Obamacare will raise Healthcare spending by 0.1%

[kmcrawfo]

I read this article in one of my journals over the weekend. It is interesting that this bill was touted by the current administration and the democratic party at be essential to dramatically reduce healthcare costs. Now that the most recent studies show it will essentially be a wash it is being heralded as successful because costs did not go up. Anyone with a clue about government run healthcare, knows it will dramatically increase costs by magnitudes (we will see at least a 30-40% increase, I guarantee it).

Medicare estimates: When started in 1967 CBO estimated 12 billion by 1990. Actuall cost: 98 billion

Medicaid estimates: When started in 1987 CBO estimated 1 billion cost in 1992. Actual cost: 17 billion.

Obamacare: How much will the CBO be off this time.

Bottom line: The government never does anything efficiently and will not start here.

CMS Study: Reform Will Raise Healthcare Spending By 0.1%.
A new report showing that the healthcare law will increase medical spending only slightly is being hailed by supporters of the law as proof that it is successful, while opponents consider it evidence that President Obama's signature legislation has failed to reduce healthcare costs. Print media widely covered the release of the data.
Politico (7/29, Norman) reports, "The Affordable Care Act will drive health care spending up slightly, to nearly a fifth of the country's gross domestic product by 2020, while extending insurance coverage to 30 million more Americans, a new report from" the Centers for Medicare and Medicaid Services (CMS). Yet, "health care's hefty share of the country's economic output is reached through an average annual growth in medical spending of 5.8 percent over the next decade -- just 0.1 percent more than would have been spent without the health reform law, the report claims." The findings were published Thursday in the journal Health Affairs. During "a Health Affairs forum Wednesday, CMS chief actuary Rick Foster, who has a record of questioning long-range spending projections based on overly optimistic assumptions, nonetheless said that 'we like to think that the reality in 2014 will be much closer to the projections' than similar projections from the past."
The Wall Street Journal (7/29, Adamy, Subscription Publication) says that according to the data, the ACA will change who pays for healthcare in the US. By 2020, government will be responsible for nearly 50% of healthcare costs, mainly because of the expanded Medicaid provision in the law. Meanwhile, employers will pay for a somewhat smaller portion of healthcare costs because it is expected that some companies will cease to provide coverage. Nevertheless, the actuaries who compiled the data warned that their projections could be altered if parts of the healthcare law are revamped.
Bloomberg News (7/29, Young) reports the data suggest that the ACA "'just rearranges health-care spending so different people get to take advantage of it,' said Joseph Antos, an economist at the American Enterprise Institute, a Washington policy organization, in a telephone interview yesterday. 'It really doesn't reduce health-care spending.'" Meanwhile, Nancy-Ann DeParle, deputy chief of staff to President Barack Obama, wrote on the White House website that the "study indicates the health overhaul will be successful because 'more Americans will get coverage and save money and health-expenditure growth will remain virtually the same.'"
The Hill (7/29, Pecquet) reports in its "Healthwatch" blog, "Spending on prescription drugs and physicians and clinical services will grow much faster than without the law (10.7 percent in 2014 for drugs and 8.9 percent for clinical services), while the law will have relatively little effect on hospital spending despite the millions of newly insured people." This is due to the fact that "'many of the newly insured will be younger and healthier,' the actuaries wrote, '[and] are expected to use physician services and prescription drugs to a greater extent than hospital or other more intensive services.'"
The Washington Times (7/29, Cunningham) reports that these data "gave Republicans -- who uniformly opposed the legislation -- an opportunity to remind Mr. Obama of the emphasis he put on cutting back health care costs. While trying to sell his health care plan in 2009, Mr. Obama frequently stressed 'bending the cost curve.'" Commenting on the study, Sen. Orrin G. Hatch (R-UT) said, "Simply put, this report states the obvious, that Americans have known for more than a year -- the $2.6 trillion law only makes the fundamental problem of skyrocketing health care costs worse."
CNNMoney (7/29, Kavilanz) notes that experts expressed markedly different reactions to the report. For instance, Leslie Norwalk, "former acting administrator for CMS, said the report paints a 'very difficult' situation for the country." Norwalk added that it "shows health care spending is growing faster than the economy and faster than inflation. ... Health care spending will double by 2020, and the government will pay 50% of that -- this is troubling." In contrast, Deborah Chollet, "senior fellow and health economist at Mathematica Policy Research," argued, "The good news is that many more people will get health care coverage, for very little change in the rate of increase in overall health care spending."
Also covering the story are Reuters (7/29, Seaman), the NPR (7/29, Rovner) "Shots" blog, National Journal (7/29, Fox, Subscription Publication), CQ (7/29, Adams, Subscription Publication), Kaiser Health News (7/29, Galewitz), PBS NewsHour (7/29, Kane) "The Rundown" blog, and Modern Healthcare (7/29, Daly, Subscription Publication).

[X Factor]

Totally agree. EVERY government program ends up costing WAY MORE than what they tell the people.

I don't want the government involved in ANY part of my life, especially healthcare.

[HuskyMuskie]

Could you IMAGINE what the stock price of a company would do in one day if the expensees of the company were underestimated by 17 times their actual value?

Try looking at a balance sheet for the American government and find ONE Fortune 500 CEO who would willingly take on a company that is that far in over their head. Not. One.

[danaandvictory]

I don't want the government involved in ANY part of my life, especially healthcare.

OK. Henceforth, you are not allowed on any public road. Good luck.

[Fred Garvin 2.0]

OK. Henceforth, you are not allowed on any public road. Good luck.

gay.

[stophorseabuse]

Well, considering my best option for health care is 450 a month, with 25.00 co pay for any visit, and 25% on all scripts, and a 2500 dollar deductible before I get anything, I believe I will take my chances with the government. And this is a teacher's option.

[muskienick]

Well, considering my best option for health care is 450 a month, with 25.00 co pay for any visit, and 25% on all scripts, and a 2500 dollar deductible before I get anything, I believe I will take my chances with the government. And this is a teacher's option.

But the tea partiers on this board would have everyone believe that teachers and others who belong to unions in the public sector are bleeding the taxpayers dry in their extortion of their employers' negotiators over endless and over-extravagant fringe benefits. It's strange that recent reports such as your health insurance plight, contracts with police departments for three-year wage freezes and staffing cuts (usually through attrition), severe reductions in force of fire departments, etc. are becoming almost routine.

Our state government drastically cuts payments to their cities, townships, and villages by slashing Local Government funding and eliminating the Estate Tax with little notice and no compensatory action other than leaving these entities to their own devices. Given the timing and limited (or, more aptly, NO) options, local governments must pile the burden on the backs of their employees (and the people they serve) since there is little or no empathy from the voting public for increases in earnings or property taxes over which they have total control.

[GuyFawkes38]

But the tea partiers on this board would have everyone believe that teachers and others who belong to unions in the public sector are bleeding the taxpayers dry in their extortion of their employers' negotiators over endless and over-extravagant fringe benefits. It's strange that recent reports such as your health insurance plight, contracts with police departments for three-year wage freezes and staffing cuts (usually through attrition), severe reductions in force of fire departments, etc. are becoming almost routine.

Our state government drastically cuts payments to their cities, townships, and villages by slashing Local Government funding and eliminating the Estate Tax with little notice and no compensatory action other than leaving these entities to their own devices. Given the timing and limited (or, more aptly, NO) options, local governments must pile the burden on the backs of their employees (and the people they serve) since there is little or no empathy from the voting public for increases in earnings or property taxes over which they have total control.

It's a brutal situation for all.

We have 3 options. We can raise taxes. Or we can lower compensation. Or we can layoff workers.

I think even liberals would agree that raising taxes during a brutal recession isn't a great option. Furthermore, raising taxes at the local level is tough. If you raise taxes in Blue Ash, it's easy for a resident or business owner to move to Madeira. It's not like leaving the country.

That leaves lowering compensation or laying off workers. I'm firmly in the lowering compensation camp. Does that make me a radical tea partier. I don't think so. It's the best option from a crappy list of options.

What frustrates me is that public sector unions (although they would never admit it), would rather layoff younger workers than lower compensation for their senior members.

[bobbiemcgee]

The reality is if someone in your family comes down with a serious illness, you will soon be bankrupt just paying the co-pays, etc. 62% of all bankruptcies involve medical costs. These costs don't go away. Nope, they just sock it to the next guy in higher premiums. If you and your spouse both have insurance, they won't pay and point the finger at each other. You'll have to sue them to get them to pay, even if they pre-approved the procedures. Then if you happen to be self-employed or in a small group, they'll raise your premium 70-80%.

I know this board is full of 30 somethings who have never been sick or had a debilitating disease. Don't get sick, and if you do, please die quickly. Your life will be a living hell even though you tried to do all the "right things".

I recently buried my brother who retired with a 7 figure 401k. After 8 years of illness of first his wife (Alzheimer's) and then himself (various illnesses) put him on Medicaid the last
weeks of his life.

If you do get sick, go out and blow all your money having fun quickly. Bury your cash in the backyard. Fuck the system. It hasn't worked for some time now.

[bobbiemcgee]

We have a governor in Florida who defrauded medicare and medicaid out of billions and billions of dollars when he ran Columbia Healthcare. They "forced" him out with a 300 million dollar severance package. Instead of doing time in a Florida prison, he is running the state after putting 75 million into his campaign. Welcome to healthcare in America.

[GuyFawkes38]

We have a governor in Florida who defrauded medicare and medicaid out of billions and billions of dollars when he ran Columbia Healthcare. They "forced" him out with a 300 million dollar severance package. Instead of doing time in a Florida prison, he is running the state after putting 75 million into his campaign. Welcome to healthcare in America.

That sums it all up. Health care in America is seen as a place to get rich. Consumers have no agency in the system.

It isn't just an issue for the seriously sick. If a kid gets strep and doesn't have insurance, the parent has to take the kid to the ER and might receive a $500 bill.

In Italy, that parent takes the kid to the pharmacist. The pharmacist is allowed to exam, diagnose, and prescribe an antibiotic. All for a small percentage of the cost in the US.

I'm sure doctors in the US would object that the Italian pharmacist isn't qualified to do that. Is that true? Doesn't seem so to me.

[stophorseabuse]

Bobbie, my wife worked in a Florida Prison. Once he was elected she said F it, took out here entire retirement in a lump sum, and has decided to enroll in nursing school. She isn't even 30. If she had waited she would have had her salary cut, benefits cut, safety eliminated, and would have been unable to pull her retirement the way she did.What he is doing to the corrections system is terrifying for the safety of CO's and those who interact around inmates. He is an absolute piece of shit. I'm not even going to take the time to go into what he is doing to teachers, and the emergency services.

[stophorseabuse]

That sums it all up. Health care in America is seen as a place to get rich. Consumers have no agency in the system.

It isn't just an issue for the seriously sick. If a kid gets strep and doesn't have insurance, the parent has to take the kid to the ER and might receive a $500 bill.

In Italy, that parent takes the kid to the pharmacist. The pharmacist is allowed to exam, diagnose, and prescribe an antibiotic. All for a small percentage of the cost in the US.

I'm sure doctors in the US would object that the Italian pharmacist isn't qualified to do that. Is that true? Doesn't seem so to me.

Exactly, and if they were wrong about the strep, it's not like an antibiotic hurt anybody. Honestly, I think all meds should be available without consulting a doctor. I know exactly what the Dr. is going to do half the time. I know if I have pain I need a pain killer, if I have an infection an antibiotic, etc.

I am on meds that work for me. Why the F do I have to go to the Dr. every 3 months to stay on the meds I have been on for years? So they can get a check, thats why. They refuse to just call in my refills because they want the 100 dollars for the visit, spend 2 minutes with me, take by Benjamin, go get the next sucker.

I would honestly medicate myself if I could. Go in to a lab to get my own bloodwork, get the results, go buy my own meds. If I need a Drs advice, that is when I am happy to go see a Dr. and pay their BS fees.

[bobbiemcgee]

I actually had a Dr. who sent me back to the waiting room after I described the symtoms I was having on a new script he gave me on a previous visit. Said he could only deal with 2 at a time. Can't say in public what I told him, but think they had the cops on the phone as I almost knocked down the door. Irony was it was high blood pressure medication. LOL

[kmcrawfo]

Exactly, and if they were wrong about the strep, it's not like an antibiotic hurt anybody. Honestly, I think all meds should be available without consulting a doctor. I know exactly what the Dr. is going to do half the time. I know if I have pain I need a pain killer, if I have an infection an antibiotic, etc.

I am on meds that work for me. Why the F do I have to go to the Dr. every 3 months to stay on the meds I have been on for years? So they can get a check, thats why. They refuse to just call in my refills because they want the 100 dollars for the visit, spend 2 minutes with me, take by Benjamin, go get the next sucker.

I would honestly medicate myself if I could. Go in to a lab to get my own bloodwork, get the results, go buy my own meds. If I need a Drs advice, that is when I am happy to go see a Dr. and pay their BS fees.

If medicine is so darn simple, why do I get 30-40 consults each day from doctors asking me to help them figure out issues their patients have. I guess those patients should have just gone to their pharmacist first and then all would be well, right?

And yes an antibiotic can kill you. I have seen dozens of cases of Steven Johnsons Syndrom, Toxic Epidermal Necrolysis, Anapylaxis, and other problems that have killed people from antibiotics. Not to mention fixed drug eruptions, acute hypersensitivity reactions, etc.

Doctors do not see patient every 3 months for pills unless there is a risk involved with that particular medication (liver damage, kidney damage, etc). You believe that patients and pharmacists are somehow qualified to evaluate those risks and labs themselves, right? I suppose you think the trend of lawsuits towards doctors and pharmaceutical companies would drop off if once a patient was prescribed a med once by a doctor, they could just go get in on their own and order their labs and monitor their own side effects, right?

Do you know how absurd your argument is? No one forces you to go to the doctor. No one forces you to take your medication. You can stop taking it. You can quit going to the doctor except for an emergency. You can find a different doctor with more lax restrictions or who spends more time with you. You can make your own decision and keep your Benjamins.

You obviously have some angst against the medical field... Don't worry, as things look now you'll soon get your wish of only being able to see a physician assistant, nurse practioner, or pharmacist for your problems because when the government adds millions and millions to the government insured population and cuts reimbursement, thousands of doctors will opt out. That means many, many more people and less docs.

Who will see the patients? Not docs. But... since you are so certain that docs aren't needed and are just greedy, money hungry jerks it sounds like that should all be just fine to you.

[smileyy]

Health Care needs to be seen as a public service, not a for-profit industry. I don't see how anyone, in good conscience, can view the industry as one that should be driven by profits.

[DC Muskie]

I'm just blown away by the fact a dermatologist gets 30-40 consults a day from other doctors.

[GoMuskies]

I don't see how anyone, in good conscience, can view the industry as one that should be driven by profits.

People who have spent 20 years in school plus 4+ years in a residency are probably looking to get paid, and I doubt they feel too bad about that.

A lot of money that goes into medical research is profit seeking as well. Take out the profit motive, and my guess is that the quality of medical research and innovation goes way down.

[XU 87]

Health Care needs to be seen as a public service, not a for-profit industry. I don't see how anyone, in good conscience, can view the industry as one that should be driven by profits.

You are basically advocating to socialize health care. Unfortunately, socialism doesn't work. Capitalism works.

Why don't we then just take the profit motive out of all other industries as well? Go ask Cuba, North Korea and the old Soviet Union how that experiment worked out.

I am really surpised when educated people think the way to solve all problems is to "get rid of the profit motive". We became a great nation because we have incentivized risk and hard work via profits (ie. people making money).

But maybe someone can explain why liberals think "profit" is such a dirty word.

[Strange Brew]

Health Care needs to be seen as a public service, not a for-profit industry. I don't see how anyone, in good conscience, can view the industry as one that should be driven by profits.

wow, ignorance on parade with this comment. The average profit margin for healthcare coverage and services ranges between 3-5%. This margin is generally funneled back into the retained earnings as a hedge against future losses. If not for profit and retained earnings, hospitals would likely shutdown if there were to be a run on services.

The fact is that we have the absolute best healthcare system in so far as cutting edge treatment options available. The "problem" is that to provide these options requires highly skilled labor and high COST (liability side) inputs. Thus, it is expensive. Profit is not the problem. COST IS. AGAIN. COST FOR CUTTING EDGE TREATMENT IS EXPENSIVE. YOU HAVE TO PAY FOR IT. Dammit, some people today seem to think that the medical profession should provide everyone a Lexus and not just a basic Chevy for the same price. It's ridiculous.

Oh, and by the way. Most "non profits" run on a positive margin or evil, ugly PROFITS.

[DC Muskie]

Can someone tell me who exactly determines who is a doctor and who isn't? I don't really understand that process.

You can do years and years of studying, residency etc. Why? Does the market decide that needs to happen in order to get a license?

[bobbiemcgee]

So you get a 2% raise this year, 3% or maybe no raise for the last 2-3 yrs, but it's perfectly ok with you that health care costs went up 10-11% a yr. in the meantime, and oh, don't forget to add the 3-5% we need for profit. maybe you got good raises but the ins. premiums took it all.
Yep, used to be 7-800 a day a few yrs. ago to stay in a hospital, but now it's 3 grand a day. 5 Yrs from now 4500 a day. Who the hell cares, my ins. will pay. Not for long.

[Strange Brew]

Can someone tell me who exactly determines who is a doctor and who isn't? I don't really understand that process.

You can do years and years of studying, residency etc. Why? Does the market decide that needs to happen in order to get a license?

What's your point? I'm guessing that you think that because Doctors are licensed by the Gov't, they should be Gov't employees? Does that go for Lawyers as well?

More so. I'm licensed to drive by the Gov't, does that mean I am then required to work for it as well?

[XU 87]

So you get a 2% raise this year, 3% or maybe no raise for the last 2-3 yrs, but it's perfectly ok with you that health care costs went up 10-11% a yr. in the meantime, and oh, don't forget to add the 3-5% we need for profit. maybe you got good raises but the ins. premiums took it all.
Yep, used to be 7-800 a day a few yrs. ago to stay in a hospital, but now it's 3 grand a day. 5 Yrs from now 4500 a day. Who the hell cares, my ins. will pay. Not for long.

Are you aware that most hospitals are non-profits?

But your statement of "who the hell cares, insurance will pay" is one reason for skyrocketing health care costs. If someone else is paying the bill, there is no incentive for the consumer to be prudent. I know enough people who are doctors and have heard stories such as "the dying comatose patient who went into kidney failure and the family wanted, and the patient got, kidney dialysis". Medicare paid for it by the way.

Do you have the same feelings about the rising costs of education? Do you blame the profit motive on that as well?

But do you find it interesting that government is so intrisically involved in both health care and education, and both have costs that are out of control?

[DC Muskie]

What's your point? I'm guessing that you think that because Doctors are licensed by the Gov't, they should be Gov't employees? Does that go for Lawyers as well?

More so. I'm licensed to drive by the Gov't, does that mean I am then required to work for it as well?

Not at all, but really you did prove the point I was going to make.

I hate this absolutism about socialism, capitalism, etc. The United States of America is not Cuba, North Korea, etc, because we are not absolutism. We are not extreme, one way or another.

