But overutilization is mostly about unnecessary and even harmful procedures and tests.
The system which makes most sense is the system they have in France, world’s number one rated health care system. A “base” level of government-paid and regulated (though provided by private doctors and hospitals) health care. And the freedom to purchase supplemental private insurance, for anyone worried about “rationing” or waiting in line or other such bogeymen.
Facts are that Medicare produces the highest level of consumer satisfaction of all the major medical plans; costs the less; and results in the fewest personal bankruptcies.
Where is the example of purely private health care which works? Health care doesn’t play by the rules of classic economics. Turn over the responsibility for police, fire, public health, and the military to the purely private sector, and all would cost more, provide less consumer satisfaction, and do a worse job (imagine a police CEO responsible to shareholders and not the public).
What I’d add to a French style system would be tort reform, expansion of medical schools, and easing of restrictions on immigration of foreign medical graduates.
Larry, you and I are not that all far apart on some items. Just some conclusions… those being:
1: Yes, health insurance is over used and people expect free care when they run to the doctor for a sniffle. The different cures we see is that I’d like a tax benefit medical account for the general care, and insurance for the catastrophic…different tiers for different “catastrophes”, of course. One for the cancers and long term expensive illness, and another for the less serious but still time consuming healing time for broken limbs, etc.
2: Medicare may be “wonderful” in some instances you mention, and not so “wonderful” in others. However you miss the base point that Medicare is absolutely bankrupt and on the verge of destruction. This when every working American who pays FICA taxes can’t support even the senior percentage draining the system now, So putting the nation on a similar program, is a recipe for disaster.
3: You don’t need to add “to a French style system” tort reform since the French have no malpractice legislation and also pay for their doctors tuition. And oh, BTW, none of these bills resemble the “french style system”. You may pine for it it, but you must eventually recognize what you want, and what Congress has constructed, bears no resemblence to each other. Also, if you decide to pay future doctors’ tuitions, and support the proposed slashes to Medicare reimbursements, are you not leaving several generations of doctors and their educational expense out in the cold?
And oh, BTW… when will you decide to again opt in as a Medicare participant to your own services, being that it’s so wonderful? You have to realize, all that you say has absolutely no credibility since you have been honest and forthright enough to admit that you opted out as a medical practictioner over a year ago.
And hey… weren’t you telling us how there were barrages of those entering med school? Now you’re here telling us that the admissions are too stringent and we have less that we did before? Pick a stance, and stick with it please… or explain why you are doing the 180 for us.
Like I’ve posted elsewhere…they get one foot in the door, if anything passes, we will be eventually fried in this country….Nationalized Health Care will eventually be the govt. take over, it is the leftists agenda, they will do it one step at a time over the years.
NO BILL is a GOOD Bill with this administration/congress-critters.
The Public Plan Option. The House health reform bill includes a public plan that will be administered by the federal government and “compete” with private insurance plans. However, premiums in the public plan will be at least 10 percent lower and more likely 20-25 percent lower, on average, than premiums in private plans.[3] – this is why we have no successful private insurance – lets get rid of unfair tax laws and give insurers the change to build their business.
In fact, the Lewin Group, a non-partisan health care consulting firm, more recently estimated that when fully implemented, the number of enrollees in the public plan is likely to be 103.4 million, and an estimated 88.1 million of these enrollees would be shifted out of their current employer-based coverage.[4] Between Medicare, Medicaid, SCHIP, and a large enrollment of Americans in the new public plan, the government could control the health care of well over 200 million Americans.[5]
This would move American health care closer to President Obama’s once-stated preference for a single-payer system. According to the legislation, physician participation in the public plan would be “voluntary.” However, as physicians know from the managed care experience, non-participation in a plan of that size would not be a practical option for most physicians.
Physician Payment Methods. More troubling is the congressional plan to replace the current doctor payment system with the Medicare Economic Index (MEI), which attempts to estimate inflation in the costs of providing medical services. However, the MEI was implemented in the Medicare system in the 1970s, did not reduce Medicare spending, and was abandoned.[6] There is no reason to believe it will be any more effective this time around.
Misplaced Value Incentives
For decades the government has tried to control spending in Medicare by deciding what benefits patients should receive and setting the price for more than 7,000 individual services. Obviously these efforts have been entirely unsuccessful. Congress has so far failed to recognize that cost, as well as quality of care in the health care system, is driven by decisions made by individual patients and their doctors. To contain costs, the incentive structure needs to be shifted to the individual level.
Congress should provide broader flexibility to states while still ensuring that clear benchmarks and performance measure are met. States, in turn, should build on the concepts in the Florida and South Carolina proposals and work to integrate market-based ideas into the Medicaid program.
@openid.aol.com/runnswim: Do tell us “dummies” what government programs have EVER delivered on their promises and done so at what they were initially projected to cost.
It would seem that the only “dummies” here are the people that somehow think that this massive new complicated government power grab is miraculously going to work perfectly and at the projected cost with no negative consequences.
The French system pays their doctors about sixty percentof what docs are paid here in the States. They have no malpractice laws, yet their system is still going broke.
When Laure Cuccarolo went into early labor on a recent Sunday night in a village in southern France, her only choice was to ask the local fire brigade to whisk her to a hospital 30 miles away. A closer one had been shuttered by cost cuts in France’s universal health system.
Doctors, trade unions and others have called national protests against French health-care cutbacks this year. One petition signed by prominent physicians said they feared the intent of the reform was to turn health care into a ‘lucrative business’ rather than a public service.
Ms. Cuccarolo’s little girl was born in a firetruck.
France claims it long ago achieved much of what today’s U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.
In recent months, France imposed American-style “co-pays” on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses. “A hospital doesn’t need to be money-losing to provide good-quality treatment,” President Nicolas Sarkozy thundered in a recent speech to doctors.
And service cuts — such as the closure of a maternity ward near Ms. Cuccarolo’s home — are prompting complaints from patients, doctors and nurses that care is being rationed. That concern echos worries among some Americans that the U.S. changes could lead to rationing.
The French system’s fragile solvency shows how tough it is to provide universal coverage while controlling costs, the professed twin goals of President Barack Obama’s proposed overhaul.
French taxpayers fund a state health insurer, Assurance Maladie, proportionally to their income, and patients get treatment even if they can’t pay for it. France spends 11% of national output on health services, compared with 17% in the U.S., and routinely outranks the U.S. in infant mortality and some other health measures.
The problem is that Assurance Maladie has been in the red since 1989. This year the annual shortfall is expected to reach €9.4 billion ($13.5 billion), and €15 billion in 2010, or roughly 10% of its budget.
We started all this back then, including the content of the Lewin Group report which I linked. A discussion you abandoned since I was headed to Florida. I might point out that I said I could check in… yet you never returned.
I suggest we have unfinished business there before you start all over from scratch here.
Skye #5: you are linking to state administered Medicaid… a completely different critter than federally adminstrated Medicare. What they share in common is that they, too, are bankrupt.
Good comments, Skye, Mata, and Aye. Mata, are you back on the FA beat, full time? What was the thread on which we were talking before you had to travel? I’d like to continue that, also. If everyone will continue this discussion on the current high level, I do believe that progress can be made. Back when I’ve got the time. – Larry Weisenthal/Huntington Beach, CA
I think I’ve made it clear that my preference is for a French-style system, consisting of (1) independent, private practice doctors, (2) independent, private hospitals, (3) patients having choice of doctors and hospitals. (4) “Competing” public and private insurance.
Now, when this type of system was instituted in France, what happened, in effect, is that the public option “out-competed” private insurance for providing coverage for a basic level of medical care. This lowered overall costs, while preserving private practice medicine and preserving patient choice. Private insurance then concentrated on doing what it could do best, which was providing for a higher, “concierge” level of service for people who wanted it and were willing to pay for it. Because so much basic medical care was provided satisfactorily through the public option, the cost of this supplemental, “concierge” coverage was relatively modest.
This business about “single payer” is a bogeyman. Single payer only exists in a single Western country — Canada. And no one is suggesting or will ever support outlawing private insurance. I fully expect that a “public option” would, indeed, eventually attract a majority of Americans, as it did in France, but this would not be a “single payer.” I expect that the vast majority of Americans would be perfectly happy with the “public option” as their only health insurance, as is the case in France. But, for those people who were afraid of “rationing” (discussed below) or who just wanted some sort of special benefits or special treatment by providers, there is no doubt that resourceful insurance companies would offer a wide range of plans to supplement the “public option,” while some companies would doubtless compete successfully with the “public option,” with regard to providing complete coverage.
With respect to your post on South Carolina and Florida, these pertained to Medicaid, which is a certified basket case/mess. Medicaid is simply a cobbled together patch to provide health care for the uninsured, indigent, and, yes, “illegal” segment of the health care seeking population. Health care reform would greatly assist Medicaid in cleaning up its mess, by taking large numbers of the uninsured (though leaving behind the “illegals”) out of the Medicaid system.
@Mike #7 You ask: “What gov’t programs have ever delivered?”
Well, I’d argue police, fire, the military, public health agencies, and the National Institutes of Health, among others. In other words, “programs” to safeguard the well being of the nation and its citizens. Health care is much more akin to these “programs” than it is to those areas of the economy which work so successfully in the private sector. Health care doesn’t work as a market economic system for reasons described in my first comment, above (#1).
By the way, one very relevant government program which has “delivered” very well is Medicare, as noted also in #1. Medicare ranks number one in consumer satisfaction among health plans, costs less, does the least “rationing,” gives the greatest consumer choice in providers and hospitals, provides unsurpassed clinical outcomes, and produces the fewest personal bankruptcies for unreimbursed health care costs. These are the facts, as inconvenient as they may be to those who would disparage the Medicare system.
@Aye #8 You begin by once again trotting out the same incredibly misleading graph, showing Medicare deficits.
Medicare is facing deficits simply because the cost of health care is exploding, not because of any sort of bureaucratic inefficiency. You have to begin by making a basic decision: is the country going to provide health care to elderly people, whose health care costs are much higher than those of young people, and who do not have employers to pay the cost of their healthcare?
What is the alternative to Medicare? Given that the costs of Medicare are substantially less than those of private insurance. Do you junk Medicare and let all those senior citizens fend for themselves? Who is going to pay what would truly be exorbitant rates for their health insurance? Many if not most wouldn’t even qualify for private health insurance, because of pre-existing conditions and because of general actuarial considerations.
Medicare would be in less trouble, were it allowed to negotiate over prescription drug prices, something which it is prohibited from doing because of GOP sponsored legislation.
The overall costs for caring for the elderly are lower under Medicare than they would be under private insurance, yet, as noted, Medicare insurance is a superior product, by all objective criteria. Thus, Medicare is a government program which works.
Moving on to your consideration of the French system. As a minor point, you don’t provide a link to that article which you cut and paste. As a major point, I don’t think that you understand that the article supports my point of view, more than it supports yours.
With regard to the French system “going broke:” It’s only “growing broke” for the same reason that the US Medicare system is “going broke.” This is, again, not because of bureaucratic inefficiency, but because the cost of health care in general is going through the roof. In the US private sector, insurance premiums are rising 30% per year. This is unsustainable. In both the US and France, costs in the publicly funded systems are not rising as rapidly, but they are rising rapidly enough to present both systems with major challenges.
With regard to the money made by French doctors, it is an average of $149,000 per year for specialists and $92,000 per year for GPs. This is low by US standards, but there is a virtually limitless number of highly qualified pre-med students in the USA who would be happy to work for these compensation levels, if given the chance to enter the profession of medicine through expanded medical school enrollments, now tightly restricted, as described in my earlier comment #1.
Aye goes on to give an example of a French hospital “shuttered by cost cuts.” Many US hospitals close each year. Where I live, in one of the wealthiest counties in the USA, the Irvine Medical Center, in the “Platinum Triangle,” for goodness sake, failed, for the same general reasons that lots of private businesses fail. Flawed business plan, poor management, poor performance. Aye gives an example of a child who had to be taken 30 miles to the nearest hospital. For Aye’s information, this is not at all unusual, here in the good old capitalistic USA.
Aye includes a complaint by French unions, echoed by some French doctors, that the French government, in an attempt to control costs, is trying to turn health care into a lucrative business, rather than a public service. I don’t think that Aye appreciates the irony. This simply refers to attempts to cut public costs by pushing more privatization. “Borrowing US tactics,” as it were.
But this simply means trying to institute Medicare style co-payments, to reduce overutilization. This doesn’t mean junking the French system and going to a US style system. It simply means that if something is given away for free, it will always be used in a wasteful fashion; in an era of exploding costs, it makes perfect sense to institute co-payments and other measures to discourage wasteful utilization. This will provide further opportunities for the private insurance sector, which is the same sort of thing which will happen in the US, if/when there is “competition” between public and private health plans.
With regard to the claim that French “health care is being rationed” (e.g. by hospital closings), for goodness sake, this goes on in US private health care every day. Again, what is rationing? It is not prohibiting anything, it’s simply saying that the insurance agency (public or private) won’t pay for it. There is vastly more rationing which goes on with Blue Cross and Aetna and US Healthcare and Humana and Kaiser than goes on in Medicare.
@Mata (will address yours in point by point detail):
1: Yes, health insurance is over used and people expect free care when they run to the doctor for a sniffle. The different cures we see is that I’d like a tax benefit medical account for the general care, and insurance for the catastrophic…different tiers for different “catastrophes”, of course. One for the cancers and long term expensive illness, and another for the less serious but still time consuming healing time for broken limbs, etc.
