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Dems giving away store on immigration & obamacare

Races for the Senate, U.S. House, etc. and other issues of national importance.

Re: Dems giving away store on immigration & obamacare

Postby snoqueen » Sun Mar 10, 2013 12:14 pm

So you want us to depend on the "good will of the provider?" Don't make me laugh.

Insurance companies' interest lies in making a profit.

If they can provide acceptable care and still make a profit, they'll provide it -- on their terms. If they can't, they cut the care before they cut the profit. Otherwise, their enterprise fails (in the business sense).

I have been medicare-eligible for a little over a year and believe me, it's the craziest system imaginable. It's better than solely private insurance because it's costing me around $400 less per month, but it's so complicated I had to find an insurance professional to sort it out when I enrolled. Parts A, B, C, and D (or something) are all totally different and while some you just sign up for, send in a form, and you're in, others basically require signing up (over and over again) for one of an array of private insurance policies.

I tried figuring out for myself which was most suitable and realized I was totally over my head. When I consulted with a professional, I found out the policy I thought was best wasn't at all. I ended up signing for two different ones instead. I have no way of knowing whether this advice was sound or not. I gave up and went with it.

All I can tell you is I'm paying that $400/mo less, so I ought to be satisfied and in a way I am. I can't complain, in other words. But I've got no way to know for sure.

For the record, I am educated, literate, and I can understand numbers. I've got no idea what those who cannot do when they enter Medicare. It's certainly an imperfect system but it's better than no system at all. God forbid we should go all to vouchers -- then even the basic part of Medicare (is that A?) will be as scrambled as the B, C, D part. I am sure it'll cost more, and I'm sure more people won't be able to afford what some can't afford now.

I support the Medicare system and I support clarifying it and cleaning it up. I'm sure there are suppliers that have found ways to play Medicare for a profit (I can cite examples) and detecting and reining in those abuses should be an ongoing part of the program. So should other cost-control measures. But it's still better than buying my own insurance every month. I've been there (I was there about 30 years, in fact) and I don't want to go back. The more distance between me and private insurance companies, the better. Make no mistake -- they act in no one's interest but their own.

Oh, I take that back. If you own enough insurance company stock that your dividends and appreciation outweigh whatever they're gouging you for, then I suppose you think the system is working just fine.

But geez. Why not move to single-payer universal coverage and be done with all this crap?
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Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Sun Mar 10, 2013 3:51 pm

snoqueen wrote: Insurance companies' interest lies in making a profit.

Exactly right. So you have to rig the playing field in such a way that insurers can profit by delivering a fixed standard of quality health care, rather than by cherry-picking who they insure and when they pay. Obamacare goes a long way towards accomplishing this goal.

(My severe objection of turning-over medicaid to private insurers right now is that the regulation and public support is not in place to make it work. Insuring the poor is controversial. Even in a relatively compassionate state like Wisconson, we were never able to follow-through on the promise of BadgerCare.)

snoqueen wrote: But geez. Why not move to single-payer universal coverage and be done with all this crap?

Well, for one, you have to ask yourself how we get from here to there politically. It is a myth that a majority of Americans are ready to sign-on to medicare for all.
85% of the population already has health insurance, many of whom have generous, tax-exempt plans from their employer.
The elderly already on medicare are the most hostile of all to "socialized medicine." They got theirs, and they are afraid to see their own benefits diluted.

Medicare for all would be fine with me, and you are right, less crap. But it not the only approach to delivering universal health care. The most successful health systems around the world have public-private mixes, often with heavily regulated private insurance companies working as agents of the government.
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Re: Dems giving away store on immigration & obamacare

Postby Henry Vilas » Sun Mar 10, 2013 4:10 pm

Ryan says House GOP budget includes health care repeal

Is Ryan really serious about repealing health care reform, or is he just using that threat as a bargaining chip?
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Re: Dems giving away store on immigration & obamacare

Postby DCB » Sun Mar 10, 2013 5:01 pm

manoletters wrote: But but by now I completely doubt Obama's sincerity regarding the need to preserve important social programs.
http://www.commondreams.org/view/2013/03/08-2

from your link
That’s right: The White House has been trying to impose this benefit cut on Social Security’s elderly and disabled recipients for years, and Republicans don’t even know.


or
The idea that the sequester was to force both sides to go back to try at a big or grand barain with a mix of entitlements and revenues (even if there were serious disagreements on composition) was part of the DNA of the thing from the start.