Americans love socialism. They hate when socialism gets extreme. It's the same way in terms of capitalism. We love capitalism, but hate it when it gets extreme.

I'm not saying doctors should or should not be government employees. What I am saying is government has a role in the process. What that role is, that is the debate.

But you can't have a debate when you have people who say, "I don't want government in my life at all."

Okay. Then who is going to make sure there are standards in the building you work in, live in, play in? Or the roads that you drive on, or the traffic laws, or the standards that doctors must have in order to treat you?

Our government is set up that is pretty strong in socialism. What exactly is checks and balances? Isn't it great that we are not Cuba where one guy with the strongest army can control the entire country.

Each state has two senators. The Senate has six year terms. The Supreme Court has life time appointments. It's a mesh of many different approaches.

It's not one or the other. It's not socialism is bad and capitalism is good. It's not about the government getting out the way of the health care system. You can't cut and paste one approach to resolve issues and think it will work in all cases.

We will never get the best out our government if we continue to perpetuate the notion that our government as it stands right now is bad. And then pointing back to the 18th century to say that's when it was good. Where else in your life do you make this comparison. When you have determined that "profits" are bad, then someone else comes in and says "government is bad" how in the world do you get anything done?

[DC Muskie]

But do you find it interesting that government is so intrisically involved in both health care and education, and both have costs that are out of control?

The government is also intrinsically involved in defense, and those costs are out of control. Should government get out the defense business? There is an argument that we should.

But really, how should poor people get proper care? Should we have a system that says, "If you can't pay for dialysis, sorry you don't get dialysis, and you will have to die?" That;s sort of sick don't you think?

Where is the other side of the coin, how do you make health care affordable to people who don't have the means? I'm not sure you just lay it at the foot of capitalism and say it will work itself out.

I don't think you take health care and lump it into the same place as education and say: here you go. government sucks. Here are two places where they shouldn't be.

[bobbiemcgee]

[QUOTE=XU 87;280421]But your statement of "who the hell cares, insurance will pay" is one reason for skyrocketing health care costs. If someone else is paying the bill, there is no incentive for the consumer to be prudent.

QUOTE]

That was exactly my point. Reread. The consumer, the doctor or the hospital don't need to be prudent. Also, are you aware of several different pricing points for a college education? In Healthcare, we have the "have ins. price", "the medicare/medicaid price" and the "stick it to 'um sticker price" if they have no ins.

[Strange Brew]

Not at all, but really you did prove the point I was going to make.

I hate this absolutism about socialism, capitalism, etc. The United States of America is not Cuba, North Korea, etc, because we are not absolutism. We are not extreme, one way or another.

Americans love socialism. They hate when socialism gets extreme. It's the same way in terms of capitalism. We love capitalism, but hate it when it gets extreme.

I'm not saying doctors should or should not be government employees. What I am saying is government has a role in the process. What that role is, that is the debate.

But you can't have a debate when you have people who say, "I don't want government in my life at all."

Okay. Then who is going to make sure there are standards in the building you work in, live in, play in? Or the roads that you drive on, or the traffic laws, or the standards that doctors must have in order to treat you?

Our government is set up that is pretty strong in socialism. What exactly is checks and balances? Isn't it great that we are not Cuba where one guy with the strongest army can control the entire country.

Each state has two senators. The Senate has six year terms. The Supreme Court has life time appointments. It's a mesh of many different approaches.

It's not one or the other. It's not socialism is bad and capitalism is good. It's not about the government getting out the way of the health care system. You can't cut and paste one approach to resolve issues and think it will work in all cases.

We will never get the best out our government if we continue to perpetuate the notion that our government as it stands right now is bad. And then pointing back to the 18th century to say that's when it was good. Where else in your life do you make this comparison. When you have determined that "profits" are bad, then someone else comes in and says "government is bad" how in the world do you get anything done?

Giant strawman argument. I NEVER said that Gov't has NO role. I responded to those who irrationally blame the profit motive.

[GoMuskies]

I don't want the government involved in ANY part of my life, especially healthcare.

You didn't say it Brew, but it was said in this thread.

[Strange Brew]

You didn't say it Brew, but it was said in this thread.

Fair enough but he was quoting my statement.

[DC Muskie]

Giant strawman argument. I NEVER said that Gov't has NO role. I responded to those who irrationally blame the profit motive.

Well I just asked a question about how licenses get issued and you jumped to becoming government workers.

I think that if you actually read what I wrote, you and I can debate what that role should be.


You didn't say it Brew, but it was said in this thread.

This.

[GuyFawkes38]

If medicine is so darn simple, why do I get 30-40 consults each day from doctors asking me to help them figure out issues their patients have. I guess those patients should have just gone to their pharmacist first and then all would be well, right?

And yes an antibiotic can kill you. I have seen dozens of cases of Steven Johnsons Syndrom, Toxic Epidermal Necrolysis, Anapylaxis, and other problems that have killed people from antibiotics. Not to mention fixed drug eruptions, acute hypersensitivity reactions, etc.

Doctors do not see patient every 3 months for pills unless there is a risk involved with that particular medication (liver damage, kidney damage, etc). You believe that patients and pharmacists are somehow qualified to evaluate those risks and labs themselves, right? I suppose you think the trend of lawsuits towards doctors and pharmaceutical companies would drop off if once a patient was prescribed a med once by a doctor, they could just go get in on their own and order their labs and monitor their own side effects, right?

Do you know how absurd your argument is? No one forces you to go to the doctor. No one forces you to take your medication. You can stop taking it. You can quit going to the doctor except for an emergency. You can find a different doctor with more lax restrictions or who spends more time with you. You can make your own decision and keep your Benjamins.

You obviously have some angst against the medical field... Don't worry, as things look now you'll soon get your wish of only being able to see a physician assistant, nurse practioner, or pharmacist for your problems because when the government adds millions and millions to the government insured population and cuts reimbursement, thousands of doctors will opt out. That means many, many more people and less docs.

Who will see the patients? Not docs. But... since you are so certain that docs aren't needed and are just greedy, money hungry jerks it sounds like that should all be just fine to you.

holy crap, this post is unhinged.

Do you really think that a physician assistant or even a nurse wouldn't be able to diagnose strep throat? (of course, I'm sure I just don't understand because I'm not a doctor and I'm out to get them.....)

Let's just admit it. We have a sh*tty health care system. We pay much more per person than anywhere else on earth without better results. It's the definition of being on the wrong side of the diminishing returns curve.

I'm not sure about the ACA, but anything is better than the status quo.

I almost choked when I read the part in bold. Are you serious? It might not be an issue to you, but some people want health care but can't afford it because the system as a whole is too expensive.

[stophorseabuse]

If medicine is so darn simple, why do I get 30-40 consults each day from doctors asking me to help them figure out issues their patients have. I guess those patients should have just gone to their pharmacist first and then all would be well, right?

And yes an antibiotic can kill you. I have seen dozens of cases of Steven Johnsons Syndrom, Toxic Epidermal Necrolysis, Anapylaxis, and other problems that have killed people from antibiotics. Not to mention fixed drug eruptions, acute hypersensitivity reactions, etc.

Doctors do not see patient every 3 months for pills unless there is a risk involved with that particular medication (liver damage, kidney damage, etc). You believe that patients and pharmacists are somehow qualified to evaluate those risks and labs themselves, right? I suppose you think the trend of lawsuits towards doctors and pharmaceutical companies would drop off if once a patient was prescribed a med once by a doctor, they could just go get in on their own and order their labs and monitor their own side effects, right?

Do you know how absurd your argument is? No one forces you to go to the doctor. No one forces you to take your medication. You can stop taking it. You can quit going to the doctor except for an emergency. You can find a different doctor with more lax restrictions or who spends more time with you. You can make your own decision and keep your Benjamins.

You obviously have some angst against the medical field... Don't worry, as things look now you'll soon get your wish of only being able to see a physician assistant, nurse practioner, or pharmacist for your problems because when the government adds millions and millions to the government insured population and cuts reimbursement, thousands of doctors will opt out. That means many, many more people and less docs.

Who will see the patients? Not docs. But... since you are so certain that docs aren't needed and are just greedy, money hungry jerks it sounds like that should all be just fine to you.

KM, I really want to erase the notion that I disrespected medical professionals. The majority of you guys and gals are tremendously intelligent and talented people. There is no way I can do what you guys do. However, I do disrespect the current healthcare system.

My opinion was not that I can do just as well, it is that the risk is worth saving 20% of my income each year. If I have something serious I would go to the Doctor. Hell, I would go to the doctor once a year (or every other) for a checkup. My wife had to have a full hysterectomy at 24. No way would have I done anything but take her to a pro.

I spend WAY too much money on things that just aren't needed. Too often I am taking my car to the mechanic to put air in the tires. If you can afford to do it thats fine, I can't.

My angst is at insurance, not Doctors. There are not nearly enough of you guys.

Again, I apologize if I came off that way.

[GuyFawkes38]

SHB, you have absolutely nothing to apologize for.

We simply have a crappy health care system. change is coming.

[stophorseabuse]

Oh, and the thing about being allowed to quit taking my meds, I know I could do that. I'm not an idiot just because I'm not a medical doctor.

I don't want to do that though, my meds help keep me healthy. I paid a Dr. a lot of money so she could find the right meds. Why should I continue to pay the doctor and the pharmacy? Every place I have been requires at least you to come in every 6 months to reup the perscriptions.

The part that bothers me is making me jump through hoops for what I know I need.

I think my Dr. is great, but her 'group' has stupid requirements that waste my money.

[stophorseabuse]

SHB, you have absolutely nothing to apologize for.

We simply have a crappy health care system. change is coming.

Well, It was not a personal attack at him, I did want him to know that.

[smileyy]

The fact is that we have the absolute best healthcare system in so far as cutting edge treatment options available.

And a really really really awful one as far as affordable widely-available basic care goes.

[Strange Brew]

Well I just asked a question about how licenses get issued and you jumped to becoming government workers.

I think that if you actually read what I wrote, you and I can debate what that role should be.
.

Well then, like I asked. What was your point then in bringing up licenses?

[DC Muskie]

Well then, like I asked. What was your point then in bringing up licenses?

Did you read what I wrote? I'm not sure how what I said is that confusing.

Government has a role to play in pretty much everything we do. What exactly is the role in this specific area. And why is it when discussing this issue, we jump to conclusions about education and driver's licenses.

Our government is not going away. Despite people dressing up in costumes and waving flags that say "Don't tread on me" and talking about freedoms, we are not going to overthrow our government and replacing it with something else.

So unless you want to answer the original question of how we issue licenses to doctors rather than just having people becoming doctors, I think I pretty much answered the question of why I brought it up.

[Strange Brew]

KM, I really want to erase the notion that I disrespected medical professionals. The majority of you guys and gals are tremendously intelligent and talented people. There is no way I can do what you guys do. However, I do disrespect the current healthcare system.

My opinion was not that I can do just as well, it is that the risk is worth saving 20% of my income each year. If I have something serious I would go to the Doctor. Hell, I would go to the doctor once a year (or every other) for a checkup. My wife had to have a full hysterectomy at 24. No way would have I done anything but take her to a pro.

I spend WAY too much money on things that just aren't needed. Too often I am taking my car to the mechanic to put air in the tires. If you can afford to do it thats fine, I can't.

My angst is at insurance, not Doctors. There are not nearly enough of you guys.

Again, I apologize if I came off that way.

Go ahead then. Treat yourself (no one is stopping you) and save the dough.

[Strange Brew]

Did you read what I wrote? I'm not sure how what I said is that confusing.

Government has a role to play in pretty much everything we do. What exactly is the role in this specific area. And why is it when discussing this issue, we jump to conclusions about education and driver's licenses.

Our government is not going away. Despite people dressing up in costumes and waving flags that say "Don't tread on me" and talking about freedoms, we are not going to overthrow our government and replacing it with something else.

So unless you want to answer the original question of how we issue licenses to doctors rather than just having people becoming doctors, I think I pretty much answered the question of why I brought it up.

I'd be fine going to an established Doc who by means of his/her individual talent demostrated the ability to heal (in so much as a mortal can) others regardless of whether or not a body of administrators say that he/she has the capacity to do so. The actions of the Doc define his ability. A Gov't license is simply an advertisement for those who have not yet proven themselves.

[stophorseabuse]

wrong strange, legally I can't obtain my meds. That is kind of stopping me.

[Strange Brew]

SHB, you have absolutely nothing to apologize for.

We simply have a crappy health care system. change is coming.

Guy...Please explain what's crappy about it.

[Strange Brew]

wrong strange, legally I can't obtain my meds. That is kind of stopping me.

What meds? Has your lovely Gov't made them illegal? Sounds like you have a problem with your Gov't.

[muskienick]

It's a brutal situation for all.

We have 3 options. We can raise taxes. Or we can lower compensation. Or we can layoff workers.

I think even liberals would agree that raising taxes during a brutal recession isn't a great option. Furthermore, raising taxes at the local level is tough. If you raise taxes in Blue Ash, it's easy for a resident or business owner to move to Madeira. It's not like leaving the country.

That leaves lowering compensation or laying off workers. I'm firmly in the lowering compensation camp. Does that make me a radical tea partier. I don't think so. It's the best option from a crappy list of options.

What frustrates me is that public sector unions (although they would never admit it), would rather layoff younger workers than lower compensation for their senior members.

Actually, Guy, we (I guess you mean Local Governments) have only two real options since raising taxes can not be done simply by a vote of the local City or Village Council, Township Trustees, or County Commission or the pen stroke of a Mayor or Township or County Administrator. In Ohio, the voting public has the final say on any increase in both real estate taxes (bond issues or tax levies) and earnings taxes (over 1%). And we all know how unpopular they are at this stage of the game (and who can blame us?)! Because of the imensity of the cuts imposted by the State Government to local government income by the slashing of Local Government Funds and the elimination of the Estate Tax, is is not uncommon for Cities, Villages, and Townships to lose from 10 - 30% of their entire General Fund Income. Therefore they have almost no alternative but to combine layoffs with CBA's that cut benefits drastically and disallow raises for years. In addition, these same jurisdictions must also impose cuts in services to their residents in the form of such things as higher garbage and recycling costs, increased water and sewage rates, and significant increases in fees, fines, penalties, and memberships in municipal activities such as Senior Services, youth sports programs, pool patronage, etc.

It would almost be less painful to vote ourselves an increase in earnings taxes and spread the pain over a wider swath to make it less for each individual. Of course what further complicates the issue is that property values are plummetting, thus making a jurisdiction's income from property taxes decrease even more precipitously. For example, my home was re-evaluated about 5% lower than it was previously (and my previous evaluation 3 years ago suffered about a 7% loss)! So our local Governments are suffering a triple-whammy and nobody seems to give a rat's rear end about it!

[Strange Brew]

Actually, Guy, we (I guess you mean Local Governments) have only two real options since raising taxes can not be done simply by a vote of the local City or Village Council, Township Trustees, or County Commission or the pen stroke of a Mayor or Township or County Administrator. In Ohio, the voting public has the final say on any increase in both real estate taxes (bond issues or tax levies) and earnings taxes (over 1%). And we all know how unpopular they are at this stage of the game (and who can blame us?)! Because of the imensity of the cuts imposted by the State Government to local government income by the slashing of Local Government Funds and the elimination of the Estate Tax, is is not uncommon for Cities, Villages, and Townships to lose from 10 - 30% of their entire General Fund Income. Therefore they have almost no alternative but to combine layoffs with CBA's that cut benefits drastically and disallow raises for years. In addition, these same jurisdictions must also impose cuts in services to their residents in the form of such things as higher garbage and recycling costs, increased water and sewage rates, and significant increases in fees, fines, penalties, and memberships in municipal activities such as Senior Services, youth sports programs, pool patronage, etc.

It would almost be less painful to vote ourselves an increase in earnings taxes and spread the pain over a wider swath to make it less for each individual. Of course what further complicates the issue is that property values are plummetting, thus making a jurisdiction's income from property taxes decrease even more precipitously. For example, my home was re-evaluated about 5% lower than it was previously (and my previous evaluation 3 years ago suffered about a 7% loss)! So our local Governments are suffering a triple-whammy and nobody seems to give a rat's rear end about it!

You're right. Nobody gives a darn about Gov't in general having to cut back. Want to know why............Those of us who pay for Gov't have been cutting back for quite some time. Excuse me why I could care less about Gov't "suffering"

[bobbiemcgee]

Well, we always have Slab City where there are no taxes of any kind:

http://en.wikipedia.org/wiki/Slab_City

[Strange Brew]

Well, we always have Slab City where there are no taxes of any kind:

http://en.wikipedia.org/wiki/Slab_City

No point made. Thanks for the snark.

[Strange Brew]

And a really really really awful one as far as affordable widely-available basic care goes.

Really? Answer this. If you go to an emergency room for ANYTHING. Will you or will you not be treated regardless of your ability to pay?

[muskienick]

You're right. Nobody gives a darn about Gov't in general having to cut back. Want to know why............Those of us who pay for Gov't have been cutting back for quite some time. Excuse me why I could care less about Gov't "suffering"

The difference you seem to be missing is that local smallish governments (especially in Ohio) are never permitted to operate at deficits. They must spend within their means. There is no one lower down for a small city or town to pass along its pain like there is for the State or Federal Government. It is there that the individual (whether it be the City's employees or citizens or both) gets hammered one way or the other.

You are deluding yourself if you think otherwise. After all, like it or not, we are all "the government" at the local level because it is there, and only there, that we have direct contact with "government" and decide when taxes are raised, lowered, or eliminated!

[Strange Brew]

The difference you seem to be missing is that local smallish governments (especially in Ohio) are never permitted to operate at deficits. They must spend within their means. There is no one lower down for a small city or town to pass along its pain like there is for the State or Federal Government. It is there that the individual (whether it be the City's employees or citizens or both) gets hammered one way or the other.

You are deluding yourself if you think otherwise. After all, like it or not, we are all "the government" at the local level because it is there, and only there, that we have direct contact with "government" and decide when taxes are raised, lowered, or eliminated!

Yes, and those of us who actually pay for the local Gov't are saying YOU HAVE ENOUGH. No more. You figure out how to make do. Those of us in the private sector have figured out how. Time for the ahem, public servants to come to grips with it.

[Strange Brew]

[QUOTE=

Our government is not going away. Despite people dressing up in costumes and waving flags that say "Don't tread on me" and talking about freedoms, we are not going to overthrow our government and replacing it with something else.
[/QUOTE]

Ignorance often mocks what it is unable to understand.

[GuyFawkes38]

Go ahead then. Treat yourself (no one is stopping you) and save the dough.

yes, stophorseabuse will just prescribe himself the drugs he needs.

[DC Muskie]

Ignorance often mocks what it is unable to understand.

What?

Okay then good talk. Look forward to some more of your one liners that contribute nothing.

[Snipe]

Can someone tell me who exactly determines who is a doctor and who isn't? I don't really understand that process.

You can do years and years of studying, residency etc. Why? Does the market decide that needs to happen in order to get a license?