In principle, I agree with you. This is the type of plan that I have for myself — I do wish there were more choices of this type available. The problem is that this type of approach doesn’t solve the problems of exploding costs and legions of uninsured. I have reluctantly come to the conclusion that what works personally, for me and for you, won’t work on the macro scale of the entire country.
2: Medicare may be “wonderful” in some instances you mention, and not so “wonderful” in others. However you miss the base point that Medicare is absolutely bankrupt and on the verge of destruction. This when every working American who pays FICA taxes can’t support even the senior percentage draining the system now, So putting the nation on a similar program, is a recipe for disaster.
Well, for starters, it would help for you to be specific. In what particular area of providing health care for the masses does private insurance outperform Medicare?
With regard to the second point, the issue is this: Public health care (including Medicare) always costs less than private health care, because health care is not a true market system. Someone has to pay the bill, and that someone is all of us. One way or the other, people need health care. One way or the other, someone has to pay for it.
So my argument in favor of a “public option” is that its overall cost will be less than would the overall cost be of providing health care strictly through private insurance.
An equally important issue for me is that I do believe that we, as a people, should provide basic health care for all of our citizens (and especially children and the elderly), in the same way as we provide basic police, fire, public health, national defense, and education benefits. This is a classic liberal vs conservative issue; either you believe in this or you don’t. There is no answer for which point of view is correct; it’s a matter of personal philosophy.
3: You don’t need to add “to a French style system” tort reform since the French have no malpractice legislation and also pay for their doctors tuition. And oh, BTW, none of these bills resemble the “french style system”. You may pine for it it, but you must eventually recognize what you want, and what Congress has constructed, bears no resemblence to each other. Also, if you decide to pay future doctors’ tuitions, and support the proposed slashes to Medicare reimbursements, are you not leaving several generations of doctors and their educational expense out in the cold?
Firstly, I agree that tort reform is an important component to controlling costs. I agree that the Dems are in the pockets of the trial lawyers (just as the GOP is in the pockets of the pharmaceutical industry). Tort reform won’t be part of the first bill which gets passed. It may have to wait until the pendulum shifts, and the GOP is back in control of things.
With respect to the bills not being a “French style system,” I don’t entirely agree. As I wrote above, I think that the likely outcome of including a public option is a gradual migration to a system very closely resembling the French system. I explained this above.
With respect to physician reimbursement levels, once again, the average earnings of French specialists is 150K and GPs 92K (In the US, it’s 230K/161K, respectively). In the USA, it will certainly remain considerably higher than in France, though less than it is today. My older daughter will enter med school next year; she’ll end up with a $250K mortgage on her future. There are legions of highly qualified young Americans who would be more than willing to incur this level of debt for the privilege of having the greatest job in the world and getting paid in the neighborhood of $150K to do it, even with the debt. By the way, I think that GPs can and will be largely replaced by nurse practioners, with no diminution is quality of care. This will happen, no matter what, because med students are opting out of primary care in droves, these days.
..And oh, BTW… when will you decide to again opt in as a Medicare participant to your own services, being that it’s so wonderful? You have to realize, all that you say has absolutely no credibility since you have been honest and forthright enough to admit that you opted out as a medical practictioner over a year ago.
My personal story is a testimony to how well Medicare really does work, in the real world. I provide a very unique service. Were I located in Pennsylvania, the Medicare contractor there (Highmark Insurance) reimburses $3600 for the general type of service which I provide. Here in California, the Medicare contractor (Palmetto Insurance) reimburses only $1100. Were I located in Pennsylvania, I would opt in to become a Medicare provider. Here in California, it didn’t make economic sense for me to remain in Medicare; the way that I do my job, I’d lose money. Other providers here offer a service of the same generic type, only it is a more basic service, costing much less to provide. So I have complete freedom to either participate in Medicare or opt out, whatever makes the most sense. Medicare beneficiaries in California can choose to obtain a basic level of service, which will be paid for by Medicare, or, if they choose and are willing to pay for it themselves, they can obtain my “concierge” level of service. I’m confident that, one day, the California Medicare contractor will realize that what I do is both effective and cost effective, and will pay me what I need to be paid to offer this service within the Medicare system. When that day comes, I’ll opt back in; until that day comes, I’ll continue exercising my right to opt out. Pure, unrestrained capitalism.
Isn’t this rationing? Well, Blue Cross of California won’t pay my fees for my services and they won’t pay even the $1100 for the more basic level of service for which Medicare does pay. So who’s getting rationed more? A Medicare beneficiary or a Google employee with Blue Cross?
And hey… weren’t you telling us how there were barrages of those entering med school? Now you’re here telling us that the admissions are too stringent and we have less that we did before? Pick a stance, and stick with it please… or explain why you are doing the 180 for us.
You are (inadvertently, I think) twisting my words and arguments. It is not that the admissions are too stringent, it’s that the number of places open in American medical schools have been cut back drastically, to reduce competition. It was a purely selfish move by organized medicine to reduce competition and thereby protect the income of its members. My statement was that reducing physicians’ compensation levels would not reduce the supply of physicians, because there is a huge abundance of highly qualified pre-med students who would jump at the chance to go to med school and work for even greatly reduced compensation. There is no inconsistency at all with my statements on this, much less a 180.
[August 23rd, 2009 at 8:32 pm
MataHarley
11]
Larry, this “path to single payer” is just a continuation of old business that we started on my earlier Aug 8th post, Obama’s Health Care Czars to seize Congressional power – key to achieving a single taxpayer system.
We started all this back then, including the content of the Lewin Group report which I linked. A discussion you abandoned since I was headed to Florida. I might point out that I said I could check in… yet you never returned.
I suggest we have unfinished business there before you start all over from scratch here.
I’ll look it up and get back with you. Hope that your trip achieved what you hoped it would.
#14 Wrote out detailed reply (took me nearly 3 hours). Went to spam. Can someone salvage it? Thanks. – Larry W
Skye
14 years ago
I expect that the vast majority of Americans would be perfectly happy with the “public option” as their only health insurance, as is the case in France.
It is worthy to note that the ‘French system’ is increasingly remaking itself into the current American healthcare system.
The WSJ notes: Assurance Maladie has been in the red since 1989. This year the annual shortfall is expected to reach €9.4 billion ($13.5 billion), and €15 billion in 2010, or roughly 10% of its budget.
Tilting the Balance
Since France began building up its universal health-care system, in 1945, successive governments have been faced with the challenge of balancing the national health insurance budget without going back on the original promise of taking good care of the entire population. For the past three decades, small reductions in health care coverage and incremental increases in health-care taxes have been the main recipe.
1976 — Coverage of ambulance costs is reduced.
1977 — Coverage of some medications is reduced. Some hospital beds are closed.
1982 — Patients must pay a “moderating fee” of 20 francs (3 euros) out of pocket when they are hospitalized.
1985 — Coverage of some paramedical procedures is reduced.
1986 — Increase in health-care payroll taxes.
1987 — Letters sent to the national health insurance must be stamped.
1988 — Creation of a special tax on medication advertising to help fund health care.
1990 — Introduction of the CSG, a new tax levied on all types of income to help fund health care.
1991 — Increase in health-care taxes levied on payroll.
1993 — Increase in CSG rate. Coverage of doctor consultation is reduced.
1996 — Increase in health-care taxes. A new health-care tax is levied on private health-care plans.
1999 — New tax levied on drug makers when their revenue exceeds a pre-defined level.
2000 — Doctors are required to explain to the national health insurance why they granted a worker sick leave.
2003 — The “moderating fee,” which was increased over time, is raised to 15 euros.
2004 — Patients must register with a “preferred” general practitioner who will reroute them toward specialists when necessary, or face lower reimbursement for care.
2005 — The national health insurance deducts 1 euro off doctor consultation fees before it starts calculating how much it must reimburse patients.
2008 — The national health insurance deducts 50 cents off every pack of medicine before it starts calculating how much it must reimburse patients.
With respect to your post on South Carolina and Florida, these pertained to Medicaid, which is a certified basket case/mess. Medicaid is simply a cobbled together patch to provide health care for the uninsured, indigent, and, yes, “illegal” segment of the health care seeking population. Health care reform would greatly assist Medicaid in cleaning up its mess, by taking large numbers of the uninsured (though leaving behind the “illegals”) out of the Medicaid system.
This is a bellweather for what will become of Obamacare. We can do better that what has been proposed – perhaps we need a change in the House and Senate before we can get to a sensible healthcare plan.
ObamaIsAJugearedDunce
14 years ago
weisenthal opines:
“…for anyone worried about “rationing” or waiting in line or other such bogeymen.”
Bogeymen? Please look at British national health. And Canadian, which makes liberal use of the American medical industry to supplement their lack of care.
“Facts are that Medicare produces the highest level of consumer satisfaction of all the major medical plans; costs the less; and results in the fewest personal bankruptcies.”
How is this a “fact”? Medicare costs the “less”- uh, look at the graph provided by Aye Chihuahua, that doesn’t look like inexpensive healthcare to me. You might have something with the “personal bankruptcies”, but that becomes somewhat irrelevant in the face of a “national bankruptcy”, now doesn’t it?
Both you and Aye either do not understand or are intentionally avoiding the real issue:
Cost of health care.
Total cost = Taxes + Insurance Premiums + Patient out of pocket co-payments. These total costs are substantially lower under Medicare than they are under private insurance. Medicare provides a superior product at substantially lower costs, that is the real issue.
With regard to “national bankruptcy,” what is the alternative to Medicare? Most Americans get their health insurance through their employer. Who employs the Medicare population? Self employed Americans, like me, buy their own health insurance. Most Medicare beneficiaries are not self employed and have no income, outside of their retirement. How do they buy private health insurance? The costs of private health insurance (other than supplemental to Medicare) would be utterly prohibitive, given that huge numbers of Medicare patients have pre-existing, serious illness, owing to age, and all Medicare patients will eventually require end of life care, which is the most expensive component of health care.
The fact that American Medicare and French national health care have had costs go up through the roof has nothing at all to do with bureaucratic inefficiency or fraud or anything else relating to stereotypical government ineptitude. It has everything to do with the geometric-like increase in health care costs, which have nothing at all to do with Federal bureaucracy.
The fact is that Medicare is the most successful health care program in the USA, with respect to providing the most cost-effective and consumer-satisfying medical care now available. What, precisely, is the more promising alternative to Medicare? What will provide decent health care to the Medicare population at a lower overall cost?
With regard to Skye’s points regarding the French system, their costs have exploded, along with the costs of Western medicine everywhere. But Skye, like Aye, avoids the real issue:
Total costs of health care and total quality of health care. By any measure whatsoever, both Medicare in the USA and the French national health care system provide a superior product at a lower cost. Once again, neither Americans nor French citizens are constrained from purchasing supplemental private insurance to supplement their excellent basic public insurance. Many French companies provide such supplemental insurance to their workers. Most Americans buy such supplemental insurance.
British and Canadian health care have nothing at all to do with any plan under consideration in the USA. In the Canadian system, competing private insurance and competing private medicine is prohibited by law. It is a true single payer system, unlike any other health care system in the Western World. Such a system will never be put into effect in the USA. It would be supported by only hard core Left Wingers. It is completely unlike the systems in place in France, Spain, Germany, Norway, Sweden, Australia, etc. and, again, completely unlike the systems being proposed for the USA In the British system, most of the doctors are government employees and most of the major hospitals are owned by the government. It is a truly socialized system, yet the British love it. No one is supporting such a system or would support such a system here in the USA. The British system is disparaged by the French, who pointedly refer to the system as one of “socialized medicine,” which the French do not support and wouldn’t tolerate. Yet even the British system is not single payer, in that it does not prohibit private health care and private insurance and about 15% of the British public does have private insurance and private health care to supplement their national health care service.
There are three reasons for reforming US health care:
1. Non-sustainability of exploding health care costs under the private insurance-dominated system (recent 30% per year increase in insurance premiums).
2. Inadequacy of private health insurance: lifetime coverage limitations; gatekeeping, leading to delays in seeing specialists and in obtaining needed drugs and procedures; lack of coverage for off label drug indications and cutting edge diagnostic tests and treatments; an epidemic of personal bankruptcies, because of the preceding. The number one cause of personal bankruptcy in the USA are health care catastrophes in people who have health insurance and think that their medical needs will be met by their insurance, only to find out that American private health care insurance fails to be there for them, when they most need it. Virtually all of us are a catastrophic illness (or accident) away from personal bankruptcy. This is not the case in the rest of the Western world.
Great thread Skye and excellent comments. It would hard for any reasonable open minded person, even a Republican, not to conclude that Larry makes compelling and experience based arguments , even down to the admission/question of healthcare being a right (although I do disagree with the overstatment of the number of uninsured, as much of it is by choice, not lack of availabilty). Indeed Larry is correct that we have a philosophical (political), honest difference of opinion which I doubt is going to be resolved any time soon.
So let’s say that we all win over to Larry’s point of view (which isn’t really, I don’t think, too much of a stretch for most FA folks). In doing so, we would all be wise to consider what Presdent Obama recently told us about the government working with the private system, using the Netherlands as the “splendid” example.
The other day, President Obama referenced the Netherlands as a splendid example of how the “public option,” that is a government plan, worked well with a private system. To The Source contacted me and asked me to reflect on the president’s use of that particular example.
First, the president drastically understated the matter when he stated that the Dutch government was merely “involved” in the country’s health care system. Yes, there is a dual government/private system, but the private sector is regulated to the point of being handcuffed
.