Read more: http://www.politico.com/story/2013/02/e ... z2NAzqA5tR

while pretending otherwise:
http://digbysblog.blogspot.com/2013/02/ ... il-to.html

The smarter policy would be to raise the SS cap, get more revenue, and increase SS payments. Unfortunately Obama is caught up with deficit fever, so better starve granny.
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Re: Dems giving away store on immigration & obamacare

Postby wack wack » Mon Mar 11, 2013 8:36 am

Huckleby wrote:
snoqueen wrote: Insurance companies' interest lies in making a profit.

Exactly right. So you have to rig the playing field in such a way that insurers can profit by delivering a fixed standard of quality health care, rather than by cherry-picking who they insure and when they pay.


Or better yet, remove the profit motive completely from health care.
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Re: Dems giving away store on immigration & obamacare

Postby rabble » Mon Mar 11, 2013 8:45 am

wack wack wrote:Or better yet, remove the profit motive completely from health care.

I would like that too. But Huck is right, we've moved so far from that goal that I can't get my mind around the sociological shift it would take to get there.
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Re: Dems giving away store on immigration & obamacare

Postby DCB » Mon Mar 11, 2013 10:39 am

rabble wrote:
wack wack wrote:Or better yet, remove the profit motive completely from health care.

I would like that too. But Huck is right, we've moved so far from that goal that I can't get my mind around the sociological shift it would take to get there.

I don't think it would take a sociological shift in the public. Americans are much more liberal than most politicians think.

You'd just need some Democrats to wake up and lead. Just point out that the Republicans are completely full of shit and Paul Ryan can just go fuck himself.
When he unveils his budget plan this week, Rep. Paul Ryan (R-WI) will complete a 720-degree flip on President Obama’s cuts to Medicare providers in the Affordable Care Act.
...
In other words, Ryan and Republican leaders started off opposing the ACA’s Medicare cuts, then turned around and twice passed budgets that kept them, then campaigned against those cuts in the 2012 election, and are now embracing them again.

http://tpmdc.talkingpointsmemo.com/2013 ... e-cuts.php
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Re: Dems giving away store on immigration & obamacare

Postby snoqueen » Mon Mar 11, 2013 10:47 am

One way to begin removing the profit motive would be put doctors on salary (like at the VA) instead of paying them by how many procedures and tests they order.
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Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Mon Mar 11, 2013 10:51 am

wack wack wrote: Or better yet, remove the profit motive completely from health care.

Great Britian did that. They produced a system that the public cherishes and is proud of, but it did not deliver value - outcomes and wait times were not impressive given the massive spending.

The past eight years or so, GB has made dramatic efforts to re-introduce profit motive into an inefficient system. The results have been spectacular. I saw a graph somewhere that showed how dramatically health care spending has fallen in GB as percentage of their GDP.

Here is quick quote from wiki showing where things stand today:
Taken together, the World Health Organization, in 2000, ranked the provision of healthcare in the United Kingdom as fifteenth best in Europe and eighteenth in the world. A more recent report, the Commonwealth Fund survey of seven first world healthcare systems, ranked the United Kingdom as second overall, taking first place in subcategories including effective care and efficiency.
Overall, around 8.4 per cent of the United Kingdom's gross domestic product is spent on healthcare, which is 0.5% below the Organisation for Economic Co-operation and Development average and about one percent below the average of the European Union.


Canada likewise is trying to reinvigorate it's own network of private insurers and hospitals.
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Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Mon Mar 11, 2013 10:57 am

snoqueen wrote:One way to begin removing the profit motive would be put doctors on salary (like at the VA) instead of paying them by how many procedures and tests they order.