Medical Licensure (http://www.fff.org/freedom/0194e.asp)
by Milton Friedman, January 1994

A lot of it has to do with the power of the Doctor's union:


In the first place, licensure is the key to the control that the medical profession can exercise over the number of physicians. To understand why this is so requires some discussion of the structure of the medical profession. The American Medical Association is perhaps the strongest trade union in the United States. The essence of the power of a trade union is its power to restrict the number who may engage in a particular occupation. This restriction may be exercised indirectly by being able to enforce a wage rate higher than would otherwise prevail. If such a wage rate can be enforced, it will reduce the number of people who can get jobs and thus indirectly the number of people pursuing the occupation. This technique of restriction has disadvantages. There is always a dissatisfied fringe of people who are trying to get into the occupation. A trade union is much better off it can limit directly the number of people who enter the occupation-who ever try to get jobs in it. The disgruntled and dissatisfied are excluded at the outset, and the union does not have to worry about them.

The American Medical Association is in this position. It is a trade union that can limit the number of people who can enter. How can it do this? The essential control is at the stage of admission to medical school. The Council on Medical Education and Hospitals of the American Medical Association approves medical schools. In order for a medical school to get and stay on its list of approved schools it has to meet the standards of the Council. The power of the Council has been demonstrated at various times when there has been pressure to reduce numbers. For example, in the 1930's during the depression, the Council on Medical Education and Hospitals wrote a letter to the various medical schools saying the medical schools were admitting more students than could be given the proper kind of training. In the next year or two, every school reduced the number it was admitting, giving very strong presumptive evidence that the recommendation had some effect. . . .

If you limit the number of kids allowed to medical school, you limit the number of doctors. We have a shortage of doctors. That is not good for us, as it drives up the price (and value) of the remaining Doctors. It is easy to see while it isn't good for us, it is great for the Doctors (more income, less competition).

Med Schools have their quotas dictated to them. Controlling the number of kids in medical school IS controlling the number of Doctors. If you want health care costs to come down, one method would be to double the number of admissions to medical schools.

That is not all of it though:


If "medical practice" is to be limited to licensed practitioners, it is necessary to define what medical practice is, and featherbedding is not something that is restricted to the railroads. Under the interpretation of the statutes forbidding unauthorized practice of medicine, many things are restricted to licensed physicians that could perfectly well be done by technicians, and other skilled people who do not have a Cadillac medical training.

My kid gets a cut on his finger and it gets infected. I need a standard anti-biotic generic penicillin. Last time I got that stuff I found they make it so cheap that they fill that prescription for free at Myer. It was probably a couple of bucks, but they give it too you just to get you in the store.

Now I know what a cut on a kids finger looks like, and I can tell when it is infected. And if you are a new father and were somewhat unaware of cuts and infections, you could educate yourself pretty fast on the net.

It costs real money to schedule a visit with a doctor to show her an infected cut on your kids hand. It costs time and money, and time is money. What a waste of time and money. If I tried to get some unused penicillin from a neighbor, that would be a illegal transaction of controlled substances. People go to jail for that, at least black people do.


When these effects are taken into account, I am myself persuaded that licensure has reduced both the quantity and quality of medical practice; that is has reduced the opportunities available to people who would like to be physicians, forcing them to pursue occupations they regard as less attractive; that it has forced the public to pay more for less satisfactory medical service, and that it has retarded technological development both in medicine itself and in the organization of medical practice. I conclude that licensure should be eliminated as a requirement for the practice of medicine.

Big Doctor!

I hate being a patient slave to Big Doctor!

Maybe things would be better off if we scrapped the whole system. That includes the FDA! If anyone requests more Friedman I will look up and compile a little of what he has to say about them and their effect on medicine. It isn't pretty, it costs us money and it costs many lives as well as pain and suffering.

Plenty of things we could do to improve the quantity and quality of medical care all while decreasing the costs of such, but it begins with getting rid of the regulation. I think the current approach is "more and better regulation". Friedman says that isn't the way, and it hurts our innovation.

[XU 87]

The Obama administration just issued some executive order ordering all insurance companies to provide birth control, without any co-pay.

Now you may think this is a good idea. You may think it's a bad idea. But one think we should agree on- it will drive up health insurance costs when you mandate something and don't make the consumer pay for it.

[Mrs. Garrett]

Most doctors just want to make money. I'm so sick of hearing about all the schooling they had to take, and that's why they should get paid more.

A few months ago I had my annual physical (I'm 36). A few days later I get a call from one of the receptionists that the doctor needs me to come back in for a follow up. So I asked the receptionist if it was something bad. She said she wasn't allowed to discuss it with me over the phone. I would have to wait until I saw the doctor.

So for about a week I sat and worried about my results. Do I have cancer? Is my heart bad? Could I just drop dead at any minute?


I get there, my doctor says "Congratualtions on your great health", and 5 minutes later I was out the door.

What a scam. All to collect an office visit fee for something that could have been said over the phone. That is why insurance costs are so high. My insurance got billed for something totally unnecessary.

I now have a new doctor.

[Kahns Krazy]

They also just announced an across the board 11% reimbursment for Nursing Homes effective October 1st. Just try to run a business with that kind of change in your top line with two months to prepare.

[Porkopolis]

The Obama administration just issued some executive order ordering all insurance companies to provide birth control, without any co-pay.

Now you may think this is a good idea. You may think it's a bad idea. But one think we should agree on- it will drive up health insurance costs when you mandate something and don't make the consumer pay for it.

Obama didn't sign an executive order. This is part of ACA.

http://www.medpagetoday.com/Washington-Watch/Washington-Watch/27834

[DC Muskie]

So basically Friedman says we should do away with licenses for doctors because there are associations that set standards on who can be doctors.

Interesting concept. Maybe we could have better innovation if we just allow everyone who wants to be a doctor to be a doctor. As long as they pass medical school, and those medical schools should be allowed to have whatever standards each of those medical schools decide to have. This will then allow more students and therefore better medical care.

The AMA currently represents 22% of doctors and medical students. 22%. That is sort of like the number of eligible voters who actually vote deciding on how the country will be run. I can see the idea that a limited few controlling the direction of things would be a bad thing.

It's also interesting to see there are trade associations for almost all areas of specified medicine. Take a look at the American Academy of Dermatologists. (Which sort of sounds like it could be called the American Academy of Dermatologists of America). Anyway they did not endorse ACA. However recently they supported the FDA's regulation on how sunscreen manufacturers label their products that ensures what they are selling to people is accurate in what it can protect them from.

So on one hand this organization is able to decry the intrusion of government in the aspect of overall health care reform, while on the other cut into business profits by supporting government intrusion on marketing strategies.

I actually like this approach. The AAD (or AADA) can look at what the government is doing and by a case-by-case basis formulate an opinion. I have to respect that line of thinking.

I do not know whether it is a good idea to have trade associations give out medical school credentials, and place standards for those schools to meet in order to graduate doctors. But I do feel like we need to have standards, just base line requirements to ensure the quality of healthcare begins at some point.

[DC Muskie]

The Obama administration just issued some executive order ordering all insurance companies to provide birth control, without any co-pay.

Now you may think this is a good idea. You may think it's a bad idea. But one think we should agree on- it will drive up health insurance costs when you mandate something and don't make the consumer pay for it.

I think this specifically is a bad idea. But it does beg the question of how and who should pay for necessary medication and procedures for those who cannot.


They also just announced an across the board 11% reimbursment for Nursing Homes effective October 1st. Just try to run a business with that kind of change in your top line with two months to prepare.

What is this reimbursement for? To the patients? Sorry, I don't understand.

[XU 87]

Obama didn't sign an executive order. This is part of ACA.

http://www.medpagetoday.com/Washington-Watch/Washington-Watch/27834

I said the "Obama Administration". The order was issued by his head of Health and Human Services. Providng free birth control is not specifically contained in the ACA- the article says as much. Now where the Constitution states that a cabinet director can order a private insurance company to provide free birth control is beyond me.

But there is no doubt about one thing- birth control isn't free and this order will drive up health insurance costs.

[bobbiemcgee]

Maybe:eek: not. We won't have to support as many welfare babies until they're 80.

[Kahns Krazy]

What is this reimbursement for? To the patients? Sorry, I don't understand.

It wasn't a well written post, so no need to apologize. I thought it was going to follow right behind 87's.

Medicare announced on Friday that the rates that it will pay for Skilled Nursing Facility services will be cut by 11% effective October 1st.

Here's an article that sums up the impact this is having on Skilled nursing care providers. The companies referenced in that article (and the individuals that hold those shares) lost about $1 billion in market cap today.

http://online.wsj.com/article/BT-CO-20110801-710571.html

[bigdiggins]

But your statement of "who the hell cares, insurance will pay" is one reason for skyrocketing health care costs. If someone else is paying the bill, there is no incentive for the consumer to be prudent. I know enough people who are doctors and have heard stories such as "the dying comatose patient who went into kidney failure and the family wanted, and the patient got, kidney dialysis". Medicare paid for it by the way.


I've thrown this out before in a similar thread, but I think it is worth repeating here


If the objective is to maximize bang for the buck—i.e., to produce healthy years of life with the greatest possible efficiency—then it's worth questioning whether it makes sense to devote 28 percent of Medicare spending to recipients' final year of life, as the U.S. did in 2008."

We need death panels.

[DC Muskie]

Medicare announced on Friday that the rates that it will pay for Skilled Nursing Facility services will be cut by 11% effective October 1st.

So you are saying these business need to make up that 11% out their pocket?

I'm completely stupid here. Sorry.

Medicare says they cut across the board payments to SNF by 11%. So does that mean these places need to have 11% to cover costs like utilities or salaries?

I guess I'm asking, where on the bottom line is this going to hit?

[Porkopolis]

I said the "Obama Administration". The order was issued by his head of Health and Human Services. Providng free birth control is not specifically contained in the ACA- the article says as much. Now where the Constitution states that a cabinet director can order a private insurance company to provide free birth control is beyond me.

Fair enough, then. But an executive order, by definition, can only be issued by the President. I know it is semantics, but in our current culture of paranoia and half-truths semantics matter. Obama's Executive Order 13535 in reference to ACA is found at the link below. Some people feel that the new policy violates certain provisions of Obama's own E.O. I don't know that I agree but I can see their point.

http://www.presidency.ucsb.edu/ws/index.php?pid=87661#axzz1ToR7HN6l

[Kahns Krazy]

So you are saying these business need to make up that 11% out their pocket?

I'm completely stupid here. Sorry.

Medicare says they cut across the board payments to SNF by 11%. So does that mean these places need to have 11% to cover costs like utilities or salaries?

I guess I'm asking, where on the bottom line is this going to hit?

All the way at the bottom. If you are in the business of providing nursing home services to Medicare patients, the amount you get paid for your services will drop by 11%. If you were getting paid $100 for a therapy hour, you will now get $89. Your cost structure will stay the same, unless you can get your employees, your landlord, your utility company and your insurance company to all drop their rates by 11% as well.

Looking at one company in that article - Skilled Healthcare, they generate 16% of their total revenues from Medicare. In Q2, they generated $10.5 million in net income off total revenues of $215.5 million. $34 million of that revenue comes from Medicare. Take 11% of that revenue away, and you lose nearly $4 million off your bottom line. Now you're generating $6.7 million off $215.5 million in sales, for a whopping 3.1% margin.

[bigdiggins]

Looking at one company in that article - Skilled Healthcare, they generate 16% of their total revenues from Medicare. In Q2, they generated $10.5 million in net income off total revenues of $215.5 million. $34 million of that revenue comes from Medicare. Take 11% of that revenue away, and you lose nearly $4 million off your bottom line. Now you're generating $6.7 million off $215.5 million in sales, for a whopping 3.1% margin.

That assumes that every cost that Skilled Healthcare has is a fixed cost. I doubt it is a straight drop to the bottom line.

That being said I understand where you are going and agree with the point. Some of the costs would be fixed, and even some of the variable which can be adjusted would not be pleasant to do so (ie hourly workers headcount and/or available hours etc.)
EDIT:
Never mind, I wasn't thinking clearly. The patients being reimbursed for are still there so the variable costs are as well, just getting less for those same patients.

[Kahns Krazy]

That assumes that every cost that Skilled Healthcare has is a fixed cost. I doubt it is a straight drop to the bottom line.

That being said I understand where you are going and agree with the point. Some of the costs would be fixed, and even some of the variable which can be adjusted would not be pleasant to do so (ie hourly workers headcount and/or available hours etc.)
EDIT:
Never mind, I wasn't thinking clearly. The patients being reimbursed for are still there so the variable costs are as well, just getting less for those same patients.

Bingo. The one piece I did botch is the tax effect. Not sure what their income tax rate is, but lower income =lower taxes, so you would only take the after-tax portion off net income. I'm sure that is of little comfort the the 10,000 employees of Skilled Healthcare who are being told that the company they work for is likely to default on certain debt covenants because of this cut.

[bobbiemcgee]

SKilled Heathcare's CEO muddled thru on a 2.1 million dollar income last year, so I'm sure they'll survive.

[GuyFawkes38]

Most doctors just want to make money. I'm so sick of hearing about all the schooling they had to take, and that's why they should get paid more.

A few months ago I had my annual physical (I'm 36). A few days later I get a call from one of the receptionists that the doctor needs me to come back in for a follow up. So I asked the receptionist if it was something bad. She said she wasn't allowed to discuss it with me over the phone. I would have to wait until I saw the doctor.

So for about a week I sat and worried about my results. Do I have cancer? Is my heart bad? Could I just drop dead at any minute?


I get there, my doctor says "Congratualtions on your great health", and 5 minutes later I was out the door.

What a scam. All to collect an office visit fee for something that could have been said over the phone. That is why insurance costs are so high. My insurance got billed for something totally unnecessary.

I now have a new doctor.

Of course, kmcrawfo would respond, "No one is forcing you to go to a doctor. Treat yourself."

heh.

[Kahns Krazy]

SKilled Heathcare's CEO muddled thru on a 2.1 million dollar income last year, so I'm sure they'll survive.

What an idiotic statement.

[GoMuskies]

SKilled Heathcare's CEO muddled thru on a 2.1 million dollar income last year, so I'm sure they'll survive.

Relevance? He's probably got an employment contract, too, and it's doubtful he'll accept an 11% pay decrease for the coming year.

[Snipe]

I do not know whether it is a good idea to have trade associations give out medical school credentials, and place standards for those schools to meet in order to graduate doctors. But I do feel like we need to have standards, just base line requirements to ensure the quality of healthcare begins at some point.

Getting rid of trade union regulations and quotas is not getting rid of standards. This is important. A little thinking about it and it should become obvious.

The Ohio State University has a medical school. It's web page touts the fact that "OSU's Medical Programs Ranked Among Nation's Best (http://medicine.osu.edu/Pages/default.aspx)" Do you think they care about their reputation? Do you think that they have standards? If medical trade union regulations or quotas didn't exist, do you think that The Ohio State University would just give up their standards or care about their national rankings? Do you think that the Dean's there desire to put out wonderfully talented, well educated and competent Doctors? I think that they do, and they would do it regardless.

What about the Christ Hospital? Do you think they care about their standards? I think very highly of them and both of my boys were born there. Will they abandon their standards? I think they get very high ratings and care about their image as a leader in Cincinnati. I can't see them lowering their standards.

After my kids were born I started taking them to Children's Hospital. I also think very highly of that institution. I think that they have very high standards and that it has nothing to do with the AMA.

Lastly, what about you? Do you have standards? I bet you do. I know that I do. We picked our Children's primary care physician carefully. We love him and wouldn't go anywhere else. We picked the Christ Hospital and Children's hospital carefully. These were not random decisions. I bet you have high standards about your own health care too. If the AMA wasn't dictating things, would you lose your high standards? I bet you wouldn't.

You feel that we need to have standards. We do indeed have standards with or without the AMA. Where did they go to school? What hospital, network or association are they affiliated with? We network with friends and people use personal word of mouth recommendations. In this day and age you can even rate or be critical of doctors on the internets.

And Friedman is not saying that we need to dissolve the AMA, just medical licensure in general. We could still have an AMA, and they could still have members and certify people as competent. Some people would care if their doctor was AMA certified, but every doctor would not need to be AMA certified or pay dues. It would be a case of free association.

Would we be taking great risks? I doubt my risk level would rise at all, given the decisions that I have made. And if you randomly pick a doctor now, are you really safe if he passed his medical boards 25 years ago? Does that mean he is fully competent and up to date on the latest medical advances in the last few decades? But we don't randomly pick doctors, just as Ohio State doesn't randomly graduate medical students and Christ Hospital doesn't randomly hire and promote people. I don't think that standards are going to be a problem.

[Kahns Krazy]

What a scam. All to collect an office visit fee for something that could have been said over the phone. That is why insurance costs are so high. My insurance got billed for something totally unnecessary.

I now have a new doctor.

This is a real problem. I am now on a high deductible insurance program, and I'm asking my doctors how much things cost. It is mind boggling how often they don't know. It took almost 4 weeks to get an answer about a dental procedure. More healthcare consumers need skin in the game at the transaction level.

[GuyFawkes38]

Woot Friedman.

I know this sounds crazy, but even poor, 2nd world countries have similar health care outcomes as the US, while paying their health care workers very low wages.

What does that tell us. I think Britain has the right idea. Provide a very basic, cheap health care system for everyone. Yes, allow nurses to take on more responsibility like treating patients for sore throats. Make tough end of life decisions. It's not a death panel because the patient can spend whatever he wants outside of the public system.

Indeed, unlike Canada, allow private citizens to spend whatever they want for their own care outside of the public safety net. Everyone should have the right to spend their money as they choose, including health care.

[bobbiemcgee]

What an idiotic statement.

Yeah, he made 63 times the median pay and the stock is 5 bucks, so he's well worth it.

You ask what things cost but could careless what the ceo makes. He made 20% of all profits.

[bobbiemcgee]

Relevance? He's probably got an employment contract, too, and it's doubtful he'll accept an 11% pay decrease for the coming year.

Not the way things work in Corp America. They'll give him a raise and fire people.

[GoMuskies]

The stock was doing pretty well until today.

[Porkopolis]

Indeed, unlike Canada, allow private citizens to spend whatever they want for their own care outside of the public safety net. Everyone should have the right to spend their money as they choose, including health care.

A good friend of mine (US Citizen) has been living in the UK for a while now. He absolutely loves their system. He really enjoys the option of NHS for basic and emergency care but uses private doctors for anything more extensive that is planned in advance. He actually goes to Prague for his dental work. All in all he spends much less in the British system than he did in the states and feels he generally gets better treatment. Though he is very conservative the experience has turned him into an advocate of a single payer system.

[GuyFawkes38]

A good friend of mine (US Citizen) has been living in the UK for a while now. He absolutely loves their system. He really enjoys the option of NHS for basic and emergency care but uses private doctors for anything more extensive that is planned in advance. He actually goes to Prague for his dental work. All in all he spends much less in the British system than he did in the states and feels he generally gets better treatment. Though he is very conservative the experience has turned him into an advocate of a single payer system.

Definitely. I think you can make a very conservative/libertarian argument for a British type system.

There should be a cheap safety net in place. But that doesn't mean that we should all receive the same care. Bill Gates should be allowed to spend much more on health care than a homeless guy on the street.

[Kahns Krazy]

Yeah, he made 63 times the median pay and the stock is 5 bucks, so he's well worth it.