It’s really important to read the whole thing, from one sharp bioethics attorney, Wesley Smith who now devotes his entire career to these issues. I recommend perusing his entire blog, as it contains much of what you will never see or hear about in many other places.
If hearing Obama’s own words aren’t scary enough, let me remind you who his regulatory (operative word) is, Cass Sunstein, who’s as far left as left can go, especially on human rights. Sustein is also my personal prediction for the next SCOTUS . He’s also a paternalist, and of course, consistent with many of the White House Harvard elites who know SO much better the needs of “we the simpletons.” And if being the Obama head of regulatory isn’t scary enough, consider his last book, ‘Nudge’, with behavior economist Richard Thayer, another “Chicago Player.” If , you can understand what ‘Nudge’ is really about, you will understand how we will get to where Palin thinks we are going and then as “How did this happen?” Never under-estimate a brilliant legal mind, the head of regulatory, and the “great ability to tweak.”
Forget about any check and balances, as we all the appointed like minds are in place.
Bottom line, even with Larry’s best defense (which is quite good), what he fails to take into consideration is the million dollar question, of “Who’s regulating.”
So Larry I would like to ask you a direct question. Would you be fine with all that you support PROVIDING there is iron clad language for a conscience clause, no nationally funded abortions, respect for all human life, no excessive financial taxation on any one group, and one more thing I believe is very important, no government access to patient records?
May guess is you will say yes, but even if so, it will NEVER pass with those restrictions, which sadly, as much as it upsets many, brings us back to the LOGICAL CONCERN over life and death issues. After all, as I posted earlier this week, the plutocrats (and Obama advisors) have one “philanthropic” goal they all agree on, population control. Considering the current administration, it’s more than a logical leap to assume there is more than meets the ‘average eye’ in Obama healthcare “reform”, even if it wouldn’t prove to be financially catastrophic.
May 25,2009
Washington, DC (LifeNews.com) — Some of the richest people in the world met secretly in New York recently and talked about their favorite causes. The group, which includes some of the most well-known business people in the world, adopted population control, which would undoubtedly include abortion, as their main cause.
The London Times indicates the rich elites spend 15 minutes each during the meeting talking about their favorite passions and issues and, led by Microsoft founder Bill Gates, they adopted reducing the world’s population as the main issue to put their money behind.
Patricia Stonesifer, former chief executive of the Bill and Melinda Gates Foundation, indicated the billionaires would continue meeting over the next few months.
The newspaper indicated the meeting took place at the home of Sir Paul Nurse, a British Nobel Prize-winning biochemist and president of Rockefeller University, and that Gates was the organizer of the gathering.
The “billionaires club” meeting, according to the Times, included such notables as Bill Gates, David Rockefeller, Ted Turner, Oprah Winfrey, Warren Buffett, George Soros and Michael Bloomberg.
That’s simple. In the USA, it’s never Federal Bureaucrats, meeting behind closed doors. Coverage decisions are made openly, with full transparency and opportunities for public input, comment, scrutiny. For the most important decisions, outside panels of experts are convened, representing doctors, nurses, the insurance industry, patient advocates, social workers, etc. These proceedings and deliberations are open to the public, for the most part, and all of it is public domain information. Compare and contrast this with the way it works in the private insurance industry, which is accountable to no one, save shareholders, where these decisions are made in private, behind closed doors; where public input, critique, commentary is neither welcomed nor a formal part of the process, and where ultimate coverage decisions are not subject to any legislative oversight.
Let us say that Pat’s suspicions are, indeed, true. Obama is truly an agent of the Devil, who seeks to consolidate ultimate control over life and death in his own hands. Neither he nor his administration could possibly get a law passed which gave him such unprecedented dictatorial powers, truly evocative of Hitler.
But, if you say things like this loudly enough, you can eventually scare a lot of people.
Let’s look at Sarah Palin, for example.
The House health care bill has the exact same language regarding “end of life counseling” as prior Medicare bill proposed by Orrin Hatch in 2004, and Sarah Palin charges that Obama wants to kill old people and kids with Down’s syndrome. Thanks to her histrionics, with the support of the GOP, that particular provision was taken out of the bill, which will result in thousands of people having their ribs broken from futile CPR performed, with breathing tubes rammed down their throats, while their bodies are receiving multiple jolts of 200 watt-second electricity. And then there will be the additional thousands of with terminal cancer who will put their families in debt and cost the government billions with futile chemotherapy instead of receiving end of life hospice care. But it was sure worth it, to score those political points.
These total costs are substantially lower under Medicare than they are under private insurance
Thanks to DRG’. The difference in cost is passed on to private insurers and spending restcrictions (i.e rationing). These costs also don’t include the unfunded mandates that are required by hospitals who admit m/m patients. Hospitals accepting these patients are squeezed of every penny – and yet the costs of M/M are skyrocketing.
In the USA, it’s never Federal Bureaucrats, meeting behind closed doors. Coverage decisions are made openly, with full transparency and opportunities for public input, comment, scrutiny. For the most important decisions, outside panels of experts are convened, representing doctors, nurses, the insurance industry, patient advocates, social workers, etc. These proceedings and deliberations are open to the public, for the most part, and all of it is public domain information.
Thanks to her histrionics, with the support of the GOP, that particular provision was taken out of the bill, which will result in thousands of people having their ribs broken from futile CPR performed, with breathing tubes rammed down their throats, while their bodies are receiving multiple jolts of 200 watt-second electricity.
That is not a decision for you or a DC panelist to decide. Quite frankly, Sarah Palin has engaged the public to read the provision in which doctors are incentivised by government funding to conduct ‘end of life ‘ counseling. There is no problem with discussing with your family, doctor, priest or rabbi about what your wishes would be, but the government has absolutely NO place in such a discussion – let alone giving out funding.
Larry, I’ve been present at numerous codes, don’t you dare minimize the lifesaving skills involved or the decisions made by family members.
No time at the moment to do any in depth posting on this subject.
I will, however, address this one snippet of what Larry had to say earlier.
Such a system will never be put into effect in the USA. It would be supported by only hard core Left Wingers.
Who is in this category of “hard core Left Wingers” to which Larry refers?
Well, let’s see what the evidence has to say shall we?
Roll the tape:
2009:
This is what he told us before.
2003:
2007:
Well damn!
The joker in that video looks a helluva lot like B-rock Obama….the guy that Larry voted for last November. Of course, Larry would never admit that BO is a “hard core Left Winger”. That would require consistency and, as we all know, consistency is not Larry’s strong suit. (More on that later, when I have more time to devote to it.)
President Obama has a problem keeping his story straight.
Perhaps Larry will try to convince us all that that’s not really BO in those videos at all, but rather a Republican sponsored impersonator.
Then we have Senator Barney Frank. (You’ll notice that Frank doesn’t oppose single payer.)
Roll the tape:
Here are some of the people who are behind the scenes pushing this. (Do some reading on Dr. Jacob Hacker and the Tides Foundation). Take note of Hacker’s “Trojan horse” statement.
Roll the tape:
Here’s Senator John Kerry. (You’ll notice that he doesn’t express an opposition to single payer. He just makes the argument that there aren’t sufficient votes at the moment to get it through.)
Roll the tape:
Senator Mikulski “not opposed to” single payer.
Roll the tape:
Rep. Henry Waxman, not opposed, just not enough votes.
In the British system, most of the doctorst are government employees and most of the major hospitals are owned by the government.
They love it enough to spend untold millions out of pocket for backdoor medicine because the NHS is not providing quality care.
I will tell you the hospitals are overburdened and struggling with skyrocketing CVC-BSI HAI’s ( Central Venous Catheter – Blood Stream Infection, Hospital Acquired Infection.
These total costs are substantially lower under Medicare than they are under private insurance
Thanks to DRG’. The difference in cost is passed on to private insurers and spending restcrictions (i.e rationing). These costs also don’t include the unfunded mandates that are required by hospitals who admit m/m patients. Hospitals accepting these patients are squeezed of every penny – and yet the costs of M/M are skyrocketing.
There is vastly more “rationing” which goes on with Blue Cross, Aetna, United Healthcare, Humana, Kaiser, et al than goes on in Medicare. Providers aren’t forced to care for Medicare patients; if the provider wants to opt out of Medicare, he/she can. I did (opt out, that is), as described above (#14).
Yes, Medicare costs are skyrocketing; costs for purely private insurance funded health care are skyrocketing even faster.
Quoting me:
In the USA, it’s never Federal Bureaucrats, meeting behind closed doors. Coverage decisions are made openly, with full transparency and opportunities for public input, comment, scrutiny. For the most important decisions, outside panels of experts are convened, representing doctors, nurses, the insurance industry, patient advocates, social workers, etc. These proceedings and deliberations are open to the public, for the most part, and all of it is public domain information.
Skye retorts:
Yeah…only in your dreams larry.
Actually, no. In my real life; not in my dreams. I wrote before of my personal experiences with Medicare coverage decisions (“rationing”, with complete and utter transparency) vs purely private sector coverage decisions (“rationing,” on steroids, and with complete and utter opacity).
Here’s how the M/M coverage decision process works:
I just wrote out a reply to Skye’s #24,25,26, but it went to spam. All of my comments go first to spam. It is hard to carry on a debate with this technical obstacle. I notice that others are having similar problems. Is this a technical glitch?
With regard to:
Larry, I’ve been present at numerous codes, don’t you dare minimize the lifesaving skills involved or the decisions made by family members.
This is a total straw man. When did I ever “minimize the lifesaving skills involved or the decisions made?”
“End of life” issues are HUGE. They are a huge problem for many if not most families in America. There is an enormous amount of the total health care economy spent on care during the last 90 days of life. The number one cause of personal bankruptcies are health care expenses in people who have insurance and this extends to the families who survive the death of the patient. These are real issues and these are issues which need to be dealt with. The only reason that my mother got a living will — in the three weeks of her life — is that I got her to write and sign one. The only reason that my 96 y.o. Dad now has a living will is that my sister got him to write and sign one. So are both of us responsible for “killing” our parents? I don’t think so; our parents are fortunate that they have doctors in the family who understand what goes on at the end of life; most people don’t.
Is is remotely possible that provisions for “end of life” counseling could be misused? Yes. Is that a reason not to include it? No.
I’m sure that, whatever bill passes and gets signed will indeed have language to mollify the critics — although I’ve read the language and, for the life of me, I don’t see anything at all in the language of the bill, as it is now written, which would give me the slightest concern whatsoever.
With regard to Aye’s “roll the tape,” it’s a semantic red herring.
What’s the meaning of “single payer?” Well, there’s single payer like Canada; no competition allowed. Then, in a looser and more generic sense, there is “single payer” like Medicare, where competition is allowed. No one’s proposing Canada and there’s no chance that this would ever pass. Few people are proposing “Medicare for all;” though that would be a vast improvement over th present system. Best of all is the French system, as I argued above. Which isn’t to say that even the French system couldn’t be improved; the French have been tweaking and improving their system since it was instituted, and they continue to do so.
@Skye (#29). Who’s advocating a British system (doctors employed by the government/hospitals owned by the government)? No one. Another straw man. And my reply to #24,25,26,27 went to spam. Sigh. – Larry W
End of life” issues are HUGE. They are a huge problem for many if not most families in America. There is an enormous amount of the total health care economy spent on care during the last 90 days of life.
Again, end of life decisions are no place for a government panel. It lends to the idea that cutting these enormous costs is to not provide it…talking people in an early death.
There is an enormous amount of the total health care economy spent on care during the last 90 days of life. The number one cause of personal bankruptcies are health care expenses in people who have insurance and this extends to the families who survive the death of the patient.
Filing for bankruptcy is not the end of the world – denying care is.
Please cite your source for personal bankruptcies.
Is is remotely possible that provisions for “end of life” counseling could be misused? Yes. Is that a reason not to include it? No.
There will be widespread abuse, especially with incentivized doctors who aren’t getting paid well under Obamacare.
The fact you either don’t know or just willfully ignoring is that this discussion occurs with EVERY inpatient in EVERY hospital in the nation. The front page of care/progress notes are required to include the code status of the patient. Basically, this tells your care team what you want done OR not done regarding your care at end of life occurrence. You, the patient, are dictating your ‘end of life’ practices. The patient or POA for the patient has every right to change the status during their stay. If I were hospitalized today, I would be asked to verify and sign a form detailing my ‘code’ status (FYI: it would be FULL CODE).
That is not a decision for you or a DC panelist to decide. Quite frankly, Sarah Palin has engaged the public to read the provision in which doctors are incentivised by government funding to conduct ‘end of life ‘ counseling. There is no problem with discussing with your family, doctor, priest or rabbi about what your wishes would be, but the government has absolutely NO place in such a discussion – let alone giving out funding.
I doubt that any doctors do more “end of life counseling” than oncologists; so I feel well qualified to address this issue, head on. With 50% of deaths from cardiovascular disease, the first symptom is sudden death. No end of life counseling required. But with cancer, in the roughly 50% of cases where it’s not cured, there is virtually always a situation where end of life counseling is appropriate.
Cancer patients usually have unrealistic expectations. They always want to go for the cure. This is all well and good; I’m an optimist, and it takes a lot to convince me that a given situation is truly hopeless. It is so easy to just keep giving more chemotherapy. It takes 5 minutes to write out an order for an infusion regimen which results in hundreds to thousands of dollars of private insurance and/or Medicare reimbursement. It can easily take an hour to raise and discuss the issue of eschewing further chemotherapy and, possibly, entering a hospice. And this currently provides no reimbursement for time spent. This is the sort of “end of life counseling” which is most in need of reform. And it affects hundreds of thousands of patients every year.