Yes. This is the key reform that needs to be made.

Massachussettes is already on a path to encouraging this reform, along with many other cost-controlling behaviors. MA is blazing the trail for Obamacare and beyone.

BTW, medicare-for-all doesn't take the profit motive out of the system. Insurance companies are sucking-out only a small slice of the profits in the health care system. The big culprit is the health care delivery system, from drugs to doctors to MRI scans.
Last edited by Huckleby on Mon Mar 11, 2013 10:58 am, edited 1 time in total.
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Re: Dems giving away store on immigration & obamacare

Postby wack wack » Mon Mar 11, 2013 10:57 am

Huckleby wrote:The past eight years or so, GB has made dramatic efforts to re-introduce profit motive into an inefficient system. The results have been spectacular. I saw a graph somewhere that showed how dramatically health care spending has fallen in GB as percentage of their GDP.

Here is quick quote from wiki showing where things stand today:
Taken together, the World Health Organization, in 2000, ranked the provision of healthcare in the United Kingdom as fifteenth best in Europe and eighteenth in the world. A more recent report, the Commonwealth Fund survey of seven first world healthcare systems, ranked the United Kingdom as second overall, taking first place in subcategories including effective care and efficiency.
Overall, around 8.4 per cent of the United Kingdom's gross domestic product is spent on healthcare, which is 0.5% below the Organisation for Economic Co-operation and Development average and about one percent below the average of the European Union.


Canada likewise is trying to reinvigorate it's own network of private insurers and hospitals.


While I accept that your intent may be genuine, it seems your Wiki quote tells me that the Apples ranked GB 18th in 2000, then the Oranges, in a "more recent report," ranked GB #2.
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Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Mon Mar 11, 2013 11:09 am

wack wack wrote:While I accept that your intent may be genuine, it seems your Wiki quote tells me that the Apples ranked GB 18th in 2000, then the Oranges, in a "more recent report," ranked GB #2.

http://en.wikipedia.org/wiki/Healthcare ... ed_Kingdom

Yes. That was the first quote I could find quickly. I'll find you better documentation if you are interested. Notice that the WHO ranked GB only 15th in Europe in 2000. That's pretty rotten for the system that is held-up as the ultimate example for squeezing out profits.

The WHO (World Health Organization) no longer gives out their rankings, not sure why. Whenever you hear the oft-repeated phrase "The U.S. ranks 37th in the world in health care" it comes from that 2000 report.

Here summary of the WHO report from 2000:
http://www.who.int/whr/2000/media_centr ... elease/en/

2010 Commonwealth Fund report:
http://www.commonwealthfund.org/Publica ... pdate.aspx

The quote I gave from wiki, though unscientific as you point out, is accurate depiction, G.B. has dramatically improved their system's performance. They actually spend larger share of GDB on health care today than they did in 2000, but that is because that figure has risen dramatically all around the world, the result of medicine getting more sophisticated and broad, IMO. But GB's costs have risen more slowly compared to rest of world as result of finding that optimum public-private mix.
http://www.guardian.co.uk/news/datablog ... ending-gdp

BTW, you are fundamentally correct that the problem with the U.S. system today is excess of profit motive. So don't beat yourself up. :)
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Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Sat Mar 16, 2013 5:16 pm

Why an MRI costs $1,080 in America and $280 in France

“In my view, health is a business in the United States in quite a different way than it is elsewhere,” says Tom Sackville, who served in Margaret Thatcher’s government and now directs the IFHP. “It’s very much something people make money out of. There isn’t too much embarrassment about that compared to Europe and elsewhere.”

The result is that, unlike in other countries, sellers of health-care services in America have considerable power to set prices, and so they set them quite high. Two of the five most profitable industries in the United States — the pharmaceuticals industry and the medical device industry — sell health care. With margins of almost 20 percent, they beat out even the financial sector for sheer profitability.

The players sitting across the table from them — the health insurers — are not so profitable. In 2009, their profit margins were a mere 2.2 percent. That’s a signal that the sellers have the upper hand over the buyers.
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