You ask what things cost but could careless what the ceo makes. He made 20% of all profits.

First, executive pay and profits are not related in the same way that normal pay is. Accounting rules require the expensing of executive pay in a way that does not reflect the actual components of pay in a very realistic way. Over half of his $2.1 million in "pay" was in company stock, which is likely restricted, and which he has not sold in any case. He took a substantial retroactive 2010 pay cut today.

He is also the head of a company that provides healthcare services to over 10,000 elderly, sick and poor, and in a time of rediculous government regulation and unilateral reductions in reimbursement, has managed to turn a small profit for investors and keep nearly 10,000 employed.

The stimulus act spent nearly $800 billion to create or save around 2 million jobs. By that math, the CEO of Skilled should be paid around $4 billion.

No matter what, the CEO did more for the company than Medicare, which just announced it's going to take twice what the CEO made away from the company. The idea that it's okay for the government to take $4 million away from a company because the CEO "made" $2.1 million last year is, as I said before, idiotic.

[GuyFawkes38]

Speaking of Milton Friedman, here's Milton Friedman and William Buckley:

http://youtu.be/6hryAp1i3S8

What a combo. That turned me on.

[kmcrawfo]

SHB, you have absolutely nothing to apologize for.

We simply have a crappy health care system. change is coming.

We hands down have the best health care system in the world. We have the best trained doctors, the most advanced treatments, the most inovation. Our outcomes and wait lists blow other countries out of the water when it comes to cancer survival, surgical outcomes, time to wait for surgical procedures, etc. Yes, we spend more per capita. The US outspends every country on everything (military, highway system, education). It is not just healthcare that is a money pit.

Government regulation and law suits dramatically increase the costs of healthcare. An example is this new ridiculous law that insurers now have to include birth control with no copay or cost to the patient. What if you have had a hysterectomy and want to decline that coverage and lower your monthly payment. Too bad. What is you want to decline OB coverage and lower your premium. Too bad. The government requires coverage for all these things. This makes costs go up.

The reason doctors require patients to come back to check on their medications is:
1. They care about their patients and want to make sure they are doing well
2. They have to maintain records to reduce their liability if a patient has an adverse event and sues.

I can't believe comments on here that doctors are all about $$$. In general, doctors tend to be some of the least money hungry professionals in existent. They are grossly underpaid when you take into account the years of education and hours they work. A pediatrician or family practice doctor make around $120,000 per year. Sure that is a lot of money, but they have likely $250,000 to $500,000 of student loans and went to school for 11 years to get that degree/license. They also are never off-duty. A pediatrician may get a call at 2am any night to go see her patient. There really aren't any other professions that require the hours and life-long education requirements that medicine does.

Most docs are just trying to make enough money to justify the insane hours and education they had to endure. There is a reason medical school application are steadily falling. It is just not that lucritive of a profession for the vast majority of people in it. There are exceptions in a hand full of specialities, but they are so insanely difficult to get because you essentially have to be in the top 2 or 3 in your medical school class to be accepted into the training programs. You would be much better off financially to get a business degree, engineering, or other professional degrees.

Most docs would gladly see patients at a reduced cost or for free, but the government does not allow it. It you accept Medicare, you must charge all patients a set fee schedule. If I see you and you state you can not afford your deductible I am not allowed to waive it because the government would consider it "insurance discounting" which is medicare fraud. The government states if you given any patient a discount you must give the same discount across the board to all patients. It is extremely frustrating.

If I was a money hungry son of a gun, I wouldn't be the only dermatologist in southern indiana who accepts medicaid. I wouldn't volunteer at the Indianapolis Veterans Hospital to allow Vets better access to care and reduce their wait times. I wouldn't have paid a consultant to set up a government approved program that allows me to treat and uninsured or underinsured patient free of charge.

In general people do not understand what they are asking for when the want health care reform. I have seen socialized medicine having served in the military for 13 years. It does not work. It is worse when you try to place it in a larger population.

The poor will have the same care they have now = Medicaid Equivelant. I am the only Medicaid dermatologist for 300,000 people. Do you think more doctors will jump on board when the reimbursement go down with Obamacare.

The middle class will have worse health care. More demand + same/less docs = worse access. Also, more restrictions to get access to the newest treatments and medications (The military was notorious for this). Also, longer waits.

The upper class will have the same heathcare because they will be able to opt out and pay cash (Just like Canada and the UK).

Finally, socialized medicine is not sustainable. The UK and Canada are desperately trying to get away from it and privatize healthcare due to skyrocketing costs. The problem is once that door is open it is difficult to close. How on earth with our current debt crisis can anyone think we can possibly afford universal healthcare.

Yes, change is coming. Just be careful what you wish for as it won't be pretty.

The solution is relatively simple. Have people get true Health Insurance and not prepaid Healthcare which is what everyone has right now. Medicine should go back to a cash system where the relationship is directly between the patient and the physician. The 3rd party insurers are removed completely.

If patients have insurance, they can submit a claim on their own. Walmart, Targer, etc would keep their $4 drug program. I could charge $25 for a visit, $50 for a biopsy, etc. Because insurance is removed the rediculous documentation and restrictions imposed by the government/insurance would be removed allowing doctors to be doctors. Overhead would be reduced to a point where you wouldn't have to see 60 patients a day to meet expenses. Ask yourself if you could see a doc for $25-50 and gets your meds for $4 would your really need to pay that premium each month. you would carry a catastrophic care policy just in case you get hospitalized with an emergency.

Really, most docs just want to take care of their patients. The problem is that government, insurance, and lawyers make it much harder to do so.

[GuyFawkes38]

kmcrawfo, thanks for responding. You definitely give a lot of food for thought.

I apologize for being so combative. We have some of the brightest and hardest working people on earth working within our healthcare industry. Labeling doctors as greedy isn't helpful and largely isn't true. The system as a whole is, IMHO, twisted. But that shouldn't reflect negatively on most of the hardworking people within the system.

[bobbiemcgee]

The stimulus act spent nearly $800 billion to create or save around 2 million jobs. By that math, the CEO of Skilled should be paid around $4 billion.

No matter what, the CEO did more for the company than Medicare, which just announced it's going to take twice what the CEO made away from the company. The idea that it's okay for the government to take $4 million away from a company because the CEO "made" $2.1 million last year is, as I said before, idiotic.

Blame Obama and give the CEO a raise. It's not his fault , man, he inadverently took too many Medicare/Medicaid patients and now the company is going to lose their ass. Can't have it both ways. That's IDiOTIC.

[Kahns Krazy]

You lost me there.

[muskienick]

Yes, and those of us who actually pay for the local Gov't are saying YOU HAVE ENOUGH. No more. You figure out how to make do. Those of us in the private sector have figured out how. Time for the ahem, public servants to come to grips with it.

The private sector can raise their prices on goods and services but the public sector must rely on people agreeing (through the ballot box) to higher taxes, the only significant source of income to local government.

I'd love to see how smug you'd be on this issue if you had to have your customers vote their approval each time you wanted to raise your prices!!!

[XU 87]

The private sector can raise their prices on goods and services but the public sector must rely on people agreeing (through the ballot box) to higher taxes, the only significant source of income to local government.

I'd love to see how smug you'd be on this issue if you had to have your customers vote their approval each time you wanted to raise your prices!!!

In light of the fact that a huge number of people in America don't pay federal income taxes, your analogy isn't accurate. A better analogy would be that the private sector votes to have a minority of people pay for the majority's goods and services.

[Kahns Krazy]

In light of the fact that a huge number of people in America don't pay federal income taxes, your anaology isn't accurate. A better analogy would be that the private sector votes to have a minority of people pay for the majority's goods and services.

http://www.xavierhoops.com/forums/picture.php?albumid=22&pictureid=483

[GoMuskies]

I'd love to see how smug you'd be on this issue if you had to have your customers vote their approval each time you wanted to raise your prices!!!

The customers do vote their approval or disapproval anytime a company raises prices.

[chico]

The customers do vote their approval or disapproval anytime a company raises prices.

Wait, you mean I can actually try to find a better price for something from another source if I feel the one I'm paying is too high? And if I don't want to buy something I don't have to? So, in effect, you're saying I'm "voting" with my wallet, by the financial decisions I make. This is wonderful - why are people keeping this a secret from Nick?

[muskienick]

In light of the fact that a huge number of people in America don't pay federal income taxes, your analogy isn't accurate. A better analogy would be that the private sector votes to have a minority of people pay for the majority's goods and services.

You are inaccurate about my analogy. Mine had nothing to do with federal income tax. It had to do with LOCAL taxes available to Cities, Villages, and Townships in the State of Ohio. Hence, my reference to "...local government" in the analogy.

[muskienick]

Wait, you mean I can actually try to find a better price for something from another source if I feel the one I'm paying is too high? And if I don't want to buy something I don't have to? So, in effect, you're saying I'm "voting" with my wallet, by the financial decisions I make. This is wonderful - why are people keeping this a secret from Nick?

Your sarcasm is largely unwarranted and too simplistic when you consider the fact that price increases are usually industry-wide. When Shell raises its prices, we find that the other gasoline providers have done so also. When was the last time you were able to find a half-gallon container of any brand of ice cream in a store. They have all gone to 56 or 48 oz containers while charging the same (or even more) for their product. When the cost of lumber went up precipitously a couple of years ago, it was reflected in the prices charged by all suppliers, not just Home Depot or Lowes.

Sure, people can shop for the best deals available, but sometimes even that doesn't work too well. For example, it doesn't always pay to travel 10 miles (and a half-hour) extra to pay 1or 2 cents a gallon less for gasoline. And it's a helluva lot easier to do an extensive cost comparison when buying a specific new Chevy or Hyundai model than it is to pick up and buy a home in another taxing jurisdiction!

Somebody tell me at which hospital I can get the significantly cheapest frontal lobotomy!

[Kahns Krazy]

Those are all commodity items, not services. Healthcare is a service. The "Little Clinic" in Kroger stores is a great example of healthcare services available significantly cheaper than other service venues. Even pharmacies have varying costs to deliver the same medication.

You just can't compare healthcare and commodity models. I would suggest they are exact opposite ends of the spectrum.

[XU 87]

Besides "free" birth control, the Obama administration has also ordered that breast pumps and domestic violence counseling are also to be included in all health insurance policies, without co-pays.

We sure wouldn't want someone to pay for birth control pills or breast pumps.

[bigdiggins]

When Shell raises its prices, we find that the other gasoline providers have done so also.

Ride a bike. Walk. Take the Metro. Get in a carpool. Americans love to complain about gasoline prices, but nobody wants to actually change their driving habits so the demand stays the same.
You can vote on gasoline prices with your wallet in some way other than driving around town trying to save 1 or 2 cents.

[muskienick]

Ride a bike. Walk. Take the Metro. Get in a carpool. Americans love to complain about gasoline prices, but nobody wants to actually change their driving habits so the demand stays the same.
You can vote on gasoline prices with your wallet in some way other than driving around town trying to save 1 or 2 cents.

bd,

At least be realistic with your retorts! Perhaps America will change its transportation habits over a long period of time as it has with the smoking of tobacco. But for at least the foreseeable future it is highly unlikely that the typical American will take to bus schedules, Schwinn purchases, and putting up with three other people's morning and afternoon drive-time idiosyncrasies for a half-hour each way to save a few bucks. We have had various types of problems with gasoline dating back to the dreadful Jimmy Carter Administration days and our love affair for convenience driving has changed little over the ensuing 30+ years. Why would anybody think your suggested solutions would be widely accepted now?

You said it yourself: "Americans love to complain about gasoline prices, but nobody wants to actually change their driving habits so the demand stays the same."

[GoMuskies]

So consumers vote yes on gas price increases.

[muskienick]

So consumers vote yes on gas price increases.

I guess they do in a strange sort of way. It's kinda like voting for beheading over hanging since it might go faster.

And consumers certainly don't vote down rising gas prices in favor of pedaling their Schwinn, riding the bus, or sharing a car with three other people they might not even know (or, worse yet, have learned not to like) back and forth to work every day.

[GoMuskies]

They could also move closer to work. Or choose not to take long trips that involve driving. Or choose to leave the home less or maybe live somewhere where they could walk to do some of their errands or go to restaurants.

It's not like buses, Schwinns and carpools are the only ways one could choose to reduce consumption if the price gets too high for them. But people pay it, which means they value their current lifestyle and petrol use more than they value the money they spend on the gas. So they vote to approve the price increase.

[Kahns Krazy]

I guess they do in a strange sort of way. It's kinda like voting for beheading over hanging since it might go faster.

And consumers certainly don't vote down rising gas prices in favor of pedaling their Schwinn, riding the bus, or sharing a car with three other people they might not even know (or, worse yet, have learned not to like) back and forth to work every day.

They are doing something. Gasoline demand in the US in May of 2011 was at an 8 year low. With a population 7.5% larger than it was 8 years ago, at least some people are changing some habits.

[GuyFawkes38]

I stumbled upon this graph from another thread.

The cost of health care is increasing around the world. Just dramatically more in the US:

http://assets.theatlantic.com/static/mt/assets/meganmcardle/6a00d8341c66b253ef0147e0453e06970b.jpg

[Strange Brew]

The private sector can raise their prices on goods and services but the public sector must rely on people agreeing (through the ballot box) to higher taxes, the only significant source of income to local government.

I'd love to see how smug you'd be on this issue if you had to have your customers vote their approval each time you wanted to raise your prices!!!

Nick. Others have already highlighted the flaws in your logic so I'll be nice. I'd suggest that if you are going to make a statement regarding the price points of goods and services in a private market you at least educate yourself on the basic economic concepts of demand, supply, price equilibrium and the maximization of utility whether it be of the producer or consumer variety.

I wasn't trying to be smug. I was merely stating that the private market producers are on the verge of wondering whether or not the Risk of doing private business is worth it. If they decide it is not, production and income slows and taxes collected by the Gov't shrink. Which, I'm lead to believe by your comments, would not be in your best interests.

[Snipe]

In free market capitalism we have something called the price-mechanism. We use this price mechanism to allocate scarce goods and resources. In a free market, you vote every day with every dollar. Those dollars are the votes.

Nick seems to be oblivious and ignorant of this. Even when presented with evidence he evades and declines to tackle the argument.

Specifically to this threat he asks:


Somebody tell me at which hospital I can get the significantly cheapest frontal lobotomy!

I don't think that we do frontal lobotomies anymore, but I still think it is a useful question. If we did do them, where would you go to get the best deal?

Take Mammograms. Women get them every year, and they are mandated in preventative care legislation. How much does a mammogram cost? Good luck finding out.

It is almost impossible to find out what one would pay. That is a problem for something my wife gets every year. You can't get a quote from Christ Hospital, which is an industry leader in Cincinnati for a procedure that is routine maintenance.

Every woman over a certain age is supposed to get these mammograms every year. Tens of millions of women do this every year. Why can't I find a cost for this procedure? If you want to discredit my argument, show me how much a mammogram costs and I will accept defeat. What does it cost at Christ? or Deaconess, or the Jewish Hospital?

I bet you can't. I picked one maintenance procedure that women get every year and found out that no price information is available. People are not allowed to vote with their dollars when price information is not available.

That is part of our health care problem. Doctors often have no idea what you will be charged, and they are the ones giving you the service. In what other industry does that happen? My roofer knows his costs and expenses as well as the bid price that was agreed upon, and he knows what he will make off the deal. Used car salesmen know their take as well. Why does my Doctor not have a clue?

The majority of medical coverage is paid for by third parties. Someone other than the Doctor and the patient. And that gives us a radical result that we tend to all be surprised about. No market mechanism, no economics of scarcity or price fluctuation, no nothing. We end up just billing someone else, most likely the government or an insurance provider. This system was broken years ago, and it is still broken now. One way to fix it is to fundamentally change the system. The other way to fix it is that we can throw more Chinese money that we don't have at it.

Your choice.

[Snipe]

I stumbled upon this graph from another thread.

The cost of health care is increasing around the world. Just dramatically more in the US:

http://assets.theatlantic.com/static/mt/assets/meganmcardle/6a00d8341c66b253ef0147e0453e06970b.jpg

I don't think it is fair to include that graph from that thread and not this...


http://farm4.static.flickr.com/3451/3771860397_0fa1de9729.jpg

I wanted to put these two graphs one after another.

In 1960 about half the cost of health care was paid out of pocket. The rest was picked up by insurance, charities and government. Notice the drop once that Medicare is past, it is about 10%. Today we pay around 10% of our health care costs out of pocket. Most people have no idea what the cost of their healthcare is, they never see the actual bills.

We used to pay for these things and demand value. We don't anymore. The government pays more and more.

Growing up I knew of a man that had a "Do not resuscitate" order because he didn't want medical care. He was concerned about the cost. They saved him anyway and sued and won. His goal was to give his life savings to his children, and he didn't want to spend money on health care at the end of his life.

With the government footing the bill, he wouldn't have to worry about that today.

We used to be our own death panels. If I had to pay $250,000 for something and I had spent my whole life getting that money, I would do a cost benefit analysis as to whether I want to spend my life savings or pass it on to my children. People used to make those decisions all the time. And when half the cost of health care was out of pocket, market forces made health care cheaper. Now only 10% is out of pocket, and you don't get a cash discount for avoiding the paperwork. The sad thing is you get charged more if you pay cash and don't have a good insurance provider to negotiate rates. Seriously, that is the case. It is the only field of play that a cash payer will pay more to my knowledge. We have self insured and you should see those hospital bills if you have a kid. They people that will pay the most have no insurance, so "out of pocket" is now a drawback.

Imagine a world where we offered people $50,000 to forgo a $100,000 treatment. Is that a cruel world? Some people would take the money and pass it on to their kids. Imagine the $250,000 treatments, you could make a pretty penny for your next generation by passing on that. But we don't let them pass on that. It is all or nothing and they pay it all to the doctors or don't pay at all. My dad was at the Cleveland Clinic for Cancer. It is debatable how much it really cost even if my sister saw bills totaling $250,000. I doubt my dad would have paid that with his own money. None of it was out of pocket. In that case, spare no expense.

Think about the incentives. What is going to drive costs down? What will make costs go up? When government pays the bills and people don't pay anything the costs go up. Look at the last 45 years of Medicare. If you are below 55, that Medicare will not be around for you.

It won't. We simply don't have the money. This country has been bankrupt for more than a decade, we are only just realizing it. We can't afford to pay our obligations. Thank God 75% of Mexican Immigrant families are on Welfare, because without that I don't know how we could pay the bills tomorrow.

We used to pay for our medical care. Now we don't, and somebody else does. It doesn't surprise me that when someone else is paying we demand more medical care.

Isn't this simple? The consequences may be hard, but isn't understanding the problem simple?

And since we don't have the money, shouldn't we change things up?

[paulxu]

IWe used to pay for our medical care. Now we don't, and somebody else does.

That's not really the case. You still pay for it, you just do it in a different way; taxes, payroll deduction, lower wage so your employer pays more, etc. You're still paying.

The first graph is the key. The cost of this service doesn't need to be that much of our GDP to get effective medical care for every citizen. Other industrialized nations have proven it. The missing part of your good discussion about the market, price points, competition, etc. is the impact of effective monopolies in most of the country...where one or two private carriers control the majority of a market.