Because of the efforts of Ms. Palin and her ardent, albeit hysterical supporters, there is now no possibility that “end of life counseling” will be component of health care reform. This is a great pity, on many levels.
Filing for bankruptcy is not the end of the world – denying care is.
This is the sort of hysterical fear-mongering which would make Al Gore blush. How is care “denied?” What you are speaking about is which medical services a given health care plan will pay for and which services it will not pay for. This is what is commonly referred to as “rationing,” and it is much more prevalent in the privately-funded health care system (e.g. Blue Cross, Aetna, United Health Care, Humana, Kaiser) than it is in the publicly funded health care system (e.g. Medicare). If you are “ration-averse,” then just go out and buy some private insurance, to supplement the base level of coverage provided by the public system. This is what the French people do, and it works perfectly well for that.
Despite Aye’s deep suspicion over the deep, inner wishes of Obama and some very liberal Democrats, none of the various health insurance reform bills under consideration prohibit private insurance, as either an alternative to publicly funded insurance or as a supplement to it.
I do not have the position that the House bill is perfect. No one has yet discovered health care Utopia. It is perfectly appropriate to shine a bright light on provisions of the bill which are troublesome. I’m not an advocate of rushing any bill through. I think that the bill does provide a useful “rough draft,” which will certainly undergo a lot of modification before it passes the House and before it gets reconciled with an independent Senate bill and signed into law. I am even supportive of the vigorous efforts to delay passage of the bill; I’m confident that these efforts will result in a much better bill than might have been passed before the recess. It it takes another year to get an insurance-reform bill passed and signed into law, that’s all for the better. We’ve waited decades for fixes to our broken health care system, and another year to get it right would be just fine.
The fact you either don’t know or just willfully ignoring is that this discussion occurs with EVERY inpatient in EVERY hospital in the nation. The front page of care/progress notes are required to include the code status of the patient.
Yes, I am familiar with the process. Patient checks into hospital. Patient directed first to a clerk, who collects lots of information, has the patient fill out and sign numerous forms and present several documents. At some point, the “code” sheet is passed to said patient. There is no discussion about what goes on in a “code” (and, yes, I’ve personally broken my share of sternocostal articulations and ribs in the process of carrying out such a “code;” I’ve also given mouth to mouth resuscitation to strangers (twice, including one case complicated by violent patient vomiting). Most patients (including my parents) don’t like thinking about those things. In my experience, it’s pretty random, what choices get made. Often, doctors stop by on rounds, are told by the nursing staff that a given patient who should be a “no code” has not been duly documented. So there is a perfunctory bedside conversation, which could have/should have been an unhurried discussion in an office setting far in advance.
But the “code”/”no code” decision is only a small part of “end of life counselling” (see #37).
Larry I don’t even know where to start, except to say you often avoid many difficult questions and/or hard evidence.
You also contradict you own argument with end of life care. How can you be so convinced that the wording for docs is only about payment when you just admitted what we all know, that docs will be few and far between. If they aren’t busy enough treating their own families, they will be busy treating the elites, you know, the ones who won’t be on Obamacare, with little time left to be tending to grandma or the handicapped. NP’s (and I suspect even LPN’s) will be just fine for the end of life stuff (C’mon, how hard is an IV), especially without conscience clauses, which is one of the reasons I asked you specifically about them.
As for the living wills, I admit I often have said that every person needs at least one savvy medical person in the family for patient advocacy. While my family has sufficient medical folks, my parents were not medical, but somehow, even being devout Catholics, they managed to have living wills (compatible with Catholic Teaching BTW), by their own doing, years before they needed them. I too personally abhor extraordinary means for a terminal illness, but if someone wants to go for the 10th round of drug resistant chemo, who I am or anyone else to stop them? As Skye pointed out, life is far more important than money, and it isn’t our job to tell anyone else what “quality” of life they are allowed or not allowed to endure OR if they chose to risk bankruptcy in the process. I’ve written many times, some of life’s greatest lessons are learned at the death beds of loved ones.
Likewise, suffering has redemptive value. That might not mean much to the non believers, but for those of us who believe in life after death, union (and surrender) to God, is the ultimate meaning of life, trusting that if God’s will be done, there will be a profound reason for having allowed such suffering, and in the big picture, a small price to pay for eternal salvation. Many times it’s actually the person AT the bedside who benefits most from the suffering of the loved one, and always,like most things in life, it always above love.
Here’s one of the best articles I’ve ever read on suffering and death. (I seem to remember a longer version, but this will suffice to make my point)
Neither woman pauses to consider whether “assisted death,” much like abortion, serves to cut off avenues of love before they are fully traveled. Nor do they seem to grasp what the “cult of the natural” and the “religious view” have been trying to teach: that life brings love, and love is God; that life interrupted is love interrupted, and love interrupted is God interrupted. Nor does either woman wonder what or who is served by such interruption.
Isn’t it ironic that with all this “my body right to choose” rhetoric that’s been going on for the last 40 years, how “choice” in healthcare now takes on a new meaning?
Anyone would have to be blind not to see the perils of “early termination” upon us. Absolutely everything is in place, from legal assisted suicide, to an entire handpicked death culture in the current administration. Even worse, it’s not a secret! Just like Obama is “transforming” America as promised, the radicals in the WH will do all in their power to finally rid us of the silly notion that all human life, from conception to natural death, has value. They already told us by their books and their actions.
The one thing you do respond to is objectivity, as you have many times reminded us that “As the economy goes, so goes Obama’s 2nd term “(as if a 2nd term is really his goal). Regardless, it will be “objective”, for all to see soon enough. The other thing that will be objective is healthcare with a conscience clause. If health reform under Obama passes WITH an iron clad (and I mean IRON CLAD) conscience clause, AND no funded abortions, I’ll be the first to admit that I was totally wrong. In the meantime, I’ll just keep following the big money (and hoping you address the conscience clause).
At some point, the “code” sheet is passed to said patient. There is no discussion about what goes on in a “code”
Bullshit, Larry – the patient physician and/or POA go over the form, checking off actions they choose to have performed on them in the vent of a code. Part of the form asks if the patient/POA understands their options.
(and, yes, I’ve personally broken my share of sternocostal articulations and ribs in the process of carrying out such a “code;”
You have very poor technique that would cost you your job in Pa. I’ll bet you routinely break antiseptic technique as well. I’d hate to know how many HAI’s have been attributed to you. Although, we don’t like to place blame…
I’ve also given mouth to mouth resuscitation to strangers (twice, including one case complicated by violent patient vomiting).
So what? You want a medal?
Often, doctors stop by on rounds, are told by the nursing staff that a given patient who should be a “no code” has not been duly documented.
The doctors should be reading charts before seeing a patient, and documenting code status is a Joint Commission requirement. If the nursing or physician cannot do the job tasked to them, they need to be fired.
If you are “ration-averse,” then just go out and buy some private insurance, to supplement the base level of coverage provided by the public system.
So pay twice the amount for the healthcare coverage. Pay out of pocket and pay outrageous taxes for diminishing public coverage. This is bad medicine all around.
This is the sort of hysterical fear-mongering which would make Al Gore blush. How is care “denied?”
You prove this true by stating that the french have to purchase additional healthcare to cover what the public option doesn’t….sounds like rationing to me!
Medicare would be in less trouble, were it allowed to negotiate over prescription drug prices, something which it is prohibited from doing because of GOP sponsored legislation.
Dayum!
I reaallly hate it when those darned GOP presidents make secret deals with big PhRMA after telling the American people that they will have all of the negotiations in the open on C-SPAN.
Those darned GOP presidents. Making deals with the very people that they excoriated on the campaign trail.
Don’t you just hate it when that happens?
Oh….wait, Obie’s not a GOP prez is he?
My bad.
Tom in CA
14 years ago
Can anyone answer why in the state of California as a self employed person, I have only two insurance companies from which to choose.
Is it because only two companies care to compete, or is it mandated by state or federal government?
Because if you’re a sole practitioner, you cannot qualify for “group” plans where pre-existing conditions cannot be denied, Tom. To qualify for a group plan, you must have at least one (or two?) W-2 employee(s) (even tho you are a 1099/indy contractor). They also have husband/wife groups available.
Can’t do those? Then you are relegated to the HSA (medical account plans) or an individual health plan with high deductable and more out of pocket expenses. You can also work an HSA along with an indy healh plan.
However this is why I’ve been saying (along with many other conservatives) that allowing independent contractors the ability to form a “group” would help bring down costs for many.
This stuff is regulated by the state. You might want to read this article. It’s got links to two guides… one for small business health insurance, and the other to California’s Dept of Insurance and their regs.
Not quite back full time yet, Larry. Maybe tomorrow. Certainly back from Florida, but now playing work catch up.
Just a couple of fast notes from me at the moment.
No one’s talking about junking Medicare. We’re talking about taking a system that loses cash hand over fist (for whatever reason) and not putting over half the US citizens on it. As you point out, the majority of the French ended up there. You then say it cut costs, but they’re going bankrupt too.
The point being is that the public option is not the cure to the cost problem, and only exacerbates it.
And speaking of Medicare, perhaps you’ll let us know how they can propose $500 billion in Medicare cuts and still maintain that quality care everyone loves. (that’s a WaPo link, since you like to know where you’re going before you read…)
Baucus has declined to release details. But people involved in the talks said the plan would make more than $500 billion worth of changes to Medicare over the next decade, charging wealthy seniors more for prescription drug coverage, cutting $120 billion in payments to private insurance companies that serve some seniors and trimming projected payments to hospitals by $155 billion in an effort to spur efficiencies.
I do seem to remember you stating that in California, it’s just not a good business decision to be a Medicare participant. I can’t argue that one bit. And in fact, I’m arguing that – in light of their planned cuts via IMAC, Baucus and similar bills – there are far more of you around, and will growing in number every day. Therefore the system you praise today is set to be slowly dissected before your very eyes with these proposals.
I’ve said it before… right now everyone’s battling to keep what they have because they see the promised slashes and degradation of their care in all these measure. They add more population to the public burden, and do nothing to cut the drivers of cost.
CBS’s Dan McLaughlin had an interesting story about this cutting costs myth a couple of days ago. Says it’s less medical care, less cost for medical care, or eliminating the middle man (their latest bogeyman quest).
The entire rationale of the Democrats’ proposal is to get more people to buy insurance or have it bought for them than is currently the case, thus increasing the proportion of our health care that is paid for through intermediaries rather than directly. That’s true of people who currently buy no insurance and get little or no care, or pay for it out of pocket; it’s true as well of people who currently get their care from emergency rooms. That’s exactly the opposite direction of where you want to be moving if cutting intermediary costs is your goal.
And in the existing health care market, Democrats (with the help of big-government Republicans) have been driving up costs for the past two decades by piling on mandates and “patients’ bill of rights” legislation that ever increases the number of procedures that the insurers have to be involved in. The Medicare prescription drug plan likewise expanded the scope of health care products and services paid for through a public intermediary rather than directly by consumers. And of course, subsidizing preventative care that may be presently paid for out of pocket does the same. So, not only are the Democrats proposing to have more people use health care intermediaries (public or private), but their proposals will inevitably continue the trend towards having more types of health care paid for through intermediaries.
~~~
The elephant in the waiting room is the other big cost driver of intermediaries besides the scope of coverage and the cost of having shareholders and executives: lawsuits. Precise figures are again a subject of intense dispute, but a goodly chunk of what drives the amount of `unnecessary’ care provided, the cost of providing services and the cost of intermediaries is the need to protect against and pay for the cost of medical malpractice and denial of coverage litigation. None of the Democratic proposals, however, seek to make any practical inroads against this source of costs. Replacing a private system with a public one could arguably do so if the trial bar is effectively precluded from bringing against the government many of the kinds of lawsuits now used against private insurers – but aren’t liberals in favor of keeping those kinds of suits viable? And how likely is it that in the long run they won’t provide other mechanisms to keep one of their vital constituencies in business?
You also continue to blame the GOP for legislation that seems to prohibit negotiating prices down for drugs. Frankly, I think this nation has too many drugs…. but that’s neither here nor there. As Aye had to remind you of the Pharma/Obama deal. And I will remind you that it’s the Dems who are gifting drug manufacturers with 12 yr patents and thwarting generic drug competition to hit the market sooner rather than later.
Does not compute… does not compute….
They don’t need to reinvent the wheel, as the Big Zero and company are attempting to do. They need to get the trial lawyers and malpractice BS out, saving tons in unnecessary preventative medicine procedures.
Also, like for Tom above, to allow small individual groups to bond together and create a new “group qualified” plans.
They most definitely need to just allow the wealthier seniors to opt out of Medicare for private, and save beaucoup bit there. Instead they’re talking about charging the more affluent elderly more to pay for the less affluent elderly. How absurd. They are the ones who could leave the system and relieve a lot of that financial stress.
About the only things with a glimmer of reform is the electronic records. But even that is written up to be a data collection tool for the government. I agree records should be digitally stored to streamline bureaucratic red tape. But no government agency should have access to those records.
My guess is we agree on some basic principles. We just majorly disagree that this proposal gets us anywhere close to those basic principles.
ditto
14 years ago
I’m getting sick and tired of hearing all the DEM & GOP banter (read: BS.) over private insurance and government option(/single payer/nationalized health-care, etc…). What needs to be addressed that isn’t by any of the bills is: HOW TO SIGNIFICANTLY LOWER HEALTH COSTS!
This is why the Democrats and Obama are doing so poorly on this issue. They are ignoring the real problems and going after the insurance companies and doing other piddly-shit nanny government programs in their bills that NEVER will bring the actual costs down. If real medical costs hadn’t skyrocketed, medicare, medicaid may not be going bankrupt , our Vets would be getting decent health care, and more people could afford insurance. We could likely even afford some kind of free health care for the poor. Instead Democrats want to do social engineering and anti-capitalist political warfare against the insurance companies. (Not that I have that much sympathy for HMO’s)
1. We need more health care professionals of all levels. Have state run hospitals and medical schools take care of some of the poor patients.
2. We need to get a handle on the malpractice/tort situation. Some lawyers are getting too far overpaid for their services than they deserve, because they tell their clients “not to worry because their outrageous fees will be paid out of the settlement.”
3. The entire medical field has to have their high profit margins and price gouging reigned in. There has to be truth in billing, and enough already with doctors who see you in the hospital or E.R. for 2 minutes but bill you for 30.
4. Stop the damn illegal immigrants at the borders. Emergency room wait times and unpaid costs that are going to subsidize illegals E.R. visits will drop. If they still have to treat an illegal, call immigration to ship their ass home when they are stable and ready to be released.
5. Teach basic self-care and first-aid classes in public schools. Teach health, nutrition and how to take care of yourself to grade school kids. We had to learn use some of that in the Boy Scouts when I was a kid. (If they can handle geometry and computers, that stuff should be fairly easy.) While we’re at it BRING GYM CLASSES AND RECESS BACK! Dems complain about childhood obesity, but they are the ones that cut out physical training programs because of namby-pamby B.S..
6. Pharmaceutical prices must come down. The FDA needs to accelerate the drug approval process (within reason of course, allow trial waiver’s on potential lifesaving drugs to the dying who are willing to gamble on it’s success). If they are charging one price for medications sold to other countries, they need to charge the same price to Americans. I don’t buy that “unsafe Canadain drugs” advertising BS. If Canadian drugs are unsafe, what the hell are they doing selling them to Canadians?
7. Medical research must not get stifled. But if the government is funding it, then there has to be a trade-off on the results. I’d say that in government funded medical research, the researchers get full name credit and a bonus on successful discoveries/results, then their research and results become public domain.
8. Medical supplies/device manufacturers. This is an area where there is blatant profiteering. If you’ve ever had to buy a wheelchair, hearing-aids, etc. you know that I’m talking about.
I’m sure there are lots of other ways that we can really reduce medical costs without ever needing to go through all the “one-payer”/socialized medicine crap the Democrats want to shove down our throats, and without ignoring the problem like the GOP has done.
Healthcare economics for dummies:
1. In a true market economy, there are limited barriers to the entry of new vendors.
Reality: When I went to medical school, at the University of Michigan, in the early 1970s, there were 225 students in each entry class. Today, there are 170, and this is representative of what has happened on a nation-wide basis. In the late 70s/early 80s, organized medicine feared a “doctor glut” and admissions slots were drastically scaled back, again, on a nation-wide basis. There are enormous barriers to entry, among them, a single “B” in organic chemistry – virtually. Never have medical school admissions been more competitive. There is no way to increase the supply of doctors which will not take 15 years (much easier to cut back admissions than to increase admissions and medical training averages 9 years — 4 years of med school/5 years of residency ), save for dramatically easing the restrictions on immigration of foreign medical graduates.
2. In a true market economy, the “buyers” understand what they are buying.
Reality: 80% of people love their health insurance. Why?, because their employers pay for it and because they are happy to get free pap smears and mammograms and ER visits and payment for many costs of prescription drugs. But this is all small potatoes stuff; people don’t even need health insurance for this stuff, anymore than they need insurance to purchase food or pay for automobile and home repairs. You need health insurance when you come down with acute leukemia or Steve Jobs style liver cancer. Only then do you realize how inadequate most health insurance is. The prior authorizations (not required by Medicare, by the way) drive you and your doctors crazy. Private insurance often won’t pay for cutting edge (“off label”) indications of new drugs (Medicare more often does). You can’t go to an out of state cancer center (with Medicare, you can). You have a lifetime limit of benefits (often as low as $1 million), which can and does run out, long before the end (Medicare doesn’t have such a limit).
The rest of the story, I’m sure that you know. The current system rewards doing procedures — providing treatment, doing diagnostic tests, doing surgery, with much of this being entirely unnecessary and running up costs. Many conservative bloggers have grotesquely misrepresented Dr. Emmanuel’s JAMA article, comparing US and foreign health care systems. It has been stated that “over-utilization” is on account of more upscale facilities, creature comfort wise. But overutilization is mostly about unnecessary and even harmful procedures and tests.
The system which makes most sense is the system they have in France, world’s number one rated health care system. A “base” level of government-paid and regulated (though provided by private doctors and hospitals) health care. And the freedom to purchase supplemental private insurance, for anyone worried about “rationing” or waiting in line or other such bogeymen.
Facts are that Medicare produces the highest level of consumer satisfaction of all the major medical plans; costs the less; and results in the fewest personal bankruptcies.
Where is the example of purely private health care which works? Health care doesn’t play by the rules of classic economics. Turn over the responsibility for police, fire, public health, and the military to the purely private sector, and all would cost more, provide less consumer satisfaction, and do a worse job (imagine a police CEO responsible to shareholders and not the public).
What I’d add to a French style system would be tort reform, expansion of medical schools, and easing of restrictions on immigration of foreign medical graduates.
– Larry Weisenthal/Huntington Beach CA
Larry, you and I are not that all far apart on some items. Just some conclusions… those being:
1: Yes, health insurance is over used and people expect free care when they run to the doctor for a sniffle. The different cures we see is that I’d like a tax benefit medical account for the general care, and insurance for the catastrophic…different tiers for different “catastrophes”, of course. One for the cancers and long term expensive illness, and another for the less serious but still time consuming healing time for broken limbs, etc.
2: Medicare may be “wonderful” in some instances you mention, and not so “wonderful” in others. However you miss the base point that Medicare is absolutely bankrupt and on the verge of destruction. This when every working American who pays FICA taxes can’t support even the senior percentage draining the system now, So putting the nation on a similar program, is a recipe for disaster.
3: You don’t need to add “to a French style system” tort reform since the French have no malpractice legislation and also pay for their doctors tuition. And oh, BTW, none of these bills resemble the “french style system”. You may pine for it it, but you must eventually recognize what you want, and what Congress has constructed, bears no resemblence to each other. Also, if you decide to pay future doctors’ tuitions, and support the proposed slashes to Medicare reimbursements, are you not leaving several generations of doctors and their educational expense out in the cold?
And oh, BTW… when will you decide to again opt in as a Medicare participant to your own services, being that it’s so wonderful? You have to realize, all that you say has absolutely no credibility since you have been honest and forthright enough to admit that you opted out as a medical practictioner over a year ago.
And hey… weren’t you telling us how there were barrages of those entering med school? Now you’re here telling us that the admissions are too stringent and we have less that we did before? Pick a stance, and stick with it please… or explain why you are doing the 180 for us.
comment went to spam
Like I’ve posted elsewhere…they get one foot in the door, if anything passes, we will be eventually fried in this country….Nationalized Health Care will eventually be the govt. take over, it is the leftists agenda, they will do it one step at a time over the years.
NO BILL is a GOOD Bill with this administration/congress-critters.
Larry, are you agreeing that dems want a single payer system?
http://www.heritage.org/Research/HealthCare/wm2563.cfm
The Public Plan Option. The House health reform bill includes a public plan that will be administered by the federal government and “compete” with private insurance plans. However, premiums in the public plan will be at least 10 percent lower and more likely 20-25 percent lower, on average, than premiums in private plans.[3] – this is why we have no successful private insurance – lets get rid of unfair tax laws and give insurers the change to build their business.
In fact, the Lewin Group, a non-partisan health care consulting firm, more recently estimated that when fully implemented, the number of enrollees in the public plan is likely to be 103.4 million, and an estimated 88.1 million of these enrollees would be shifted out of their current employer-based coverage.[4] Between Medicare, Medicaid, SCHIP, and a large enrollment of Americans in the new public plan, the government could control the health care of well over 200 million Americans.[5]
This would move American health care closer to President Obama’s once-stated preference for a single-payer system. According to the legislation, physician participation in the public plan would be “voluntary.” However, as physicians know from the managed care experience, non-participation in a plan of that size would not be a practical option for most physicians.
Physician Payment Methods. More troubling is the congressional plan to replace the current doctor payment system with the Medicare Economic Index (MEI), which attempts to estimate inflation in the costs of providing medical services. However, the MEI was implemented in the Medicare system in the 1970s, did not reduce Medicare spending, and was abandoned.[6] There is no reason to believe it will be any more effective this time around.
Misplaced Value Incentives
For decades the government has tried to control spending in Medicare by deciding what benefits patients should receive and setting the price for more than 7,000 individual services. Obviously these efforts have been entirely unsuccessful. Congress has so far failed to recognize that cost, as well as quality of care in the health care system, is driven by decisions made by individual patients and their doctors. To contain costs, the incentive structure needs to be shifted to the individual level.
Here is some good reading on states that are forging ahead with much needed Medicare reforms:
Florida and South Carolina
Congress should provide broader flexibility to states while still ensuring that clear benchmarks and performance measure are met. States, in turn, should build on the concepts in the Florida and South Carolina proposals and work to integrate market-based ideas into the Medicaid program.
DG:
This bill has nothing to do with improving health care and everything to do about partisan politics.
@openid.aol.com/runnswim: Do tell us “dummies” what government programs have EVER delivered on their promises and done so at what they were initially projected to cost.
It would seem that the only “dummies” here are the people that somehow think that this massive new complicated government power grab is miraculously going to work perfectly and at the projected cost with no negative consequences.
Come on Larry… You can’t really be that stupid!
Layoff the Kool Aid Larry…
Ah yes, Medicare:
The French system pays their doctors about sixty percent of what docs are paid here in the States. They have no malpractice laws, yet their system is still going broke.
More details about the French system:
Obama video release:
Larry, this “path to single payer” is just a continuation of old business that we started on my earlier Aug 8th post, Obama’s Health Care Czars to seize Congressional power – key to achieving a single taxpayer system.
We started all this back then, including the content of the Lewin Group report which I linked. A discussion you abandoned since I was headed to Florida. I might point out that I said I could check in… yet you never returned.
I suggest we have unfinished business there before you start all over from scratch here.
Skye #5: you are linking to state administered Medicaid… a completely different critter than federally adminstrated Medicare. What they share in common is that they, too, are bankrupt.
Good comments, Skye, Mata, and Aye. Mata, are you back on the FA beat, full time? What was the thread on which we were talking before you had to travel? I’d like to continue that, also. If everyone will continue this discussion on the current high level, I do believe that progress can be made. Back when I’ve got the time. – Larry Weisenthal/Huntington Beach, CA
@Skye #4
I think I’ve made it clear that my preference is for a French-style system, consisting of (1) independent, private practice doctors, (2) independent, private hospitals, (3) patients having choice of doctors and hospitals. (4) “Competing” public and private insurance.
Now, when this type of system was instituted in France, what happened, in effect, is that the public option “out-competed” private insurance for providing coverage for a basic level of medical care. This lowered overall costs, while preserving private practice medicine and preserving patient choice. Private insurance then concentrated on doing what it could do best, which was providing for a higher, “concierge” level of service for people who wanted it and were willing to pay for it. Because so much basic medical care was provided satisfactorily through the public option, the cost of this supplemental, “concierge” coverage was relatively modest.
This business about “single payer” is a bogeyman. Single payer only exists in a single Western country — Canada. And no one is suggesting or will ever support outlawing private insurance. I fully expect that a “public option” would, indeed, eventually attract a majority of Americans, as it did in France, but this would not be a “single payer.” I expect that the vast majority of Americans would be perfectly happy with the “public option” as their only health insurance, as is the case in France. But, for those people who were afraid of “rationing” (discussed below) or who just wanted some sort of special benefits or special treatment by providers, there is no doubt that resourceful insurance companies would offer a wide range of plans to supplement the “public option,” while some companies would doubtless compete successfully with the “public option,” with regard to providing complete coverage.
With respect to your post on South Carolina and Florida, these pertained to Medicaid, which is a certified basket case/mess. Medicaid is simply a cobbled together patch to provide health care for the uninsured, indigent, and, yes, “illegal” segment of the health care seeking population. Health care reform would greatly assist Medicaid in cleaning up its mess, by taking large numbers of the uninsured (though leaving behind the “illegals”) out of the Medicaid system.
@Mike #7 You ask: “What gov’t programs have ever delivered?”
Well, I’d argue police, fire, the military, public health agencies, and the National Institutes of Health, among others. In other words, “programs” to safeguard the well being of the nation and its citizens. Health care is much more akin to these “programs” than it is to those areas of the economy which work so successfully in the private sector. Health care doesn’t work as a market economic system for reasons described in my first comment, above (#1).
By the way, one very relevant government program which has “delivered” very well is Medicare, as noted also in #1. Medicare ranks number one in consumer satisfaction among health plans, costs less, does the least “rationing,” gives the greatest consumer choice in providers and hospitals, provides unsurpassed clinical outcomes, and produces the fewest personal bankruptcies for unreimbursed health care costs. These are the facts, as inconvenient as they may be to those who would disparage the Medicare system.
@Aye #8 You begin by once again trotting out the same incredibly misleading graph, showing Medicare deficits.