That is why over 60% of phyisicians favor a single payer plan, however it is administered. There's just too much inefficiency built into our current system.

[muskienick]

In free market capitalism we have something called the price-mechanism. We use this price mechanism to allocate scarce goods and resources. In a free market, you vote every day with every dollar. Those dollars are the votes.

Nick seems to be oblivious and ignorant of this. Even when presented with evidence he evades and declines to tackle the argument.

Specifically to this threat he asks:


I don't think that we do frontal lobotomies anymore, but I still think it is a useful question. If we did do them, where would you go to get the best deal?

Take Mammograms. Women get them every year, and they are mandated in preventative care legislation. How much does a mammogram cost? Good luck finding out.

It is almost impossible to find out what one would pay. That is a problem for something my wife gets every year. You can't get a quote from Christ Hospital, which is an industry leader in Cincinnati for a procedure that is routine maintenance.

Every woman over a certain age is supposed to get these mammograms every year. Tens of millions of women do this every year. Why can't I find a cost for this procedure? If you want to discredit my argument, show me how much a mammogram costs and I will accept defeat. What does it cost at Christ? or Deaconess, or the Jewish Hospital?

I bet you can't. I picked one maintenance procedure that women get every year and found out that no price information is available. People are not allowed to vote with their dollars when price information is not available.

That is part of our health care problem. Doctors often have no idea what you will be charged, and they are the ones giving you the service. In what other industry does that happen? My roofer knows his costs and expenses as well as the bid price that was agreed upon, and he knows what he will make off the deal. Used car salesmen know their take as well. Why does my Doctor not have a clue?

The majority of medical coverage is paid for by third parties. Someone other than the Doctor and the patient. And that gives us a radical result that we tend to all be surprised about. No market mechanism, no economics of scarcity or price fluctuation, no nothing. We end up just billing someone else, most likely the government or an insurance provider. This system was broken years ago, and it is still broken now. One way to fix it is to fundamentally change the system. The other way to fix it is that we can throw more Chinese money that we don't have at it.

Your choice.

My use of the frontal lobotomy line was meant as a form of humor to lighten the overall tone of this back-and-forth exchange. Snipe seems to be "ignorant" of what many would have seen as obvious irony.

Variety is the spice of life. Different strokes for different folks. Those old saws still mean something. In this thread they refer to the fact that people hold different beliefs based on many factors and many different sets of observations and "evidence." Furthermore statistics can be easily skewed and "artfully" interpreted to fit one's own mindset.

An obvious example of this is someone's interpretation for the lesser demand for gasoline supposedly being the direct result of people driving their cars less. In fact, unless one has been spending most of his time with head-in-sand, blithely ignoring the world around him, he would have noticed that the entire auto industry has steadily increased gas mileage specifications to comply with State and Federal regulations. But let's not bring reality into play when it refutes our stances on the issues.

[Fred Garvin 2.0]

I guess they do in a strange sort of way. It's kinda like voting for beheading over hanging since it might go faster. And consumers certainly don't vote down rising gas prices in favor of pedaling their Schwinn, riding the bus, or sharing a car with three other people they might not even know (or, worse yet, have learned not to like) back and forth to work every day.

Nick, I know you mentioned looking into a frontal lobotomy but don't rule out this beheading option.

[Fred Garvin 2.0]

That's not really the case. You still pay for it, you just do it in a different way; taxes, payroll deduction, lower wage so your employer pays more, etc. You're still paying.

The first graph is the key. The cost of this service doesn't need to be that much of our GDP to get effective medical care for every citizen. Other industrialized nations have proven it. The missing part of your good discussion about the market, price points, competition, etc. is the impact of effective monopolies in most of the country...where one or two private carriers control the majority of a market.

That is why over 60% of phyisicians favor a single payer plan, however it is administered. There's just too much inefficiency built into our current system.

So your solution is allowing shopping for health insurance across state lines a la car insurance?

[kmcrawfo]

That is why over 60% of phyisicians favor a single payer plan, however it is administered. There's just too much inefficiency built into our current system.

60% of physicians absolutely do not favor a single payer plan.

Virtually no physicians outside of academic, VA, state/county, military, etc. favor such a system. A substantial percentage of these physicians favor such a system because they are already in extremely inefficient systems and are already currently for the most part paid on salary (not performance). I have worked in academics, the military, and private practice. The quality and access of care you receive in private practice blows the other models out of the water. why is it better? Because the physicians have incentive to offer you a better product to retain your business and patronage to their office. Private offices are efficient despite the inadequacies of the current system. If they are not, they do not survive. Huge academic and government institutions are virtually always cumbersome and inefficient. Yet, they still survive due to a variety of reasons beyond the scope of this thread.

I do not know a single (not a single one) owner/partner of a private physicians office who favors a single payer system.

[Fred Garvin 2.0]

KCraw,

In the past I've supported the idea of creating a new class of BTC drugs much like Britain has several classes of BTC drugs. Let's face it, not all drugs require the same amount of monitoring. Hell, I think Zocor should be OTC. I don't have any problem with a woman coming into a pharmacy and taking a blood test to get her birth control pill.

The problem is the Law of Uninteded Consequences. No way this doesn't increase demand on the time of pharmacists. Frankly, I don't think it is right I have to wait to talk with the pharmacist because Nick is getting a blood test to procure her pill.

[kmcrawfo]

KCraw,

In the past I've supported the idea of creating a new class of BTC drugs much like Britain has several classes of BTC drugs. Let's face it, not all drugs require the same amount of monitoring. Hell, I think Zocor should be OTC. I don't have any problem with a woman coming into a pharmacy and taking a blood test to get her birth control pill.

The problem is the Law of Uninteded Consequences. No way this doesn't increase demand on the time of pharmacists. Frankly, I don't think it is right I have to wait to talk with the pharmacist because Nick is getting a blood test to procure her pill.

I would have no problem with some basic stuff. However, this is a slippery slope. To use a single example, Everyone needs to remember that we are having a crisis with bacterial resistance around the world. Strains of MRSA and other bacteria are now resistant to more and more Rxs. The more access you give to the public to abx, the worse this problem becomes. That is just one example.

If you did give pharmacists ability to prescribe Abx it would have to be tightly regulated. They would have to run a rapid strep test and get absolute confirmation of the diagnosis prior to prescribiing, for instance. You then have to ask yourself what is the cost of instituting these regs, testing, add'l trainging, credentialing, billing etc.

The UK does not exactly have the most cost efficient Health Care either. There is no easy answer here.

Increasing the number of medical students doesn't solve the problem. These people still would have to pass USMLE I, USMLE II, USMLE III, and board certification Exams. A significant number of the current applicants don't even pass those tests. Just increasing the number at the starting gate actually would increase cost for training, but would not necessarily increase the number of licensed physicians.

Certainly, people would not advocate lowering the standards/difficulty of the Medical Licensing and Board Certification Exams. That would be a serious mistake and they currently test for what is considered minimum competency to practice in the United States.

Finally, medical applicants are going down (not up). People have figured out there are much more lucrative careers with much less stress/educational demands/regulation/etc. Single payer, socialized medicine, etc will only make that problem worse. The incentive to be a doctor is being removed. You can't do it for the $$$ anymore. And it is becoming hard to do it because you want to help people due to increasing demands, restrictions, control, etc.

[paulxu]

60% of physicians absolutely do not favor a single payer plan.


Craw, I respect your view as I understand you are a practicing physician. I spent 4 years in Navy medicine, and have a brother who is a solo practicioner (pediatrics).

I didn't dream up the number. In 2002, researchers at Indiana University did a survey, and followed it up in 2008. In the latest survey, the number of doctors was up to 59% favoring it. Below is a link that details the specialites who responded, and I believe the metrics of the survey were done correctly. Would invite you to read entire report if you subscribe to the Annals of Internal Medicine (April of 2008). The below link is only a summary.

My approach tends to be business in nature. Although Cleveland Clinic, Mayo, etc provide the best care in the world...that is only available for a select few. When every other industialized nation covers all its people with primary care, and we leave millions uncovered, and use twice of our GNP to do it...I believe we can do much, much better...and at a lower cost.

Maybe it's like having fire depts. Once that was a private venture, but we soon learned that we needed everyone covered for the best result. Other countries realize the best result (for everyone, not the select few) is to provide this basic coverage. One way to do it is single payer. Another may be public option. But we need to extend coverage, and lower the cost for all of us...for our physcial and fiscal health.

Would be interested to know what you think of the Indiana University study.

http://www.pnhp.org/docsurvey/annals_physician_support.pdf

[Kahns Krazy]

An obvious example of this is someone's interpretation for the lesser demand for gasoline supposedly being the direct result of people driving their cars less. In fact, unless one has been spending most of his time with head-in-sand, blithely ignoring the world around him, he would have noticed that the entire auto industry has steadily increased gas mileage specifications to comply with State and Federal regulations. But let's not bring reality into play when it refutes our stances on the issues.

Uhhh, I don't know if this was a shot at me or not, but I certainly didn't draw the conclusion that reduced gasoline consumption is the "direct result" of people driving their cars less. Certainly, average fuel economy plays into the total demand.

As for the rest of your post, according to the USDOT statistics, road miles driven peaked in 2007 and have been decreasing since, but let's not bring data into play when it intereferes with our ability to be a condescending prick.

[muskienick]

Uhhh, I don't know if this was a shot at me or not, but I certainly didn't draw the conclusion that reduced gasoline consumption is the "direct result" of people driving their cars less. Certainly, average fuel economy plays into the total demand.

As for the rest of your post, according to the USDOT statistics, road miles driven peaked in 2007 and have been decreasing since, but let's not bring data into play when it intereferes with our ability to be a condescending prick.

Once again we find creative statistics at work. You fail to mention that the price of a gallon of gas went up to its highest level of well over $4 in 2008. One might guess that kept a lot of folks at home during their normal 2-week vacation periods and planted in front of their TV's instead of going across town to a restaurant, movie, or club. Perhaps that's why the USDOT stats showed driving miles taking a dive in 2008 over 2007!

Like I said, people will always use stats to their advantage. We are both doing it now. It doesn't make either of us condescending pricks. We're merely normal human beings with strong convictions with a convenient set of stats we can use to our own advantage! Perhaps you'll find some more to back up your stance. I'll be able to do so as well.

What's your take on a married priesthood? (This should be fun!)

[GoMuskies]

Once again we find creative statistics at work. You fail to mention that the price of a gallon of gas went up to its highest level of well over $4 in 2008. One might guess that kept a lot of folks at home during their normal 2-week vacation periods and planted in front of their TV's instead of going across town to a restaurant, movie, or club.

Wait, so you're now agreeing that consumers sometimes vote against price increases with their wallets? Good.

[DC Muskie]

All the way at the bottom. If you are in the business of providing nursing home services to Medicare patients, the amount you get paid for your services will drop by 11%. If you were getting paid $100 for a therapy hour, you will now get $89. Your cost structure will stay the same, unless you can get your employees, your landlord, your utility company and your insurance company to all drop their rates by 11% as well.

Looking at one company in that article - Skilled Healthcare, they generate 16% of their total revenues from Medicare. In Q2, they generated $10.5 million in net income off total revenues of $215.5 million. $34 million of that revenue comes from Medicare. Take 11% of that revenue away, and you lose nearly $4 million off your bottom line. Now you're generating $6.7 million off $215.5 million in sales, for a whopping 3.1% margin.

I can't rep you, but thanks for this. Helps me understand.

[Kahns Krazy]

Once again we find creative statistics at work. You fail to mention that the price of a gallon of gas went up to its highest level of well over $4 in 2008. One might guess that kept a lot of folks at home during their normal 2-week vacation periods and planted in front of their TV's instead of going across town to a restaurant, movie, or club. Perhaps that's why the USDOT stats showed driving miles taking a dive in 2008 over 2007!


I find myself unable to argue against people changing their driving habits because of higher gas prices. It's as though that was my point to begin with...

[kmcrawfo]

Craw, I respect your view as I understand you are a practicing physician. I spent 4 years in Navy medicine, and have a brother who is a solo practicioner (pediatrics).

I didn't dream up the number. In 2002, researchers at Indiana University did a survey, and followed it up in 2008. In the latest survey, the number of doctors was up to 59% favoring it. Below is a link that details the specialites who responded, and I believe the metrics of the survey were done correctly. Would invite you to read entire report if you subscribe to the Annals of Internal Medicine (April of 2008). The below link is only a summary.

My approach tends to be business in nature. Although Cleveland Clinic, Mayo, etc provide the best care in the world...that is only available for a select few. When every other industialized nation covers all its people with primary care, and we leave millions uncovered, and use twice of our GNP to do it...I believe we can do much, much better...and at a lower cost.

Maybe it's like having fire depts. Once that was a private venture, but we soon learned that we needed everyone covered for the best result. Other countries realize the best result (for everyone, not the select few) is to provide this basic coverage. One way to do it is single payer. Another may be public option. But we need to extend coverage, and lower the cost for all of us...for our physcial and fiscal health.

Would be interested to know what you think of the Indiana University study.

http://www.pnhp.org/docsurvey/annals_physician_support.pdf

I took a look at that article. There are some flaws with the study. The pool they used was from the AMA. The AMA currently represents about 15% of all physicians in the country. Of the AMA's approximately 240,000 members, about 48,000 are medical students, and 30,000 are resident and fellow physicians. Of the remaining approx 150,000 about 60-70% are in academic/government run institutions. Therefore, you are selecting from a patient population that is inherently biased towards universal healthcare.

Additionally, the study did not ask if people supported a single payer system. It asked "In priniciple, do you support or oppose government legislation to establish national health insurance?"

That is a big difference than a single payer system. It basically asked a group of doctors who are primarily in a academic/government setting if they supported a universal care policy. That is not asking to your support the obliteration of all private payers and the start of a government run, single payer system.

So.... The study basically tells you that in a group of 2193 doctors primarily comprised of medical students (it appears these may have been excluded), residents, fellows, academic, government, and primary care providers there is 59% support of legislation to establish national health insurance.

Additionally, the study did not give hard numbers of how many of each specialty replied. For all we know it could have been 2000 pediatricians, 3 radiologists, 10 surgeons, etc. That is important data.

An interesting study, but it does not show as strong of physicians support for universal healthcare as you would initially think and definately does not show support for a single payer system.

[muskienick]

I find myself unable to argue against people changing their driving habits because of higher gas prices. It's as though that was my point to begin with...

Actually, the point I remember attempting to counter was that we could just go to a different gas station for lower prices. I stated earlier that significant (life-altering) changes in consumer trends usually take decades to be effected (cigarette smoking, for example). I made the further point with lumber and gasoline that increases were industry-wide, much like the extreme hits being taken by local governments in Ohio as the politicos in Columbus shut down a number of important and significant income streams without providing enough time for local governments to adequately adjust. Also, I pointed out that the consumer really couldn't benefit much from "shopping around" and that was clearly shown by the drop off of driving miles from 2007 to 2008 due to the industry-wide hike in gas prices. I further pointed out that it was quite a bit easier to spend a 2-week vacation in town or cut down on cross-town outings in favor of stay-at-home recreation than it is to just up and sell your current house and move to another jurisdiction where you think the local government is more taxpayer-friendly. And, of course, there is also the deal where industry can simply raise their prices to match their competitors (as they all do --- even in the ice cream industry as I pointed out). This, of course is impossible for local governments to do with their most significant sources of income: earnings and real estate taxes.

The argument against my last argument (above) was that consumers supposedly vote against price increases by going elsewhere for the commodity or service in question. I stated that wasn't actually a realistic description of what occurs in the long run since the vast majority of price hikes are industry-wide. And people are wise enough to know it would generally be folly to "house-hop" from one taxing jurisdiction to another to take advantage of a temporary tax break that will likely be gone when the citizens realize their local government's limitations and finally vote for a Street Construction Levy, a Fire Levy, or an operating levy after services have been cut in those departments to debilitating levels and their property values have dropped accordingly (all of which take too long also!).

Like I said, we can continue to go round and round, you with your younger friends here and me with my 30 additional years of observations and experience (or is it more atrophied brain -- I'd guess that would be your take).

That's what makes the world go 'round!

[GoMuskies]

The argument against my last argument (above) was that consumers supposedly vote against price increases by going elsewhere for the commodity or service in question.

No, the argument was that consumers vote against price increases by not buying the product or service (or as much of it) from the person or entity that raised the price. One way to do that, of course, is to go buy it somewhere else. Another way to do that is to modify your behavior in such a way that you don't need as much of said product or service.

[GuyFawkes38]

Kmcrafo had a nice response to the doctor critics of this thread.

But the bold part here still sticks out in my mind.


We hands down have the best health care system in the world. We have the best trained doctors, the most advanced treatments, the most inovation. Our outcomes and wait lists blow other countries out of the water when it comes to cancer survival, surgical outcomes, time to wait for surgical procedures, etc. Yes, we spend more per capita. The US outspends every country on everything (military, highway system, education). It is not just healthcare that is a money pit.

That's simply not true.

Again, the key chart:

http://assets.theatlantic.com/static/mt/assets/meganmcardle/6a00d8341c66b253ef0147e0453e06970b.jpg

Of course, the US is an extremely wealthy country. So you'd expect per capita numbers to be higher.

But as the chart shows, even the percentage of GDP is much higher in the US.

That being said, I don't doubt for a second that many doctors are feeling pinched. The solution, IMHO, is to make it less costly to enter the field (find ways to reduce medical school cost, for example).

[muskienick]

No, the argument was that consumers vote against price increases by not buying the product or service (or as much of it) from the person or entity that raised the price. One way to do that, of course, is to go buy it somewhere else. Another way to do that is to modify your behavior in such a way that you don't need as much of said product or service.

That's mighty easy to do when you're talking about non-essentials. But the vast majority must drive pretty often and that takes gasoline. We know what that industry is like. For whatever reason, their prices all go up or down almost in unison (or at least within a couple of hours). I don't know about you, but the price of gas always seems to go down the day after I've filled up and it goes up the day before I need a fill-up!

I (and most other people) simply won't go to the bother and waste the additional time and burn the extra gasoline to go to three or four different grocery stores to buy every item on our shopping list at its cheapest price. It's usually cheaper in the long run to go to the local Kroger's, use your Kroger card, and cash in a handful of coupons.

You can try reasoning the way you have but reality is reality. Most people simply don't operate the way you suggest in this post. Perhaps more of them should take your advice on the purchase items where it's possible. But I'm not going to hold my breath until it actually happens. (Mainly because that would ace Garvin out of attending my beheading or witnessing my frontal lobotomy --- I haven't yet decided which way I'm going on that deal!)

[muskienick]

Kmcrafo had a nice response to the doctor critics of this thread.

But the bold part here still sticks out in my mind.



That's simply not true.

Again, the key chart:

http://assets.theatlantic.com/static/mt/assets/meganmcardle/6a00d8341c66b253ef0147e0453e06970b.jpg

Of course, the US is an extremely wealthy country. So you'd expect per capita numbers to be higher.

But as the chart shows, even the percentage of GDP is much higher in the US.

That being said, I don't doubt for a second that many doctors are feeling pinched. The solution, IMHO, is to make it less costly to enter the field (find ways to reduce medical school cost, for example).