Medicare is facing deficits simply because the cost of health care is exploding, not because of any sort of bureaucratic inefficiency. You have to begin by making a basic decision: is the country going to provide health care to elderly people, whose health care costs are much higher than those of young people, and who do not have employers to pay the cost of their healthcare?
What is the alternative to Medicare? Given that the costs of Medicare are substantially less than those of private insurance. Do you junk Medicare and let all those senior citizens fend for themselves? Who is going to pay what would truly be exorbitant rates for their health insurance? Many if not most wouldn’t even qualify for private health insurance, because of pre-existing conditions and because of general actuarial considerations.
Medicare would be in less trouble, were it allowed to negotiate over prescription drug prices, something which it is prohibited from doing because of GOP sponsored legislation.
The overall costs for caring for the elderly are lower under Medicare than they would be under private insurance, yet, as noted, Medicare insurance is a superior product, by all objective criteria. Thus, Medicare is a government program which works.
Moving on to your consideration of the French system. As a minor point, you don’t provide a link to that article which you cut and paste. As a major point, I don’t think that you understand that the article supports my point of view, more than it supports yours.
With regard to the French system “going broke:” It’s only “growing broke” for the same reason that the US Medicare system is “going broke.” This is, again, not because of bureaucratic inefficiency, but because the cost of health care in general is going through the roof. In the US private sector, insurance premiums are rising 30% per year. This is unsustainable. In both the US and France, costs in the publicly funded systems are not rising as rapidly, but they are rising rapidly enough to present both systems with major challenges.
With regard to the money made by French doctors, it is an average of $149,000 per year for specialists and $92,000 per year for GPs. This is low by US standards, but there is a virtually limitless number of highly qualified pre-med students in the USA who would be happy to work for these compensation levels, if given the chance to enter the profession of medicine through expanded medical school enrollments, now tightly restricted, as described in my earlier comment #1.
Aye goes on to give an example of a French hospital “shuttered by cost cuts.” Many US hospitals close each year. Where I live, in one of the wealthiest counties in the USA, the Irvine Medical Center, in the “Platinum Triangle,” for goodness sake, failed, for the same general reasons that lots of private businesses fail. Flawed business plan, poor management, poor performance. Aye gives an example of a child who had to be taken 30 miles to the nearest hospital. For Aye’s information, this is not at all unusual, here in the good old capitalistic USA.
Aye includes a complaint by French unions, echoed by some French doctors, that the French government, in an attempt to control costs, is trying to turn health care into a lucrative business, rather than a public service. I don’t think that Aye appreciates the irony. This simply refers to attempts to cut public costs by pushing more privatization. “Borrowing US tactics,” as it were.
But this simply means trying to institute Medicare style co-payments, to reduce overutilization. This doesn’t mean junking the French system and going to a US style system. It simply means that if something is given away for free, it will always be used in a wasteful fashion; in an era of exploding costs, it makes perfect sense to institute co-payments and other measures to discourage wasteful utilization. This will provide further opportunities for the private insurance sector, which is the same sort of thing which will happen in the US, if/when there is “competition” between public and private health plans.
With regard to the claim that French “health care is being rationed” (e.g. by hospital closings), for goodness sake, this goes on in US private health care every day. Again, what is rationing? It is not prohibiting anything, it’s simply saying that the insurance agency (public or private) won’t pay for it. There is vastly more rationing which goes on with Blue Cross and Aetna and US Healthcare and Humana and Kaiser than goes on in Medicare.
@Mata (will address yours in point by point detail):
In principle, I agree with you. This is the type of plan that I have for myself — I do wish there were more choices of this type available. The problem is that this type of approach doesn’t solve the problems of exploding costs and legions of uninsured. I have reluctantly come to the conclusion that what works personally, for me and for you, won’t work on the macro scale of the entire country.
Well, for starters, it would help for you to be specific. In what particular area of providing health care for the masses does private insurance outperform Medicare?
With regard to the second point, the issue is this: Public health care (including Medicare) always costs less than private health care, because health care is not a true market system. Someone has to pay the bill, and that someone is all of us. One way or the other, people need health care. One way or the other, someone has to pay for it.
So my argument in favor of a “public option” is that its overall cost will be less than would the overall cost be of providing health care strictly through private insurance.
An equally important issue for me is that I do believe that we, as a people, should provide basic health care for all of our citizens (and especially children and the elderly), in the same way as we provide basic police, fire, public health, national defense, and education benefits. This is a classic liberal vs conservative issue; either you believe in this or you don’t. There is no answer for which point of view is correct; it’s a matter of personal philosophy.
Firstly, I agree that tort reform is an important component to controlling costs. I agree that the Dems are in the pockets of the trial lawyers (just as the GOP is in the pockets of the pharmaceutical industry). Tort reform won’t be part of the first bill which gets passed. It may have to wait until the pendulum shifts, and the GOP is back in control of things.
With respect to the bills not being a “French style system,” I don’t entirely agree. As I wrote above, I think that the likely outcome of including a public option is a gradual migration to a system very closely resembling the French system. I explained this above.
With respect to physician reimbursement levels, once again, the average earnings of French specialists is 150K and GPs 92K (In the US, it’s 230K/161K, respectively). In the USA, it will certainly remain considerably higher than in France, though less than it is today. My older daughter will enter med school next year; she’ll end up with a $250K mortgage on her future. There are legions of highly qualified young Americans who would be more than willing to incur this level of debt for the privilege of having the greatest job in the world and getting paid in the neighborhood of $150K to do it, even with the debt. By the way, I think that GPs can and will be largely replaced by nurse practioners, with no diminution is quality of care. This will happen, no matter what, because med students are opting out of primary care in droves, these days.
My personal story is a testimony to how well Medicare really does work, in the real world. I provide a very unique service. Were I located in Pennsylvania, the Medicare contractor there (Highmark Insurance) reimburses $3600 for the general type of service which I provide. Here in California, the Medicare contractor (Palmetto Insurance) reimburses only $1100. Were I located in Pennsylvania, I would opt in to become a Medicare provider. Here in California, it didn’t make economic sense for me to remain in Medicare; the way that I do my job, I’d lose money. Other providers here offer a service of the same generic type, only it is a more basic service, costing much less to provide. So I have complete freedom to either participate in Medicare or opt out, whatever makes the most sense. Medicare beneficiaries in California can choose to obtain a basic level of service, which will be paid for by Medicare, or, if they choose and are willing to pay for it themselves, they can obtain my “concierge” level of service. I’m confident that, one day, the California Medicare contractor will realize that what I do is both effective and cost effective, and will pay me what I need to be paid to offer this service within the Medicare system. When that day comes, I’ll opt back in; until that day comes, I’ll continue exercising my right to opt out. Pure, unrestrained capitalism.
Isn’t this rationing? Well, Blue Cross of California won’t pay my fees for my services and they won’t pay even the $1100 for the more basic level of service for which Medicare does pay. So who’s getting rationed more? A Medicare beneficiary or a Google employee with Blue Cross?
You are (inadvertently, I think) twisting my words and arguments. It is not that the admissions are too stringent, it’s that the number of places open in American medical schools have been cut back drastically, to reduce competition. It was a purely selfish move by organized medicine to reduce competition and thereby protect the income of its members. My statement was that reducing physicians’ compensation levels would not reduce the supply of physicians, because there is a huge abundance of highly qualified pre-med students who would jump at the chance to go to med school and work for even greatly reduced compensation. There is no inconsistency at all with my statements on this, much less a 180.
I’ll look it up and get back with you. Hope that your trip achieved what you hoped it would.
– Larry Weisenthal/Huntington Beach, CA
#14 Wrote out detailed reply (took me nearly 3 hours). Went to spam. Can someone salvage it? Thanks. – Larry W
I expect that the vast majority of Americans would be perfectly happy with the “public option” as their only health insurance, as is the case in France.
It is worthy to note that the ‘French system’ is increasingly remaking itself into the current American healthcare system.
The WSJ notes: Assurance Maladie has been in the red since 1989. This year the annual shortfall is expected to reach €9.4 billion ($13.5 billion), and €15 billion in 2010, or roughly 10% of its budget.
With respect to your post on South Carolina and Florida, these pertained to Medicaid, which is a certified basket case/mess. Medicaid is simply a cobbled together patch to provide health care for the uninsured, indigent, and, yes, “illegal” segment of the health care seeking population. Health care reform would greatly assist Medicaid in cleaning up its mess, by taking large numbers of the uninsured (though leaving behind the “illegals”) out of the Medicaid system.
This is a bellweather for what will become of Obamacare. We can do better that what has been proposed – perhaps we need a change in the House and Senate before we can get to a sensible healthcare plan.
weisenthal opines:
“…for anyone worried about “rationing” or waiting in line or other such bogeymen.”
Bogeymen? Please look at British national health. And Canadian, which makes liberal use of the American medical industry to supplement their lack of care.
“Facts are that Medicare produces the highest level of consumer satisfaction of all the major medical plans; costs the less; and results in the fewest personal bankruptcies.”
How is this a “fact”? Medicare costs the “less”- uh, look at the graph provided by Aye Chihuahua, that doesn’t look like inexpensive healthcare to me. You might have something with the “personal bankruptcies”, but that becomes somewhat irrelevant in the face of a “national bankruptcy”, now doesn’t it?
Nice try, but fail.
@ # 17 (above):
Both you and Aye either do not understand or are intentionally avoiding the real issue:
Cost of health care.
Total cost = Taxes + Insurance Premiums + Patient out of pocket co-payments. These total costs are substantially lower under Medicare than they are under private insurance. Medicare provides a superior product at substantially lower costs, that is the real issue.
With regard to “national bankruptcy,” what is the alternative to Medicare? Most Americans get their health insurance through their employer. Who employs the Medicare population? Self employed Americans, like me, buy their own health insurance. Most Medicare beneficiaries are not self employed and have no income, outside of their retirement. How do they buy private health insurance? The costs of private health insurance (other than supplemental to Medicare) would be utterly prohibitive, given that huge numbers of Medicare patients have pre-existing, serious illness, owing to age, and all Medicare patients will eventually require end of life care, which is the most expensive component of health care.
The fact that American Medicare and French national health care have had costs go up through the roof has nothing at all to do with bureaucratic inefficiency or fraud or anything else relating to stereotypical government ineptitude. It has everything to do with the geometric-like increase in health care costs, which have nothing at all to do with Federal bureaucracy.
The fact is that Medicare is the most successful health care program in the USA, with respect to providing the most cost-effective and consumer-satisfying medical care now available. What, precisely, is the more promising alternative to Medicare? What will provide decent health care to the Medicare population at a lower overall cost?
With regard to Skye’s points regarding the French system, their costs have exploded, along with the costs of Western medicine everywhere. But Skye, like Aye, avoids the real issue:
Total costs of health care and total quality of health care. By any measure whatsoever, both Medicare in the USA and the French national health care system provide a superior product at a lower cost. Once again, neither Americans nor French citizens are constrained from purchasing supplemental private insurance to supplement their excellent basic public insurance. Many French companies provide such supplemental insurance to their workers. Most Americans buy such supplemental insurance.
British and Canadian health care have nothing at all to do with any plan under consideration in the USA. In the Canadian system, competing private insurance and competing private medicine is prohibited by law. It is a true single payer system, unlike any other health care system in the Western World. Such a system will never be put into effect in the USA. It would be supported by only hard core Left Wingers. It is completely unlike the systems in place in France, Spain, Germany, Norway, Sweden, Australia, etc. and, again, completely unlike the systems being proposed for the USA In the British system, most of the doctors are government employees and most of the major hospitals are owned by the government. It is a truly socialized system, yet the British love it. No one is supporting such a system or would support such a system here in the USA. The British system is disparaged by the French, who pointedly refer to the system as one of “socialized medicine,” which the French do not support and wouldn’t tolerate. Yet even the British system is not single payer, in that it does not prohibit private health care and private insurance and about 15% of the British public does have private insurance and private health care to supplement their national health care service.
There are three reasons for reforming US health care:
1. Non-sustainability of exploding health care costs under the private insurance-dominated system (recent 30% per year increase in insurance premiums).
2. Inadequacy of private health insurance: lifetime coverage limitations; gatekeeping, leading to delays in seeing specialists and in obtaining needed drugs and procedures; lack of coverage for off label drug indications and cutting edge diagnostic tests and treatments; an epidemic of personal bankruptcies, because of the preceding. The number one cause of personal bankruptcy in the USA are health care catastrophes in people who have health insurance and think that their medical needs will be met by their insurance, only to find out that American private health care insurance fails to be there for them, when they most need it. Virtually all of us are a catastrophic illness (or accident) away from personal bankruptcy. This is not the case in the rest of the Western world.
3. The enormous problem of the uninsured.
– Larry Weisenthal/Huntington Beach, CA
My reply to #16 and #17 went to spam. – larry w
Great thread Skye and excellent comments. It would hard for any reasonable open minded person, even a Republican, not to conclude that Larry makes compelling and experience based arguments , even down to the admission/question of healthcare being a right (although I do disagree with the overstatment of the number of uninsured, as much of it is by choice, not lack of availabilty). Indeed Larry is correct that we have a philosophical (political), honest difference of opinion which I doubt is going to be resolved any time soon.
So let’s say that we all win over to Larry’s point of view (which isn’t really, I don’t think, too much of a stretch for most FA folks). In doing so, we would all be wise to consider what Presdent Obama recently told us about the government working with the private system, using the Netherlands as the “splendid” example.
.
It’s really important to read the whole thing, from one sharp bioethics attorney, Wesley Smith who now devotes his entire career to these issues. I recommend perusing his entire blog, as it contains much of what you will never see or hear about in many other places.
If hearing Obama’s own words aren’t scary enough, let me remind you who his regulatory (operative word) is, Cass Sunstein, who’s as far left as left can go, especially on human rights. Sustein is also my personal prediction for the next SCOTUS . He’s also a paternalist, and of course, consistent with many of the White House Harvard elites who know SO much better the needs of “we the simpletons.” And if being the Obama head of regulatory isn’t scary enough, consider his last book, ‘Nudge’, with behavior economist Richard Thayer, another “Chicago Player.” If , you can understand what ‘Nudge’ is really about, you will understand how we will get to where Palin thinks we are going and then as “How did this happen?” Never under-estimate a brilliant legal mind, the head of regulatory, and the “great ability to tweak.”
Forget about any check and balances, as we all the appointed like minds are in place.
Bottom line, even with Larry’s best defense (which is quite good), what he fails to take into consideration is the million dollar question, of “Who’s regulating.”
So Larry I would like to ask you a direct question. Would you be fine with all that you support PROVIDING there is iron clad language for a conscience clause, no nationally funded abortions, respect for all human life, no excessive financial taxation on any one group, and one more thing I believe is very important, no government access to patient records?
May guess is you will say yes, but even if so, it will NEVER pass with those restrictions, which sadly, as much as it upsets many, brings us back to the LOGICAL CONCERN over life and death issues. After all, as I posted earlier this week, the plutocrats (and Obama advisors) have one “philanthropic” goal they all agree on, population control. Considering the current administration, it’s more than a logical leap to assume there is more than meets the ‘average eye’ in Obama healthcare “reform”, even if it wouldn’t prove to be financially catastrophic.
Spam I am! Thanks
Pat (#20) asks: Who’s doing the “regulating?”
That’s simple. In the USA, it’s never Federal Bureaucrats, meeting behind closed doors. Coverage decisions are made openly, with full transparency and opportunities for public input, comment, scrutiny. For the most important decisions, outside panels of experts are convened, representing doctors, nurses, the insurance industry, patient advocates, social workers, etc. These proceedings and deliberations are open to the public, for the most part, and all of it is public domain information. Compare and contrast this with the way it works in the private insurance industry, which is accountable to no one, save shareholders, where these decisions are made in private, behind closed doors; where public input, critique, commentary is neither welcomed nor a formal part of the process, and where ultimate coverage decisions are not subject to any legislative oversight.
Let us say that Pat’s suspicions are, indeed, true. Obama is truly an agent of the Devil, who seeks to consolidate ultimate control over life and death in his own hands. Neither he nor his administration could possibly get a law passed which gave him such unprecedented dictatorial powers, truly evocative of Hitler.
But, if you say things like this loudly enough, you can eventually scare a lot of people.
Let’s look at Sarah Palin, for example.
The House health care bill has the exact same language regarding “end of life counseling” as prior Medicare bill proposed by Orrin Hatch in 2004, and Sarah Palin charges that Obama wants to kill old people and kids with Down’s syndrome. Thanks to her histrionics, with the support of the GOP, that particular provision was taken out of the bill, which will result in thousands of people having their ribs broken from futile CPR performed, with breathing tubes rammed down their throats, while their bodies are receiving multiple jolts of 200 watt-second electricity. And then there will be the additional thousands of with terminal cancer who will put their families in debt and cost the government billions with futile chemotherapy instead of receiving end of life hospice care. But it was sure worth it, to score those political points.
– Larry Weisenthal/Huntington Beach, CA
My reply to #20 went to spam. – larry w
It would hard for any reasonable open minded person, even a Republican, not to conclude that Larry makes compelling and experience based arguments ,
I’d like to see the peer reviewed data supporting his opinions. Larry is full of opinions, and empty of data.
These total costs are substantially lower under Medicare than they are under private insurance
Thanks to DRG’. The difference in cost is passed on to private insurers and spending restcrictions (i.e rationing). These costs also don’t include the unfunded mandates that are required by hospitals who admit m/m patients. Hospitals accepting these patients are squeezed of every penny – and yet the costs of M/M are skyrocketing.
In the USA, it’s never Federal Bureaucrats, meeting behind closed doors. Coverage decisions are made openly, with full transparency and opportunities for public input, comment, scrutiny. For the most important decisions, outside panels of experts are convened, representing doctors, nurses, the insurance industry, patient advocates, social workers, etc. These proceedings and deliberations are open to the public, for the most part, and all of it is public domain information.
Yeah…only in your dreams larry.
Thanks to her histrionics, with the support of the GOP, that particular provision was taken out of the bill, which will result in thousands of people having their ribs broken from futile CPR performed, with breathing tubes rammed down their throats, while their bodies are receiving multiple jolts of 200 watt-second electricity.
That is not a decision for you or a DC panelist to decide. Quite frankly, Sarah Palin has engaged the public to read the provision in which doctors are incentivised by government funding to conduct ‘end of life ‘ counseling. There is no problem with discussing with your family, doctor, priest or rabbi about what your wishes would be, but the government has absolutely NO place in such a discussion – let alone giving out funding.
Larry, I’ve been present at numerous codes, don’t you dare minimize the lifesaving skills involved or the decisions made by family members.
No time at the moment to do any in depth posting on this subject.
I will, however, address this one snippet of what Larry had to say earlier.
Who is in this category of “hard core Left Wingers” to which Larry refers?
Well, let’s see what the evidence has to say shall we?
Roll the tape:
2009:
This is what he told us before.
2003:
2007:
Well damn!
The joker in that video looks a helluva lot like B-rock Obama….the guy that Larry voted for last November. Of course, Larry would never admit that BO is a “hard core Left Winger”. That would require consistency and, as we all know, consistency is not Larry’s strong suit. (More on that later, when I have more time to devote to it.)
President Obama has a problem keeping his story straight.
Perhaps Larry will try to convince us all that that’s not really BO in those videos at all, but rather a Republican sponsored impersonator.
Then we have Senator Barney Frank. (You’ll notice that Frank doesn’t oppose single payer.)
Roll the tape:
Here are some of the people who are behind the scenes pushing this. (Do some reading on Dr. Jacob Hacker and the Tides Foundation). Take note of Hacker’s “Trojan horse” statement.
Roll the tape:
Here’s Senator John Kerry. (You’ll notice that he doesn’t express an opposition to single payer. He just makes the argument that there aren’t sufficient votes at the moment to get it through.)
Roll the tape:
Senator Mikulski “not opposed to” single payer.
Roll the tape:
Rep. Henry Waxman, not opposed, just not enough votes.
Roll the tape:
HR 676 now has 93 Co-Sponsors in addition to Rep. John Conyers, the sponsor.
In the British system, most of the doctorst are government employees and most of the major hospitals are owned by the government.
They love it enough to spend untold millions out of pocket for backdoor medicine because the NHS is not providing quality care.
I will tell you the hospitals are overburdened and struggling with skyrocketing CVC-BSI HAI’s ( Central Venous Catheter – Blood Stream Infection, Hospital Acquired Infection.
http://www.hps.scot.nhs.uk/haiic/ic/wrdetail.aspx?id=39233&wrtype=6#images
This report looks at Staph Aureus bacteremias – you have to remember the resistant GNR’s and C.diff as well.
I would want to be stabilized and shipped to America instead of having a central line placed in NHS.
The British like it because they know no better – we do – and the difference is everything.
There is vastly more “rationing” which goes on with Blue Cross, Aetna, United Healthcare, Humana, Kaiser, et al than goes on in Medicare. Providers aren’t forced to care for Medicare patients; if the provider wants to opt out of Medicare, he/she can. I did (opt out, that is), as described above (#14).
Yes, Medicare costs are skyrocketing; costs for purely private insurance funded health care are skyrocketing even faster.
Quoting me:
Skye retorts:
Actually, no. In my real life; not in my dreams. I wrote before of my personal experiences with Medicare coverage decisions (“rationing”, with complete and utter transparency) vs purely private sector coverage decisions (“rationing,” on steroids, and with complete and utter opacity).
Here’s how the M/M coverage decision process works:
http://www.acr.org/Hidden/Economics/FeaturedCategories/Coverage/nmcd.aspx
It is a completely open and transparent process, safeguarded by legislative oversight.
Quoting Pat:
Skye disparages:
Flopping Aces as a peer reviewed journal?
Who knew?
If you wish to directly challenge a statement or claim I’ve made, please feel free to do so, providing, if you will, “peer reviewed data.”
– Larry Weisenthal/Huntington Beach, CA
I just wrote out a reply to Skye’s #24,25,26, but it went to spam. All of my comments go first to spam. It is hard to carry on a debate with this technical obstacle. I notice that others are having similar problems. Is this a technical glitch?
With regard to:
This is a total straw man. When did I ever “minimize the lifesaving skills involved or the decisions made?”
“End of life” issues are HUGE. They are a huge problem for many if not most families in America. There is an enormous amount of the total health care economy spent on care during the last 90 days of life. The number one cause of personal bankruptcies are health care expenses in people who have insurance and this extends to the families who survive the death of the patient. These are real issues and these are issues which need to be dealt with. The only reason that my mother got a living will — in the three weeks of her life — is that I got her to write and sign one. The only reason that my 96 y.o. Dad now has a living will is that my sister got him to write and sign one. So are both of us responsible for “killing” our parents? I don’t think so; our parents are fortunate that they have doctors in the family who understand what goes on at the end of life; most people don’t.
Is is remotely possible that provisions for “end of life” counseling could be misused? Yes. Is that a reason not to include it? No.
I’m sure that, whatever bill passes and gets signed will indeed have language to mollify the critics — although I’ve read the language and, for the life of me, I don’t see anything at all in the language of the bill, as it is now written, which would give me the slightest concern whatsoever.
With regard to Aye’s “roll the tape,” it’s a semantic red herring.
What’s the meaning of “single payer?” Well, there’s single payer like Canada; no competition allowed. Then, in a looser and more generic sense, there is “single payer” like Medicare, where competition is allowed. No one’s proposing Canada and there’s no chance that this would ever pass. Few people are proposing “Medicare for all;” though that would be a vast improvement over th present system. Best of all is the French system, as I argued above. Which isn’t to say that even the French system couldn’t be improved; the French have been tweaking and improving their system since it was instituted, and they continue to do so.
– Larry Weisenthal/Huntington Beach CA
@Skye (#29). Who’s advocating a British system (doctors employed by the government/hospitals owned by the government)? No one. Another straw man. And my reply to #24,25,26,27 went to spam. Sigh. – Larry W
@Skye (#29). Who’s advocating a British system (doctors employed by the government/hospitals owned by the government)? No one.
It pays to actually READ the bill:
Page 241: Doctors: no matter what speciality you have, you’ll all be paid the same (thanks, AMA!)
Page 253: Government sets value of doctors’ time, their professional judgment, etc.
Page 265: Government mandates and controls productivity for private healthcare industries.
Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.
Feel free to fact check HERE
End of life” issues are HUGE. They are a huge problem for many if not most families in America. There is an enormous amount of the total health care economy spent on care during the last 90 days of life.
Again, end of life decisions are no place for a government panel. It lends to the idea that cutting these enormous costs is to not provide it…talking people in an early death.
There is an enormous amount of the total health care economy spent on care during the last 90 days of life. The number one cause of personal bankruptcies are health care expenses in people who have insurance and this extends to the families who survive the death of the patient.
Filing for bankruptcy is not the end of the world – denying care is.
Please cite your source for personal bankruptcies.
Is is remotely possible that provisions for “end of life” counseling could be misused? Yes. Is that a reason not to include it? No.
There will be widespread abuse, especially with incentivized doctors who aren’t getting paid well under Obamacare.
The fact you either don’t know or just willfully ignoring is that this discussion occurs with EVERY inpatient in EVERY hospital in the nation. The front page of care/progress notes are required to include the code status of the patient. Basically, this tells your care team what you want done OR not done regarding your care at end of life occurrence. You, the patient, are dictating your ‘end of life’ practices. The patient or POA for the patient has every right to change the status during their stay. If I were hospitalized today, I would be asked to verify and sign a form detailing my ‘code’ status (FYI: it would be FULL CODE).
From Skye (#27):
I doubt that any doctors do more “end of life counseling” than oncologists; so I feel well qualified to address this issue, head on. With 50% of deaths from cardiovascular disease, the first symptom is sudden death. No end of life counseling required. But with cancer, in the roughly 50% of cases where it’s not cured, there is virtually always a situation where end of life counseling is appropriate.
Cancer patients usually have unrealistic expectations. They always want to go for the cure. This is all well and good; I’m an optimist, and it takes a lot to convince me that a given situation is truly hopeless. It is so easy to just keep giving more chemotherapy. It takes 5 minutes to write out an order for an infusion regimen which results in hundreds to thousands of dollars of private insurance and/or Medicare reimbursement. It can easily take an hour to raise and discuss the issue of eschewing further chemotherapy and, possibly, entering a hospice. And this currently provides no reimbursement for time spent. This is the sort of “end of life counseling” which is most in need of reform. And it affects hundreds of thousands of patients every year.
Because of the efforts of Ms. Palin and her ardent, albeit hysterical supporters, there is now no possibility that “end of life counseling” will be component of health care reform. This is a great pity, on many levels.