I really didn't look at that chart too closely until you reposted it, Guy. It seems really "out of character" that health care costs seemed to rise most precipitously during the Reagan and Bush 1 and Bush 2 years (although they seemed to level off during W's last 5 years or so. During Clinton's terms, it appears to level off across almost his entire 8 years.

I would have guessed just the opposite. It must have been those rascally Democrats in the House and Senate that did it!

[paulxu]

Craw,
Thanks for input. AMA has changed positions often on universal care, and many doctors apparantly have left it for that.
But if it was a "random" sample from their roll as indicated, I would think the 2000+ responses would have some validity across specialites as indicated.
National healthcare systems are generally single payer, yes? People may have additional insurance, but the basic idea of a national system would I think be what most people call single payer.
I don't favor a national system (like England.) But single payer administered by non-profit agents (like Germany) seem to work better.
They all have challenges, yet only use 10% of GDP. They've got room to improve, while providing basic care for all citizens.
We're approaching 20% of GDP spent on health care and can't cover everyone. As a businessman I think we can do a whole lot better.

[kmcrawfo]

Craw,
Thanks for input. AMA has changed positions often on universal care, and many doctors apparantly have left it for that.
But if it was a "random" sample from their roll as indicated, I would think the 2000+ responses would have some validity across specialites as indicated.
National healthcare systems are generally single payer, yes? People may have additional insurance, but the basic idea of a national system would I think be what most people call single payer.
I don't favor a national system (like England.) But single payer administered by non-profit agents (like Germany) seem to work better.
They all have challenges, yet only use 10% of GDP. They've got room to improve, while providing basic care for all citizens.
We're approaching 20% of GDP spent on health care and can't cover everyone. As a businessman I think we can do a whole lot better.

Keep in mind that in Germany all the doctors a few years went on strike because they couldn't afford to accept the payment from the healthcare system.

http://www.eurofound.europa.eu/eiro/2006/07/articles/de0607019i.htm

They went on strike again in 2010.

The German system borders on a disaster.

There is no way to cover everyone... Period. I would love for everyone to have healthcare and a "safety net". I see plenty of patients for free and volunteer time at various institutions. Unfortunately, the resources are not there. Anyone who thinks Universal Healthcare is a possibility from a resource/cost perspective is fooling themselves. The PIE is only so big and no matter how you cut it someone is not getting a piece.

Universal healthcare does not always mean single payer. It means all people have a baseline of healthcare coverage option. The Obamacare package requires all people at least participate in the universal option, or else pay a fine to opt out. This includes employers. I am oversimplifying it, but that is the jist.

[kmcrawfo]

Kmcrafo had a nice response to the doctor critics of this thread.

But the bold part here still sticks out in my mind.



That's simply not true.

Again, the key chart:

http://assets.theatlantic.com/static/mt/assets/meganmcardle/6a00d8341c66b253ef0147e0453e06970b.jpg

Of course, the US is an extremely wealthy country. So you'd expect per capita numbers to be higher.

But as the chart shows, even the percentage of GDP is much higher in the US.

That being said, I don't doubt for a second that many doctors are feeling pinched. The solution, IMHO, is to make it less costly to enter the field (find ways to reduce medical school cost, for example).

It is true, the numbers below have different units (i.e millions vs. billions vs. trillions, etc). So each section is only meant for comparison to those other numbers in the section:

U.S. tops the world in school spending but not test scores
WASHINGTON (AP) — The United States spends more public and private money on education than other major countries, but its performance doesn't measure up in areas ranging from high-school graduation rates to test scores in math, reading and science, a new report shows.

"There are countries which don't get the bang for the bucks, and the U.S. is one of them," said Barry McGaw, education director for the Paris-based Organization for Economic Cooperation and Development, which produced the annual review of industrialized nations.

The United States spent $10,240 per student from elementary school through college in 2000, according to the report. The average was $6,361 among more than 25 nations.

Military Spending:
1 United States United States $698,105,000,000 4.7%
2 People's Republic of China People's Republic of China 114,000,000,000 2.2%
3 France France 61,285,000,000 2.5%
4 United Kingdom United Kingdom 57,424,000,000 2.7%
5 Russia Russia 52,586,000,000 4.3%

Total Expenditure (2007):
1 United States $2,655,000,000,000
2 Japan $1,586,000,000,000
3 Germany $1,331,000,000,000
4 France $1,211,000,000,000
5 United Kingdom $1,071,000,000,000

Highway:
1. USA 6,420,000
2. Japan 1,140,000
3. Canada, 1,100,00
4. France 1,000,300
5. Australia 830,000


My point is the USA blows every country out of the water when it comes to spending on almost anything. When your Total Expenses are basically double the next country, the % GDP may not always be an exact reflection of how much $$$ you are spending.

Guess who in the biggest importer of goods in the world: The USA
Guess who is the biggest exporter of goods in the world: The USA was in 2009. China may have overtaken us in 2010 estimates

[GuyFawkes38]

Again, I think the point stands that it's fruitless to present spending numbers on a per capita basis when comparing international numbers. The US spends more money on nearly everything because it makes more money than nearly everyone.

To put spending numbers in context, you have to use percentage of GDP.

[Kahns Krazy]

This is a rather silly argument, and really doesn't need to be hashed out like this, but I did call you a condescending prick, so I thought I'd at least try to show why.



bd,

At least be realistic with your retorts! Perhaps America will change its transportation habits over a long period of time as it has with the smoking of tobacco. But for at least the foreseeable future it is highly unlikely that the typical American will take to bus schedules, Schwinn purchases, and putting up with three other people's morning and afternoon drive-time idiosyncrasies for a half-hour each way to save a few bucks. We have had various types of problems with gasoline dating back to the dreadful Jimmy Carter Administration days and our love affair for convenience driving has changed little over the ensuing 30+ years. Why would anybody think your suggested solutions would be widely accepted now?

You said it yourself: "Americans love to complain about gasoline prices, but nobody wants to actually change their driving habits so the demand stays the same."

Your argument here is that people don't change their driving habits. It's nothing about going to another gas station to try to save a few pennies.

I guess they do in a strange sort of way. It's kinda like voting for beheading over hanging since it might go faster.

And consumers certainly don't vote down rising gas prices in favor of pedaling their Schwinn, riding the bus, or sharing a car with three other people they might not even know (or, worse yet, have learned not to like) back and forth to work every day.

You re-iterate your position about driving habits.


They are doing something. Gasoline demand in the US in May of 2011 was at an 8 year low. With a population 7.5% larger than it was 8 years ago, at least some people are changing some habits.

I pointed out that gasoline demand is in fact dropping. I didn't claim to attach a specific reason. I am rarely more ambiguous than a statement like "Some poeple are changing some habits"".


An obvious example of this is someone's interpretation for the lesser demand for gasoline supposedly being the direct result of people driving their cars less. In fact, unless one has been spending most of his time with head-in-sand, blithely ignoring the world around him, he would have noticed that the entire auto industry has steadily increased gas mileage specifications to comply with State and Federal regulations. But let's not bring reality into play when it refutes our stances on the issues.

Here, you put words in my mouth. I never said anything specific about people driving cars less. I cited the lower demand, and attributed it to "some people changing some habits". Then, after you created an argument for me that I didn't make, you attacked me for having my head in the sand, blithely ignoring the world around me, and ignoring reality. Certainly not the worst things I've been called on the board, but given that I never even made the claim you were attacking me for, I thought it was a bit unwarrented.


Once again we find creative statistics at work. You fail to mention that the price of a gallon of gas went up to its highest level of well over $4 in 2008. One might guess that kept a lot of folks at home during their normal 2-week vacation periods and planted in front of their TV's instead of going across town to a restaurant, movie, or club. Perhaps that's why the USDOT stats showed driving miles taking a dive in 2008 over 2007!


Here's where I get a little confused. You are now arguing that the cost of gasoline has caused some people to change some habits. I figure we are on the same page at this point.


Actually, the point I remember attempting to counter was that we could just go to a different gas station for lower prices. I stated earlier that significant (life-altering) changes in consumer trends usually take decades to be effected (cigarette smoking, for example).

(.....)


Like I said, we can continue to go round and round, you with your younger friends here and me with my 30 additional years of observations and experience (or is it more atrophied brain -- I'd guess that would be your take).

That's what makes the world go 'round!

Now we are back on a different page. I wasn't attempting to argue that gasoline could be purchased for a cheaper price at another outlet. I was saying that with commodities, which I agree with you can not be shopped around for a better price, the consumer option is to change their demand. This can be done in several ways. As you pointed out, you can lower your personal demand by switching to a more fuel efficient car. You can also drive fewer miles. Some people have probably done both. Others have done the opposite. (SUV driven miles increased from 2007 to 2009). The economy plays a significant role in this, as fewer dicretionary consumer goods purchases means fewer trucks on the road. The net effect is that gasoline demand is down in spite of an increasing population for a variety of reasons, or, as I said originally, "some people are changing some habits".

[Kahns Krazy]

Again, I think the point stands that it's fruitless to present spending numbers on a per capita basis when comparing international numbers. The US spends more money on nearly everything because it makes more money than nearly everyone.

To put spending numbers in context, you have to use percentage of GDP.

That assumes that all expenditures are viewed equally in priority. Making relatively more on a per capita basis would actually explain why the US has a higher % of healthcare spend. Once the immediate needs (food, shelter) are met, discretionary income would be spent on the next highest priority. For many, that would be health.

I would fully expect the country that makes more money than everyone to spend a higher percentage on healthcare than everyone.

I have no idea if that explains the variance in the chart, but it would be interesting to see that data somehow normalized to exclude variances in GDP.

[muskienick]

This is a rather silly argument, and really doesn't need to be hashed out like this, but I did call you a condescending prick, so I thought I'd at least try to show why.

I agree with much of what you have said in the recent post that began with the above sentence. Since I know myself a bit better than you do, my agreement with you diverges considerably with your description of me as a "condescending prick." If anything, what little humor I may have might be best described as "self-deprecating" (which actually showed up in a few places throughout this thread). I guess it is possible to be a "condescending prick" while exhibiting a "self-deprecating" sense of humor but it's not easy or likely or, perhaps most importantly, intended.

I believe this exchange of ideas became very convoluted, especially in the use of observations and/or "evidence" to support one's claims. I honestly believe that's what happened to you in a few cases along the way and I'm willing to admit that might have affected my takes in a few instances as well.

The bottom line is that we were both rather naive (or temporarily forgetful of the human condition) to think that either of us had a chance of swaying the other to his way of thinking, regardless of how very right we might think we are and how illogical we might consider the other person to be in the discussion.

[GuyFawkes38]

Milton Friedman taking on the AMA in front of doctors:

http://youtu.be/TdcaLReCG3Y

That's courage.

[Snipe]

Great link. I have Capitalism and Freedom on my bedside table.

He was the greatest thinker of the 20th Century.

[GuyFawkes38]

Great link. I have Capitalism and Freedom on my bedside table.

He was the greatest thinker of the 20th Century.

I've got to read that. Yeah, such a great thinker. Even leftist seem to respect him.

[GuyFawkes38]

We need more, lower paid doctors in this country.
http://www.slate.com/articles/business/moneybox/2013/02/american_doctors_are_overpaid_medicare_is_cheaper_ than_private_insurance.html

If Obamacare can do that, I'm all for it.

[paulxu]

If Obamacare can do that, I'm all for it.

It can't. They blocked the portion of the original plan that would have let people sign up for Medicare as an insurance alternative.
Drug/Medical Device/Insurance lobbies just too strong. Too many in congress dependent on their support to get re-elected.

[kmcrawfo]

We need more, lower paid doctors in this country.
http://www.slate.com/articles/business/moneybox/2013/02/american_doctors_are_overpaid_medicare_is_cheaper_ than_private_insurance.html

If Obamacare can do that, I'm all for it.

Well... You and everyone else in this country are going to get it. Except for the members of Congress who exempted themselves for their current healthcare policy (hmmm....)

I hope everyone likes what they get because I don't think they have any idea what they are in for....

Despite the reduction in reimbursement (which I am fine with) this will affect me much less than the vast majority of people on this board and the rest of the country.

Give this 10 years and see if you are all so happy for what this does to our healthcare system and our country's financial health overall.

[paulxu]

If you've got a few minutes, here is a fascinating short video on what may really cut medical costs in the very near future.

http://www.nbcnews.com/id/21134540/vp/50582822#50582822

[ArizonaXUGrad]

I have obvious views on health care costs, but something came to mind when discussing it at work.

In today's world, you can have a recent college graduate who has no money. This student gets a job out of school and put on his/her own medical high deductible plan. He/she gets sick within 2 months of working and immediately goes into debt because of no time to even save money and a $2k bill or whatever the deductible amount is. Add to that all the co-pays they incur from repeated doctor visits. The new high deductible system we have is set up to cause a lot of young people in the work force to fail or at least assume debt immediately out of college over and above any possible student loans.

It simply should not be this way. There are a lot of things wrong with this country and this is just one of them.

There should be only one question regarding healthcare...."Do I need it?"

[waggy]

Is the health of recent college grads really that poor? Percentage of grads as you would describe is maybe .001. Or maybe you're talking about career students who graduate at 45 with a degree in philosophy.

[xu95]

No he actually just thinks we should be a Socialist society where the Government pays for everything.

[powerofX]

No he actually just thinks we should be a Socialist society where the Government pays for everything.

Ding Ding Ding...plenty of his posts would indicate this...

[ArizonaXUGrad]

Ding Ding Ding...plenty of his posts would indicate this...

I am not ashamed of it either, but I don't think everything should be socialist. Healthcare should be added a list we already have including cops, firemen, libraries, roads, etc.

With Healthcare, if you have to ask "Can I afford this?" then we have already failed.

[chico]

I am not ashamed of it either, but I don't think everything should be socialist. Healthcare should be added a list we already have including cops, firemen, libraries, roads, etc.

With Healthcare, if you have to ask "Can I afford this?" then we have already failed.

How about this: We buy everyone either a treadmill, stationary bike or elliptical machine. We also keep a database of food you purchase. The more you use your fitness machine and the less potato chips you eat and pop you drink the less you have to pay for medical care. Everybody wins.

If I don't have to pay for healthcare then why should I have to pay for the things that keep me healthy? I want a free health club membership, free fruit and vegetables.

[ArizonaXUGrad]

How about this: We buy everyone either a treadmill, stationary bike or elliptical machine. We also keep a database of food you purchase. The more you use your fitness machine and the less potato chips you eat and pop you drink the less you have to pay for medical care. Everybody wins.

If I don't have to pay for healthcare then why should I have to pay for the things that keep me healthy? I want a free health club membership, free fruit and vegetables.

Because there are a lot of diseases or conditions you can get or have at birth that have nothing to do with keeping yourself in shape. It's really just the right thing to do, I am sorry you don't agree with me.

Ironic thing is that I actually keep myself in good shape. I race mountain bikes and am working on moving into triathlon. I am already in the upper 5% out of the water at events. I really should be the one who doesn't want it, but I recognize how health care can devastate families whether they have savings or not.

[Kahns Krazy]

I am not ashamed of it either, but I don't think everything should be socialist. Healthcare should be added a list we already have including cops, firemen, libraries, roads, etc.

With Healthcare, if you have to ask "Can I afford this?" then we have already failed.


Define "you" and "we" in this statement please.

[GuyFawkes38]

Everytime I need a good laugh, I go to healthcare.gov. Yikes. What a mess. IT is deceptively difficult.

I honestly hope they get this turned around. People are counting on this.

[waggy]

Everytime I need a good laugh, I go to healthcare.gov. Yikes. What a mess. IT is deceptively difficult.

I honestly hope they get this turned around. People are counting on this.


You can go here and tell them what you really think. https://www.healthcare.gov/chat/


I've been waiting five minutes.

[waggy]

Well I never actually was able to have a conversation on that chat line. I waited about 10 minutes twice, but each time something about the chat software interfered with my computer, disconnected and then reset. Just as well, as I'd probably be on my way to Guantanamo now if I'd gotten thru.

[Masterofreality]

Wow....just wow.

This is unbelieveable.

http://www.forbes.com/sites/theapothecary/2013/10/14/obamacares-website-is-crashing-because-it-doesnt-want-you-to-know-health-plans-true-costs/

[boozehound]

Wow....just wow.

This is unbelieveable.

http://www.forbes.com/sites/theapothecary/2013/10/14/obamacares-website-is-crashing-because-it-doesnt-want-you-to-know-health-plans-true-costs/

This is an opinion piece from a guy who was a former advisor to Mitt Romney. He appears to have written like 400 articles over the past few months about how terrible the ACA is going to be. I'm not sure how much I am trusting his speculation about why you have to register before seeing costs.

Honestly, I'm really curious to see how this thing shakes out. I don't believe there is any way that this thing goes off without a hitch and has no impact on healthcare costs for people unaffected by the ACA. I also don't think there is any way that this is as bad as the detractors say it will be.

[X-band '01]

What would be informative would be to see how websites like Anthem, Humama, Medical Mutual of Ohio, etc. are doing at this time.

I'm sure you can get a quote for individual and family insurance on any of their websites; what I don't know is how much sensitive data they require versus whatever data you have to enter through the HealthCare.gov website.

Do health care premiums on those websites take into account any tax credits/advance tax credits? That's something I'm going to have to learn even if I'm not buying health insurance for others - I'm going to have to learn this when it comes to preparing tax returns for 2013, 2014 and beyond.

[xudash]

This is an opinion piece from a guy who was a former advisor to Mitt Romney. He appears to have written like 400 articles over the past few months about how terrible the ACA is going to be. I'm not sure how much I am trusting his speculation about why you have to register before seeing costs.

Honestly, I'm really curious to see how this thing shakes out. I don't believe there is any way that this thing goes off without a hitch and has no impact on healthcare costs for people unaffected by the ACA. I also don't think there is any way that this is as bad as the detractors say it will be.

I don't believe there is any way that this thing goes off without a hitch - - roger that.

and has no impact on healthcare costs for people unaffected by the ACA. - - roger that.

I also don't think there is any way that this is as bad as the detractors say it will be. - - Sure, okay.


Let's see if we can plow through and comprehend the basics:

More people covered without a proportional increase on the services side; in fact, service providers are opting out to some degree.

Obama fails to make it truly democratic, hypocritically allowing various members of his base to opt out, and they were screaming for the opt out.

The math HAS TO WORK: he needs for everyone who is supposed to sign up actually sign up for it in order for it to have a chance of achieving an effective financial result for consumers. How's that working out so far? Too early to tell you say? Sure, okay.

It was a thousand page piece of crap that few bothered to read or comprehend, and now it's coming home to roost.

[vee4xu]

I really haven't read this thread and no real interest in it other than to suggest that the current system is unsustainable. We have lots of folks making the same argument about other topics. For example, the increases in college education. Again, unsustainable. This whole health care issue didn't just jump out from behind a rock and yelled, "boo". The system has been heading for this break point for over 30 years. During that time, no one did anything to fix it. Not the docs, not the insurance companies, not Congress, not the voter. No one. Now, the legislature passes a bill, albeit far from perfect, but it represents a starting point. I ask this, how long can the health care system continue on its current path? And, what happens if it does maintain this current path unabated for the next 7-10 years. Democratic and Republican Presidents, Houses of Representatives and Senates have come and gone since the 1970's. During all of those years, there has been times when the White House and the Congress were the same party and times when they were different However, in no case did anyone ever take the initiative to fix the problem when it was more easily fixable. No, instead like so many other issues, everyone who legislates waited until we reached crisis mode and tried to employ a fix. That is what ACA is, a long overdue fix that was hastily put into place because past generations of legislators decided to ignore the problem when it was more fixable. So blame whoever you want to blame, but the real blame is on the inaction of all parties for over a generation. Those who love ACA will take talking points to defend it. Those who hate ACA will take talking points to deplore it. However, only time will tell if ACA works, or not. Whether it ultimately does or doesn't no one can argue that at least someone finally did something to try and fix it.

[GuyFawkes38]

I really haven't read this thread and no real interest in it other than to suggest that the current system is unsustainable. We have lots of folks making the same argument about other topics. For example, the increases in college education. Again, unsustainable. This whole health care issue didn't just jump out from behind a rock and yelled, "boo". The system has been heading for this break point for over 30 years. During that time, no one did anything to fix it. Not the docs, not the insurance companies, not Congress, not the voter. No one. Now, the legislature passes a bill, albeit far from perfect, but it represents a starting point. I ask this, how long can the health care system continue on its current path? And, what happens if it does maintain this current path unabated for the next 7-10 years. Democratic and Republican Presidents, Houses of Representatives and Senates have come and gone since the 1970's. During all of those years, there has been times when the White House and the Congress were the same party and times when they were different However, in no case did anyone ever take the initiative to fix the problem when it was more easily fixable. No, instead like so many other issues, everyone who legislates waited until we reached crisis mode and tried to employ a fix. That is what ACA is, a long overdue fix that was hastily put into place because past generations of legislators decided to ignore the problem when it was more fixable. So blame whoever you want to blame, but the real blame is on the inaction of all parties for over a generation. Those who love ACA will take talking points to defend it. Those who hate ACA will take talking points to deplore it. However, only time will tell if ACA works, or not. Whether it ultimately does or doesn't no one can argue that at least someone finally did something to try and fix it.

I'm coming from a similar space.

We spend an absurd amount of unnecessary cash on healthcare because we basically give doctors a blank check. Insurance companies do not have enough power to limit costs. The ACA will create a framework to finally stand up to doctors and limit costs. I hope policy makers follow through.

[boozehound]

I'm coming from a similar space.

We spend an absurd amount of unnecessary cash on healthcare because we basically give doctors a blank check. Insurance companies do not have enough power to limit costs. The ACA will create a framework to finally stand up to doctors and limit costs. I hope policy makers follow through.

I am coming from a similar place. I am 31 years old. My time horizon is (hopefully) still pretty long and I don't see the current system as a viable option 20-40 years from now. I just don't think it's sustainable.

[chico]

What would be informative would be to see how websites like Anthem, Humama, Medical Mutual of Ohio, etc. are doing at this time.

I'm sure you can get a quote for individual and family insurance on any of their websites; what I don't know is how much sensitive data they require versus whatever data you have to enter through the HealthCare.gov website.

Do health care premiums on those websites take into account any tax credits/advance tax credits? That's something I'm going to have to learn even if I'm not buying health insurance for others - I'm going to have to learn this when it comes to preparing tax returns for 2013, 2014 and beyond.

All I can tell you is that as a self-employed individual we've been told by our insurance company that our premiums are going to go up - a lot. And we have catastrophic coverage. We've been told in the 50-80% range.

[LA Muskie]

All I can tell you is that as a self-employed individual we've been told by our insurance company that our premiums are going to go up - a lot. And we have catastrophic coverage. We've been told in the 50-80% range.

Chico, you should start shopping your coverage. There is no reason you should be seeing those increases. Especially with only catastrophic coverage.

[xudash]

I certainly have no problem with taking action to fix a growing mess.

But some amount of baseline fairness and common sense should be invoked into the process of formulating a solution.

Exemptions; opting out. Really? I thought it was supposed to be a true national solution.

1,000 pages. How do you effectuate and manage that pill?

I have no problem with the idea of an ACA. I would accept a centrist version of it, understanding that not everyone could possibly be pleased with any version of it.

But something isn't always better than nothing. This thing will be better than nothing if it is made fair, all-inclusive and market-driven where it needs to be, including insurance markets and tort reform (yeah, right).

[XU-PA]

Chico, you should start shopping your coverage. There is no reason you should be seeing those increases. Especially with only catastrophic coverage.

You are 100% correct LA. I am self employed, have been buying my own insurance for 14 years now, and I've seen rates go through the roof. Now that the ACA plan is opening, and the sign up is happening, my current insurer is flooding me with info about what they are offering. Companies pushing very hard to keep customers wouldn't seem to be the type to jack rates.

[vee4xu]

Agree, dash. I absolutely do not assert that ACA is good legislation, just that at least now there is some sort of legislation. At this point the marker put down on the table, good, bad or indifferent is ACA. My point is that discourse over making ACA better is a better place to be than indifference over an unsustainable model. Which is where America was from the 1970's until ACA passed.

[xudash]

Agree, dash. I absolutely do not assert that ACA is good legislation, just that at least now there is some sort of legislation. At this point the marker put down on the table, good, bad or indifferent is ACA. My point is that discourse over making ACA better is a better place to be than indifference over an unsustainable model. Which is where America was from the 1970's until ACA passed.

Agree completely vee. In fact, you're absolutely right that it should be about making it better at this point.

[boozehound]

Agree completely vee. In fact, you're absolutely right that it should be about making it better at this point.

Agree as well. It should be about making it better at this point.

I also think that there has been a lot of misinformation about the ACA at this point. People in my company were frantically spreading rumors about how our premiums were going to go up 50% this year ahead of our open enrollment period due to costs associated with the ACA. I wasn't really sure how that was going to happen since my Massachusetts-based company self insures and has long since met all ACA coverage requirements. Nobody stopped to think it through, they just freaked out.

When we finally found out what our premiums for 2014 would be they were a (slight) increase over 2013 rates, but it was our smallest increase in 5 years.

[XU-PA]

People in my company were frantically spreading rumors about how our premiums were going to go up 50% this year ahead of our open enrollment period due to costs associated with the ACA.

When we finally found out what our premiums for 2014 would be they were a (slight) increase over 2013 rates, but it was our smallest increase in 5 years.

and I think this will be the norm across the country. The fear mongering is amazing.

I think many of us are around the age where we have seen rates go through the roof, whether we are in "regular" jobs like I was through from 1980 or self employed like I have been since 2004. Hell, rates have outpaced even college tuition since then!
After looking at the pace of rates for the last 3 and a half decades I would say that if you coverage levels stayed the same you would be paying about 15 to 20 times more now than in the early 80's. Right now my wife and I are paying just over 500 a month for a policy with a 12 grand individual deductible. Politicians have been campaining on promises to fix it as long as I can remember. Now there is a potential fix, thank goodness! I can't survive another decade of 15 to 20% yearly increases.

[boozehound]

and I think this will be the norm across the country. The fear mongering is amazing.

I think many of us are around the age where we have seen rates go through the roof, whether we are in "regular" jobs like I was through from 1980 or self employed like I have been since 2004. Hell, rates have outpaced even college tuition since then!
After looking at the pace of rates for the last 3 and a half decades I would say that if you coverage levels stayed the same you would be paying about 15 to 20 times more now than in the early 80's. Right now my wife and I are paying just over 500 a month for a policy with a 12 grand individual deductible. Politicians have been campaining on promises to fix it as long as I can remember. Now there is a potential fix, thank goodness! I can't survive another decade of 15 to 20% yearly increases.

Right. That's the part that I think is being lost in this. The rates are already increasing steadily. They will really start to increase when baby boomers start retiring en masse as will the taxes required to fund Medicare and Medicaid. We need to find a solution. The status quo isn't going to work any more.

[chico]

Chico, you should start shopping your coverage. There is no reason you should be seeing those increases. Especially with only catastrophic coverage.

The strange thing is we have been shopping around. Each company tells us the same thing. We've even looked at what the exchange might be, and it's the same there. I'm sure they're telling us worst case, but still, even the low end is a huge jump.

[chico]

and I think this will be the norm across the country. The fear mongering is amazing.

I think many of us are around the age where we have seen rates go through the roof, whether we are in "regular" jobs like I was through from 1980 or self employed like I have been since 2004. Hell, rates have outpaced even college tuition since then!
After looking at the pace of rates for the last 3 and a half decades I would say that if you coverage levels stayed the same you would be paying about 15 to 20 times more now than in the early 80's. Right now my wife and I are paying just over 500 a month for a policy with a 12 grand individual deductible. Politicians have been campaining on promises to fix it as long as I can remember. Now there is a potential fix, thank goodness! I can't survive another decade of 15 to 20% yearly increases.

I really hope you're right, but I haven't seen that with our situation. Maybe it's because we have 4 kids. We don't have any health issues to speak of, all of us are in good health (knock on wood), so it's baffling. Maybe we should be talking to who you're talking to.

[Kahns Krazy]

As long as insurance means "everyone is covered for everything", the model is unsustainable, and ACA does nothing to fix that. Everyone gets sick, everyone dies, and a lot of it is not curable. The amount of funds that can be spent on healthcare is unlimited. Should everyone in the country have access to $100,000 cancer treatments? How does that work?

The other problem is that the ACA does nothing about unwilling participation. The population that shows up in the emergency room because they haven't been to a doctor in 15 years is not suddenly going to take ownership of their health and start preventative medicine. That cost isn't going away. Fat lazy people with diabetes are still going to wind up in the ER because they can't feel their own symptoms until it is too late. ACA won't change individual behavior when it comes to healthcare.

[GuyFawkes38]

As long as insurance means "everyone is covered for everything", the model is unsustainable, and ACA does nothing to fix that. Everyone gets sick, everyone dies, and a lot of it is not curable. The amount of funds that can be spent on healthcare is unlimited. Should everyone in the country have access to $100,000 cancer treatments? How does that work?

The situation that we have in the US, which runs counter to other national health care systems around the world, is that doctors have near total discreation to make these decisions, not accountants and policy makers. Doctors have little incentive to limit costs.

The English NHS system, in part, uses a complicated formula to decide if a treatment should be done to a patient. It sounds cold, but it makes sense. The formula inputs the cost of the treatment, the amount of pain the treatment will diminish, and the extension of life possible. I think we need to move to a brutally rational system like that. Of course, outside of such a system, you'd be free to spend whatever you would like on healthcare.

[boozehound]

The situation that we have in the US, which runs counter to other national health care systems around the world, is that doctors have near total discreation to make these decisions, not accountants and policy makers. Doctors have little incentive to limit costs.

The English NHS system, in part, uses a complicated formula to decide if a treatment should be done to a patient. It sounds cold, but it makes sense. The formula inputs the cost of the treatment, the amount of pain the treatment will diminish, and the extension of life possible. I think we need to move to a brutally rational system like that. Of course, outside of such a system, you'd be free to spend whatever you would like on healthcare.

Death Panels!!!!!!

You (and Kahns) hit the nail on the head though. Part of the issue (I think) is tort reform. Doctors and hospitals err on the side of doing everything possible because (1) they make money on it and (2) they don't want to get sued. The other part of the reason is a core part of the way Americans view health care.

Unfortunately I don't see our current political system as being conducive to any kind of rationalizing of benefits. Whichever party suggests allowing that will be lambasted by the other side of the aisle for 'killing grandma'. The reality is that an 87 year old with an inoperable and terminal brain tumor should not be getting radiation or chemo. It costs far too much and rarely has a positive effect on longevity and often as a negative effect on quality of life. I use that example because it is exactly what they did with my grandmother. The treatment absolutely wiped her out and very likely hastened her passing. At a minimum it greatly diminshed her quality of life for the past few months. That same script is repeated every day in hospitals across the country.

[blobfan]

Wow....just wow.

This is unbelieveable.

http://www.forbes.com/sites/theapothecary/2013/10/14/obamacares-website-is-crashing-because-it-doesnt-want-you-to-know-health-plans-true-costs/
This article manages to discuss the issue of the web site problems without interspersing conspiracy theories: http://politicalticker.blogs.cnn.com/2013/10/14/former-obama-spokesman-fire-those-who-botched-obamacare-website/?hpt=hp_t2
It's pretty pathetic that the first President known for mastering data mining in the campaign process couldn't make sure the web site for his signature plan works properly.

As long as insurance means "everyone is covered for everything", the model is unsustainable, and ACA does nothing to fix that. Everyone gets sick, everyone dies, and a lot of it is not curable. The amount of funds that can be spent on healthcare is unlimited. Should everyone in the country have access to $100,000 cancer treatments? How does that work?
...
This is the conversation that should have taken place but all our representatives are big cowards and would rather pass a 1000+ page monstrosity largely written by insurance company lobbyists. At least this way it's big enough that it's easier to hide the special concessions and keep people confused.

The situation that we have in the US, which runs counter to other national health care systems around the world, is that doctors have near total discreation to make these decisions, not accountants and policy makers. Doctors have little incentive to limit costs.
...
You are the only one I've seen blaming doctors for this issue. Hospital and insurance company administrators? Medical malpractice attorneys? I think there's plenty of blame for them but while those actually practicing medicine do like getting paid, the majority do not want to play games with peoples lives.

[GuyFawkes38]

You are the only one I've seen blaming doctors for this issue. Hospital and insurance company administrators? Medical malpractice attorneys? I think there's plenty of blame for them but while those actually practicing medicine do like getting paid, the majority do not want to play games with peoples lives.

Blame is the wrong word. I'm just saying the incentives are twisted.

But you are blaming the 2 groups of people that are attempting, but failing, to limit costs. That's a typical American perspective that I find so frusterating (insurance companies and hospital administrators=evil, doctors=good). ugh.

[blobfan]

Blame is the wrong word. I'm just saying the incentives are twisted.

But you are blaming the 2 groups of people that are attempting, but failing, to limit costs. That's a typical American perspective that I find so frusterating (insurance companies and hospital administrators=evil, doctors=good). ugh.

How do you figure that Hospital and Insurance Execs are trying to limit costs? Insurance Execs are trying to maximize profit, which is a very different motivation. Same for Hospital Execs, at least the for profit ones, and ALL are concerned with minimizing liability. They also play a part in incentivizing doctors to run tests with higher returns. So, yeah, I put them higher on the list than doctors for creating the problem.

[Kahns Krazy]

You are the only one I've seen blaming doctors for this issue. Hospital and insurance company administrators? Medical malpractice attorneys? I think there's plenty of blame for them but while those actually practicing medicine do like getting paid, the majority do not want to play games with peoples lives.

Doctors and their lobby have long played the game that they aren't interested in providing value. It just so happens that most often the medication or procedure they recommend most is the most expensive, highest margin services.

It's time for the medical industry to step up and take some ownership of the costs. I'm tired of doctors acting like they have no way of knowing what something costs or no duty to inform the patient (customer) if there is a cheaper alternative. Put some prices on the menu and let me choose if I want a filet or a Big Mac.

We have consumer protection laws that protect me if I get an oil change, but not if I get a knee replacement. Something is f'ed up there.

[GuyFawkes38]

How do you figure that Hospital and Insurance Execs are trying to limit costs? Insurance Execs are trying to maximize profit, which is a very different motivation. Same for Hospital Execs, at least the for profit ones, and ALL are concerned with minimizing liability. They also play a part in incentivizing doctors to run tests with higher returns. So, yeah, I put them higher on the list than doctors for creating the problem.

The logic here is: For profit=Bad and expensive, Insurance Companies and Hospitals=For Profit. Not for Profit=Good and inexpensive, Doctors=Not for Profit.

Do you really think that main issue in the system is that some hospitals and insurance companies are for profit? That if we forced all insurance companies and hopsital to be not for profit, the cost issues would disappear?

[blobfan]

The logic here is: For profit=Bad and expensive, Insurance Companies and Hospitals=For Profit. Not for Profit=Good and inexpensive, Doctors=Not for Profit.

Do you really think that main issue in the system is that some hospitals and insurance companies are for profit? That if we forced all insurance companies and hopsital to be not for profit, the cost issues would disappear?
The main issue is that everyone is concerned about liability and profit before patient care. Patient care is only a factor if it affects the bottom line. I only made the profit/nonprofit distinction because I do believe that non-profit hospitals are less often driven by the profit motive.

And Kahn's, I DO believe that many doctors don't know what their procedures cost. That's part of the problem. It may be the entire problem. Doctors and patients have little idea of how much things cost in real dollars and more often than not refuse to discuss the cost in quality of life.

How does the ACA address any of this?

[XU-PA]

I really hope you're right, but I haven't seen that with our situation. Maybe it's because we have 4 kids. We don't have any health issues to speak of, all of us are in good health (knock on wood), so it's baffling. Maybe we should be talking to who you're talking to.

It sounds like your company is getting ready to greatly reduce the amount they contribute to your coverage, but I could be wrong. In any case I believe you have the right to go outside your company plan and seek coverage in one of the exchanges.

[XU 87]

[QUOTE=LA Muskie;408265]Chico, you should start shopping your coverage. There is no reason you should be seeing those increases. Especially with only catastrophic coverage.[/QUOTE

If you think Obamacare is going to lower costs for the great majority, you're mistaken. It is designed for people who can't afford coverage or who have pre-existing conditions (higher rates). To cover those costs, the healthy people with money who already have coverage have to see their rates rise. In addition, all these mandatory coverages are not free. You pay for them through higher premiums.

It is simple math. Someone has to pay for all these new people who supposedly are going to get coverage but not have to pay for it.

[chico]

It sounds like your company is getting ready to greatly reduce the amount they contribute to your coverage, but I could be wrong. In any case I believe you have the right to go outside your company plan and seek coverage in one of the exchanges.

Actually, my wife and I are both self-employed. We've talked to our agent - who is an independent agent getting quotes form several sources - and word is the exchange will be just as costly.

[LA Muskie]

If you think Obamacare is going to lower costs for the great majority, you're mistaken. It is designed for people who can't afford coverage or who have pre-existing conditions (higher rates). To cover those costs, the healthy people with money who already have coverage have to see their rates rise. In addition, all these mandatory coverages are not free. You pay for them through higher premiums.

It is simple math. Someone has to pay for all these new people who supposedly are going to get coverage but not have to pay for it.
I never said premiums wouldn't increase. I said he shouldn't be seeing 50-80% year-over-year premium increases because of the ACA. Premiums will go up. They have gone up for the last 20 years without the ACA. It wasn't the ACA's fault then. Was it?

[bobbiemcgee]

Actually, my wife and I are both self-employed. We've talked to our agent - who is an independent agent getting quotes form several sources - and word is the exchange will be just as costly.