– Larry Weisenthal/Huntington Beach, CA
From Skye:
Here’s my source (duly peer reviewed):
http://www.washingtonpost.com/wp-srv/politics/documents/american_journal_of_medicine_09.pdf
From Skye:
This is the sort of hysterical fear-mongering which would make Al Gore blush. How is care “denied?” What you are speaking about is which medical services a given health care plan will pay for and which services it will not pay for. This is what is commonly referred to as “rationing,” and it is much more prevalent in the privately-funded health care system (e.g. Blue Cross, Aetna, United Health Care, Humana, Kaiser) than it is in the publicly funded health care system (e.g. Medicare). If you are “ration-averse,” then just go out and buy some private insurance, to supplement the base level of coverage provided by the public system. This is what the French people do, and it works perfectly well for that.
Despite Aye’s deep suspicion over the deep, inner wishes of Obama and some very liberal Democrats, none of the various health insurance reform bills under consideration prohibit private insurance, as either an alternative to publicly funded insurance or as a supplement to it.
I do not have the position that the House bill is perfect. No one has yet discovered health care Utopia. It is perfectly appropriate to shine a bright light on provisions of the bill which are troublesome. I’m not an advocate of rushing any bill through. I think that the bill does provide a useful “rough draft,” which will certainly undergo a lot of modification before it passes the House and before it gets reconciled with an independent Senate bill and signed into law. I am even supportive of the vigorous efforts to delay passage of the bill; I’m confident that these efforts will result in a much better bill than might have been passed before the recess. It it takes another year to get an insurance-reform bill passed and signed into law, that’s all for the better. We’ve waited decades for fixes to our broken health care system, and another year to get it right would be just fine.
– Larry Weisenthal/Huntington Beach, CA
Reply to Skye (#35) went to spam. – Larry W
From Skye:
Yes, I am familiar with the process. Patient checks into hospital. Patient directed first to a clerk, who collects lots of information, has the patient fill out and sign numerous forms and present several documents. At some point, the “code” sheet is passed to said patient. There is no discussion about what goes on in a “code” (and, yes, I’ve personally broken my share of sternocostal articulations and ribs in the process of carrying out such a “code;” I’ve also given mouth to mouth resuscitation to strangers (twice, including one case complicated by violent patient vomiting). Most patients (including my parents) don’t like thinking about those things. In my experience, it’s pretty random, what choices get made. Often, doctors stop by on rounds, are told by the nursing staff that a given patient who should be a “no code” has not been duly documented. So there is a perfunctory bedside conversation, which could have/should have been an unhurried discussion in an office setting far in advance.
But the “code”/”no code” decision is only a small part of “end of life counselling” (see #37).
– Larry Weisenthal/Huntington Beach, CA
Reply to Skye #36 went to spam. – larry w
Larry I don’t even know where to start, except to say you often avoid many difficult questions and/or hard evidence.
You also contradict you own argument with end of life care. How can you be so convinced that the wording for docs is only about payment when you just admitted what we all know, that docs will be few and far between. If they aren’t busy enough treating their own families, they will be busy treating the elites, you know, the ones who won’t be on Obamacare, with little time left to be tending to grandma or the handicapped. NP’s (and I suspect even LPN’s) will be just fine for the end of life stuff (C’mon, how hard is an IV), especially without conscience clauses, which is one of the reasons I asked you specifically about them.
As for the living wills, I admit I often have said that every person needs at least one savvy medical person in the family for patient advocacy. While my family has sufficient medical folks, my parents were not medical, but somehow, even being devout Catholics, they managed to have living wills (compatible with Catholic Teaching BTW), by their own doing, years before they needed them. I too personally abhor extraordinary means for a terminal illness, but if someone wants to go for the 10th round of drug resistant chemo, who I am or anyone else to stop them? As Skye pointed out, life is far more important than money, and it isn’t our job to tell anyone else what “quality” of life they are allowed or not allowed to endure OR if they chose to risk bankruptcy in the process. I’ve written many times, some of life’s greatest lessons are learned at the death beds of loved ones.
Likewise, suffering has redemptive value. That might not mean much to the non believers, but for those of us who believe in life after death, union (and surrender) to God, is the ultimate meaning of life, trusting that if God’s will be done, there will be a profound reason for having allowed such suffering, and in the big picture, a small price to pay for eternal salvation. Many times it’s actually the person AT the bedside who benefits most from the suffering of the loved one, and always,like most things in life, it always above love.
Here’s one of the best articles I’ve ever read on suffering and death. (I seem to remember a longer version, but this will suffice to make my point)
Isn’t it ironic that with all this “my body right to choose” rhetoric that’s been going on for the last 40 years, how “choice” in healthcare now takes on a new meaning?
Anyone would have to be blind not to see the perils of “early termination” upon us. Absolutely everything is in place, from legal assisted suicide, to an entire handpicked death culture in the current administration. Even worse, it’s not a secret! Just like Obama is “transforming” America as promised, the radicals in the WH will do all in their power to finally rid us of the silly notion that all human life, from conception to natural death, has value. They already told us by their books and their actions.
The one thing you do respond to is objectivity, as you have many times reminded us that “As the economy goes, so goes Obama’s 2nd term “(as if a 2nd term is really his goal). Regardless, it will be “objective”, for all to see soon enough. The other thing that will be objective is healthcare with a conscience clause. If health reform under Obama passes WITH an iron clad (and I mean IRON CLAD) conscience clause, AND no funded abortions, I’ll be the first to admit that I was totally wrong. In the meantime, I’ll just keep following the big money (and hoping you address the conscience clause).
In spam again #42
At some point, the “code” sheet is passed to said patient. There is no discussion about what goes on in a “code”
Bullshit, Larry – the patient physician and/or POA go over the form, checking off actions they choose to have performed on them in the vent of a code. Part of the form asks if the patient/POA understands their options.
(and, yes, I’ve personally broken my share of sternocostal articulations and ribs in the process of carrying out such a “code;”
You have very poor technique that would cost you your job in Pa. I’ll bet you routinely break antiseptic technique as well. I’d hate to know how many HAI’s have been attributed to you. Although, we don’t like to place blame…
I’ve also given mouth to mouth resuscitation to strangers (twice, including one case complicated by violent patient vomiting).
So what? You want a medal?
Often, doctors stop by on rounds, are told by the nursing staff that a given patient who should be a “no code” has not been duly documented.
The doctors should be reading charts before seeing a patient, and documenting code status is a Joint Commission requirement. If the nursing or physician cannot do the job tasked to them, they need to be fired.
If you are “ration-averse,” then just go out and buy some private insurance, to supplement the base level of coverage provided by the public system.
So pay twice the amount for the healthcare coverage. Pay out of pocket and pay outrageous taxes for diminishing public coverage. This is bad medicine all around.
This is the sort of hysterical fear-mongering which would make Al Gore blush. How is care “denied?”
You prove this true by stating that the french have to purchase additional healthcare to cover what the public option doesn’t….sounds like rationing to me!
Here’s my source (duly peer reviewed):
http://www.washingtonpost.com/wp-srv/politics/documents/american_journal_of_medicine_09.pdf
A low powered study that includes self reporting in its data set. I hold little confidence in this study.
@openid.aol.com/runnswim:
Dayum!
I reaallly hate it when those darned GOP presidents make secret deals with big PhRMA after telling the American people that they will have all of the negotiations in the open on C-SPAN.
Those darned GOP presidents. Making deals with the very people that they excoriated on the campaign trail.
Don’t you just hate it when that happens?
Oh….wait, Obie’s not a GOP prez is he?
My bad.
Can anyone answer why in the state of California as a self employed person, I have only two insurance companies from which to choose.
Is it because only two companies care to compete, or is it mandated by state or federal government?
Because if you’re a sole practitioner, you cannot qualify for “group” plans where pre-existing conditions cannot be denied, Tom. To qualify for a group plan, you must have at least one (or two?) W-2 employee(s) (even tho you are a 1099/indy contractor). They also have husband/wife groups available.
Can’t do those? Then you are relegated to the HSA (medical account plans) or an individual health plan with high deductable and more out of pocket expenses. You can also work an HSA along with an indy healh plan.
However this is why I’ve been saying (along with many other conservatives) that allowing independent contractors the ability to form a “group” would help bring down costs for many.
This stuff is regulated by the state. You might want to read this article. It’s got links to two guides… one for small business health insurance, and the other to California’s Dept of Insurance and their regs.
Not quite back full time yet, Larry. Maybe tomorrow. Certainly back from Florida, but now playing work catch up.
Just a couple of fast notes from me at the moment.
No one’s talking about junking Medicare. We’re talking about taking a system that loses cash hand over fist (for whatever reason) and not putting over half the US citizens on it. As you point out, the majority of the French ended up there. You then say it cut costs, but they’re going bankrupt too.
The point being is that the public option is not the cure to the cost problem, and only exacerbates it.
And speaking of Medicare, perhaps you’ll let us know how they can propose $500 billion in Medicare cuts and still maintain that quality care everyone loves. (that’s a WaPo link, since you like to know where you’re going before you read…)
I do seem to remember you stating that in California, it’s just not a good business decision to be a Medicare participant. I can’t argue that one bit. And in fact, I’m arguing that – in light of their planned cuts via IMAC, Baucus and similar bills – there are far more of you around, and will growing in number every day. Therefore the system you praise today is set to be slowly dissected before your very eyes with these proposals.
I’ve said it before… right now everyone’s battling to keep what they have because they see the promised slashes and degradation of their care in all these measure. They add more population to the public burden, and do nothing to cut the drivers of cost.
CBS’s Dan McLaughlin had an interesting story about this cutting costs myth a couple of days ago. Says it’s less medical care, less cost for medical care, or eliminating the middle man (their latest bogeyman quest).
You also continue to blame the GOP for legislation that seems to prohibit negotiating prices down for drugs. Frankly, I think this nation has too many drugs…. but that’s neither here nor there. As Aye had to remind you of the Pharma/Obama deal. And I will remind you that it’s the Dems who are gifting drug manufacturers with 12 yr patents and thwarting generic drug competition to hit the market sooner rather than later.
Does not compute… does not compute….
They don’t need to reinvent the wheel, as the Big Zero and company are attempting to do. They need to get the trial lawyers and malpractice BS out, saving tons in unnecessary preventative medicine procedures.
Also, like for Tom above, to allow small individual groups to bond together and create a new “group qualified” plans.
They most definitely need to just allow the wealthier seniors to opt out of Medicare for private, and save beaucoup bit there. Instead they’re talking about charging the more affluent elderly more to pay for the less affluent elderly. How absurd. They are the ones who could leave the system and relieve a lot of that financial stress.
About the only things with a glimmer of reform is the electronic records. But even that is written up to be a data collection tool for the government. I agree records should be digitally stored to streamline bureaucratic red tape. But no government agency should have access to those records.
My guess is we agree on some basic principles. We just majorly disagree that this proposal gets us anywhere close to those basic principles.
I’m getting sick and tired of hearing all the DEM & GOP banter (read: BS.) over private insurance and government option(/single payer/nationalized health-care, etc…). What needs to be addressed that isn’t by any of the bills is: HOW TO SIGNIFICANTLY LOWER HEALTH COSTS!
This is why the Democrats and Obama are doing so poorly on this issue. They are ignoring the real problems and going after the insurance companies and doing other piddly-shit nanny government programs in their bills that NEVER will bring the actual costs down. If real medical costs hadn’t skyrocketed, medicare, medicaid may not be going bankrupt , our Vets would be getting decent health care, and more people could afford insurance. We could likely even afford some kind of free health care for the poor. Instead Democrats want to do social engineering and anti-capitalist political warfare against the insurance companies. (Not that I have that much sympathy for HMO’s)
1. We need more health care professionals of all levels. Have state run hospitals and medical schools take care of some of the poor patients.
2. We need to get a handle on the malpractice/tort situation. Some lawyers are getting too far overpaid for their services than they deserve, because they tell their clients “not to worry because their outrageous fees will be paid out of the settlement.”
3. The entire medical field has to have their high profit margins and price gouging reigned in. There has to be truth in billing, and enough already with doctors who see you in the hospital or E.R. for 2 minutes but bill you for 30.
4. Stop the damn illegal immigrants at the borders. Emergency room wait times and unpaid costs that are going to subsidize illegals E.R. visits will drop. If they still have to treat an illegal, call immigration to ship their ass home when they are stable and ready to be released.
5. Teach basic self-care and first-aid classes in public schools. Teach health, nutrition and how to take care of yourself to grade school kids. We had to learn use some of that in the Boy Scouts when I was a kid. (If they can handle geometry and computers, that stuff should be fairly easy.) While we’re at it BRING GYM CLASSES AND RECESS BACK! Dems complain about childhood obesity, but they are the ones that cut out physical training programs because of namby-pamby B.S..
6. Pharmaceutical prices must come down. The FDA needs to accelerate the drug approval process (within reason of course, allow trial waiver’s on potential lifesaving drugs to the dying who are willing to gamble on it’s success). If they are charging one price for medications sold to other countries, they need to charge the same price to Americans. I don’t buy that “unsafe Canadain drugs” advertising BS. If Canadian drugs are unsafe, what the hell are they doing selling them to Canadians?
7. Medical research must not get stifled. But if the government is funding it, then there has to be a trade-off on the results. I’d say that in government funded medical research, the researchers get full name credit and a bonus on successful discoveries/results, then their research and results become public domain.
8. Medical supplies/device manufacturers. This is an area where there is blatant profiteering. If you’ve ever had to buy a wheelchair, hearing-aids, etc. you know that I’m talking about.
I’m sure there are lots of other ways that we can really reduce medical costs without ever needing to go through all the “one-payer”/socialized medicine crap the Democrats want to shove down our throats, and without ignoring the problem like the GOP has done.