Not if you qualify for a subsidy or tax credit, and you can only qualify on the Marketplace. The Companies are offering the same plans on and off the Exchange. Off exchange = no subsidy or tax credit. Age and AGI. They are effective 1/1/14.


http://kff.org/interactive/subsidy-calculator/#state=oh&zip=45202&income-type=dollars&income=94&employer-coverage=0&people=6&adult-count=2&adults%5B0%5D%5Bage%5D=49&adults%5B0%5D%5Btobacco%5D=0&adults%5B1%5D%5Bage%5D=44&adults%5B1%5D%5Btobacco%5D=0&child-count=3&child-tobacco=0

[chico]

Not if you qualify for a subsidy or tax credit, and you can only qualify on the Marketplace. The Companies are offering the same plans on and off the Exchange. Off exchange = no subsidy or tax credit. Age and AGI. They are effective 1/1/14.


http://kff.org/interactive/subsidy-calculator/#state=oh&zip=45202&income-type=dollars&income=94&employer-coverage=0&people=6&adult-count=2&adults%5B0%5D%5Bage%5D=49&adults%5B0%5D%5Btobacco%5D=0&adults%5B1%5D%5Bage%5D=44&adults%5B1%5D%5Btobacco%5D=0&child-count=3&child-tobacco=0

Unfortunately we don't qualify since technically employee coverage is available.

[boozehound]

[QUOTE=LA Muskie;408265]Chico, you should start shopping your coverage. There is no reason you should be seeing those increases. Especially with only catastrophic coverage.[/QUOTE

If you think Obamacare is going to lower costs for the great majority, you're mistaken. It is designed for people who can't afford coverage or who have pre-existing conditions (higher rates). To cover those costs, the healthy people with money who already have coverage have to see their rates rise. In addition, all these mandatory coverages are not free. You pay for them through higher premiums.

It is simple math. Someone has to pay for all these new people who supposedly are going to get coverage but not have to pay for it.

I thought that the people who couldn't afford the coverage would get their 'assistance' in the form of a tax credit? The government isn't forcing the insurance companies to eat the cost of the subsidies for lower income individuals, are they? That would be insane.

The pre-existing condition part will definitely contribute to higher costs though.

[XU 87]

I never said premiums wouldn't increase. I said he shouldn't be seeing 50-80% year-over-year premium increases because of the ACA.

Then I suggest you call Chico and other people throughout the country and tell them they are misreading the huge premium increases they are seeing as a result of Obamacare. Like I said, someone has to pay for all these new mandatory coverages and someone has to pay for all these new people who will get insurance but can't afford to pay for insurance. Obamacare is just another liberal redistribution of income scheme.

[X-band '01]

It's a one-time change where the insurance pool is supposed to expand to everyone; we're not going to be adding hundreds of millions to the insurance pool every year. Is it fair to expect insurance premiums to go up when pre-existing conditions are no longer criteria for denial of insurance? Of course.

We'll have people who wind up going through the exchanges and people who either take the penalty for non-coverage or opt out for coverage for other reasons (i.e. unemployment, don't have to file a tax return, etc.). Any other major fluctuations that occur would likely be because of policy shifts in Obamacare.

[LA Muskie]

Then I suggest you call Chico and other people throughout the country and tell them they are misreading the huge premium increases they are seeing as a result of Obamacare. Like I said, someone has to pay for all these new mandatory coverages and someone has to pay for all these new people who will get insurance but can't afford to pay for insurance. Obamacare is just another liberal redistribution of income scheme.
XU87, I want to be clear about what you are suggesting. Would you prefer a society that doesn't care about its sick, homeless, jobless, and poor?

[chico]

I never said premiums wouldn't increase. I said he shouldn't be seeing 50-80% year-over-year premium increases because of the ACA. Premiums will go up. They have gone up for the last 20 years without the ACA. It wasn't the ACA's fault then. Was it?

Maybe I shouldn't, but that is whet we're being told. Again, maybe it's worst case, maybe we need to switch agents (we switched to our current agent because he gave us better rates than our former one about 6 years ago), maybe it's a scare tactic. I don't know. All I do know is that, even though we've had increases each year, this year they are going up at a much steeper rate. I don't know for certain if it's the ACA or not, but I do have a sneaking suspicion that it is.

I don't think 87 is advocating a society that doesn't care about it's sick, but there has to be a better solution than what is currently on the table. I think this legislation, while partially needed, was rushed through without a lot of thought. I'm certainly not for holding the government hostage over it, but I do think some revisions do need to be made.

[boozehound]

XU87, I want to be clear about what you are suggesting. Would you prefer a society that doesn't care about its sick, homeless, jobless, and poor?

Can somebody here who is self-employed help me understand this?

I have always worked for large corporations. I they have always had to cover me regardless of preexisting conditions.

If I was self employed and I developed a chronic illness can my insurance company drop me? Can they raise my premiums to astronomical rates? How does that work?

[Kahns Krazy]

XU87, I want to be clear about what you are suggesting. Would you prefer a society that doesn't care about its sick, homeless, jobless, and poor?

Handing cash to poor people is not the only way to care for them. Paying too much for insurance that will go underused is not the only way to care for the sick.

I'm surprised you didn't go straight into "because if that's what you think, then the terrorists have already won".

[XU 87]

XU87, I want to be clear about what you are suggesting. Would you prefer a society that doesn't care about its sick, homeless, jobless, and poor?

Oh goodness, do liberals always have to resort to such arguments when they have no facts to support their position? As a matter of fact, I do care about these groups. That's why I argue against these left wing policies that make and keep people poor and jobless.

By the way, do you know that conservatives like me give more to charity than liberals? I guess we care more about jobless and sick and poor people than liberals do.

[chico]

Can somebody here who is self-employed help me understand this?

I have always worked for large corporations. I they have always had to cover me regardless of preexisting conditions.

If I was self employed and I developed a chronic illness can my insurance company drop me? Can they raise my premiums to astronomical rates? How does that work?

I can try to respond, because my wife is the one who (thankfully) takes care of the health insurance. We are basically a group of one, so we pay through the nose. Luckily we have not had any serious health issues in our family so our rates have not gone up much. We renew our rates each year - I assume this is standard but someone else is probably better informed on this than me. After that year, if someone in our family contracted some nasty disease, we would probably find it really, really hard to get insurance. Our renewal would probably be jacked up or they would just not want to renew us at all.

I don't know of any government program that would bail us out, so maybe I really should be for Obamacare. I know the Bush administration at one time was trying to help the self-employed and small companies by trying to put all of us in a group so our rates would go down, but that never went anywhere.

[XU-PA]

Can somebody here who is self-employed help me understand this?

I have always worked for large corporations. I they have always had to cover me regardless of preexisting conditions.

If I was self employed and I developed a chronic illness can my insurance company drop me? Can they raise my premiums to astronomical rates? How does that work?

In essence, yes. I've been self employed since 2004. before that I was in a spot like most, big company with a standard insurance benefit. When I worked for a company i filled out a form, listed my name, DOB, along with my wife and daughter and that was it. I usually had no clue how much I would pay till I got my pay check. In later years that started to change as the company started to offer some options, and they also wanted to make sure that if my wife had a job that had insurance she was using it before mine (exactly what UPS is doing with all it's employees right now)

As a self employed idiot, I shop around all by myself, sort through absolute shitloads of paper works, spend countless hours comparing rates, co pay, co insurance, deductibles, out of pocket, drug coverage, dental etc. Then I fill out applications. I get asked exactly what my medical history is, my wife's exactly what prescription drugs we take. My wife had cancer, thyroid which is just about the best one to get if you have to have cancer, I have nothing but a very slightly elevated cholesterol level. The companies take te app and basically decide if they want to cover me, up till now they could opt just to tell me no, with no repercussions, and yes if you developed something serious they could in essence kick you off, they did it by jacking your rates or shifting you over to a policy that covered almost nothing and was only affordable by lotto winners.

Actually your employers insurer could kick you off too, but they generally did not because they had a big pool of rate payers to even out the burden. Back in the early 90's by employer was "self insured" in essence hired an insurance company to implement a plan, but backed it with their own cash instead of the backing coming from the insurance company. My employer was actually concerned about the liquidity of their plan when the wife of a co worker came down with cancer, they considered pushing her off to some other arrangement, that at the time was all legal

That is all changed with the ACA. But to be able to tell the insurance companies you have to cover everyone no matter the pre existing conditions, the ACA also has to require than everyone get in the pool, it's the only economically feasible way the insurance companies would or could go along.

For thos unaware, this is the same as what is being done in Massachusetts, and has worked for sometime, and it's the same as the GOP proposed back during the GWB term, but they were too chicken shit to enact it, OK, that's just my opinion.

[LA Muskie]

Can somebody here who is self-employed help me understand this?

I have always worked for large corporations. I they have always had to cover me regardless of preexisting conditions.

If I was self employed and I developed a chronic illness can my insurance company drop me? Can they raise my premiums to astronomical rates? How does that work?
Group policies (which employers offer) did not contain pre-existing condition exclusions or lifetime maximum payment limits. Before the ACA most individual/private policies contained both pre-existing condition exclusions and lifetime maximum payment limits. The policies were also written on annual terms, allowing the insurer to drop the insured at the end of a policy period. Together, that all meant that unemployed and self-employed insureds had far from sufficient coverage for catastrophic illness (and significantly worse policies than those who were covered by corporate group policies). Which means that the government (i.e., taxpayers) and other insureds generally paid for them when they inevitably could not pay their suddenly uninsured bills.

[LA Muskie]

Maybe I shouldn't, but that is whet we're being told. Again, maybe it's worst case, maybe we need to switch agents (we switched to our current agent because he gave us better rates than our former one about 6 years ago), maybe it's a scare tactic. I don't know. All I do know is that, even though we've had increases each year, this year they are going up at a much steeper rate. I don't know for certain if it's the ACA or not, but I do have a sneaking suspicion that it is.

I don't think 87 is advocating a society that doesn't care about it's sick, but there has to be a better solution than what is currently on the table. I think this legislation, while partially needed, was rushed through without a lot of thought. I'm certainly not for holding the government hostage over it, but I do think some revisions do need to be made.

I agree. There has to be a better solution. The ACA is far from perfect. But it is better than the status quo, and if Congress would stop playing games they have plenty of time to come up with a better one.

[LA Muskie]

Handing cash to poor people is not the only way to care for them. Paying too much for insurance that will go underused is not the only way to care for the sick.

I'm surprised you didn't go straight into "because if that's what you think, then the terrorists have already won".
I don't think the ACA is perfect. It is far from it. But the status quo was unacceptable. And it is the only proposal on the table. The GOP rejected single payor and have fought their own idea (the individual mandate). They complain, complain, complain but have yet to offer any proposal, much less a workable one.

[XU-PA]

I could never understand why one insurance company would treat two absolutely identical people completely different just based on who they worked for. If I had a history of say high blood pressure and worked for the P&G back in 1985 I would be charged one rate (which P&G would subsidize), but if I worked for myself as a fee lance writer I would be charged a completely different rate.
The other thing I could never figure was how a hospital would charge me x number of dollars for say a colonoscopy if I had health insurance, but if I was paying cash I would be charged a significantly higher price. same procedure, same guy, same american dollars.

[LA Muskie]

Oh goodness, do liberals always have to resort to such arguments when they have no facts to support their position? As a matter of fact, I do care about these groups. That's why I argue against these left wing policies that make and keep people poor and jobless.

By the way, do you know that conservatives like me give more to charity than liberals? I guess we care more about jobless and sick and poor people than liberals do.

1. I am not a liberal. Far (actually very far) from it.
2. The IRS treats churches and schools as charities. I'd be interested to hear if that's the case if you take religion out of the equation. I suspect not, but I don't now or care.
3. Thank you for your contributions. It's the right thing to do -- especially if given to the right causes. I too am generous, but I'm not going to get into a competition over who donates more.

[Smails]

Handing cash to poor people is not the only way to care for them. Paying too much for insurance that will go underused is not the only way to care for the sick.

I'm surprised you didn't go straight into "because if that's what you think, then the terrorists have already won".

No shit...it is possible to have political discourse these days that's not dripping with melodrama?
Heaven forbid you have fundamental differences with the way the ACA was crafted and implemented. You must hate sick people.

[LA Muskie]

No shit...it is possible to have political discourse these days that's not dripping with melodrama?
Heaven forbid you have fundamental differences with the way the ACA was crafted and implemented. You must hate sick people.
It's not melodrama. The ACA was implemented to provide realistic insurance to the un- and under-insured, and to provide true, equivalent insurance for the self-and unemployed. I don't expect for career P&G employees to understand it, because they've never been there. I have. I'm self-employed and my wife has been unemployed before. I've seen the process. It was absolutely horrible. And while the cost was staggering, at least we could find a way to afford it.

[bobbiemcgee]

Unfortunately we don't qualify since technically employee coverage is available.

If the total ins premium exceeds 9.5% of your monthly income, you can shop on the exchange and probably get better than catastrophic.

[XU-PA]

If the total ins premium exceeds 9.5% of your monthly income, you can shop on the exchange and probably get better than catastrophic.

Thank you for that,

[boozehound]

Thank you to all who responded to my question.

I thought I understood the situation correctly (at least from the 30,000 foot level) but it didn't seem possible that so many would oppose forcing coverage for pre-existing conditions. The self-employed really get a raw deal with respect to health insurance, and are one major illness away from bankruptcy in many cases. Then once all their assets are gone the government and hospitals are basically paying for that person.

I get why the insurance industry doesn't like it, but aside from them what is the logic behind self-employed people who oppose it? They would seem to be the ones who stand to benefit the most. Is it basically just rolling the dice and hoping you aren't the one who gets sick and then can't get insurance?

[Kahns Krazy]

It's not melodrama. The ACA was implemented to provide realistic insurance to the un- and under-insured, and to provide true, equivalent insurance for the self-and unemployed. I don't expect for career P&G employees to understand it, because they've never been there. I have. I'm self-employed and my wife has been unemployed before. I've seen the process. It was absolutely horrible. And while the cost was staggering, at least we could find a way to afford it.

It is melodrama because the "uninsured" have always actually been insured. If you need medical help and you go to a hospital, you get treated, and the rest of us pick up the tab.

There was a homeless guy on the corner of fifth and main who collapsed today. I'm going to go ahead and assume he was not carrying insurance. People didn't just walk by him and let him die. The ambulance was called, and a fire truck, a cop and an ambulance showed up in minutes. He was given medical assistance that I am quite certain he won't pay for, but he received it nonetheless. Please explain to me how the ACA will help this man. What will he get under this plan that he does not get today?

[LA Muskie]

It is melodrama because the "uninsured" have always actually been insured. If you need medical help and you go to a hospital, you get treated, and the rest of us pick up the tab.

There was a homeless guy on the corner of fifth and main who collapsed today. I'm going to go ahead and assume he was not carrying insurance. People didn't just walk by him and let him die. The ambulance was called, and a fire truck, a cop and an ambulance showed up in minutes. He was given medical assistance that I am quite certain he won't pay for, but he received it nonetheless. Please explain to me how the ACA will help this man. What will he get under this plan that he does not get today?

The ACA won't help him. But it will (and does) help the many unemployed and self-employed who couldn't get or afford healthcare insurance -- for example those with "pre-existing conditions". And it will help the many more self-employed and privately insured who would have suffered a catastrophic event that would have tapped their policy's lifetime maximum benefit.

And in so doing it will help all the rest of us because the risk will more appropriately be spread across the entire risk pool.

[XU-PA]

I get why the insurance industry doesn't like it, but aside from them what is the logic behind self-employed people who oppose it? They would seem to be the ones who stand to benefit the most. Is it basically just rolling the dice and hoping you aren't the one who gets sick and then can't get insurance?

I'm not sure why the insurance industry does not like it, guaranteeing that millions of previously uninsured health young people will sign up is exactly what they've been saying they didn't have and what they say kept rates high.
I think self employed people who are opposed are just swayed by the any ACA anti Govt rhetoric. It's a win win for us. I do know that there are an awful lot of just regular guys (gals too) out there who really have no clue what it is, when it's coming or how to get on it. I run into scores of construction subs, landscapers, pool guys, plumbers, painters etc every day. Many of them haven't even given it a thought. They have no insurance, some never have. They are the population that really need this program, but their medical plans are all what happens to be in their pocket right now. The lucky ones have spouses that are employed and are covered.
What I think I have figured out is why hospitals are not cheering the program. Would you think that they would be awful happy that almost everyone would be insured? Not so, I think the bean counters love treating every little scratch bump bruise and sniffle on the ER, then just passing the cost along to the taxpayer. When I was in Maine the State was behind in payments to hospitals by hundreds of millions of dollars but was struggling and making those payments to cover uninsured and unpaid medical care. Sounded then like they had a blank check from the taxpayers every year.

[Kahns Krazy]

The ACA won't help him. But it will (and does) help the many unemployed and self-employed who couldn't get or afford healthcare insurance -- for example those with "pre-existing conditions". And it will help the many more self-employed and privately insured who would have suffered a catastrophic event that would have tapped their policy's lifetime maximum benefit.

And in so doing it will help all the rest of us because the risk will more appropriately be spread across the entire risk pool.

What is it about healthcare costs that make it a "right" of the self employed to pay the same amount as corporate employees? There are economies of scale involved in large business. Why should the government legislate that costs are equal for services that are in fact not the same cost to provide? Corporate profits are often larger than self employment profits. Should we legislate those too, to make sure the small business owner makes the same profit margin?

Corporations bear a significant administrative and financial burden of healthcare benefits for their employees. It's called a "benefit" for a reason. When you are looking at a self employment situation or a small business, administrative costs are pushed back on the provider or the agent (additional cost layer). Moreover, one time costs such as setting up accounts and running reports are spread among far fewer paying policyholders, so the cost per policyholder to provide that service is higher.

I guess I am confused by those who choose to go into business for themselves then complain that someone else isn't paying for part of their expenses. Should we legislate that I should be able to buy apples at the same price per pound that Kroger buys them?

Also, pre-existing conditions are generally only an issue if you are coming from an uninsured situation into an insured. I have no sympathy for the guy who chooses not to be insured because he thinks he's young and healthy, then finds he can't get insurance once he is diagnosed with something. That's how insurance works. You can't buy car insurance after you get in a wreck, either.

[LA Muskie]

What is it about healthcare costs that make it a "right" of the self employed to pay the same amount as corporate employees? There are economies of scale involved in large business. Why should the government legislate that costs are equal for services that are in fact not the same cost to provide? Corporate profits are often larger than self employment profits. Should we legislate those too, to make sure the small business owner makes the same profit margin?

Corporations bear a significant administrative and financial burden of healthcare benefits for their employees. It's called a "benefit" for a reason. When you are looking at a self employment situation or a small business, administrative costs are pushed back on the provider or the agent (additional cost layer). Moreover, one time costs such as setting up accounts and running reports are spread among far fewer paying policyholders, so the cost per policyholder to provide that service is higher.

I guess I am confused by those who choose to go into business for themselves then complain that someone else isn't paying for part of their expenses. Should we legislate that I should be able to buy apples at the same price per pound that Kroger buys them?
I never said there was such a right. But there should be certain hallmarks of insurance to make sure that it is not illusory. One is not having pre-existing condition exclusions. Another is not having lifetime maximum benefits that almost certainly would be exceeded in the event of a serious illness requiring extended hospitalization or long term healthcare. The self-insured have almost always paid more than the corporate insured (even if you get rid of the subsidies). That has always been a cost of doing (self-employed) business. But especially if they are paying more, they should at least get an equivalent product.


Also, pre-existing conditions are generally only an issue if you are coming from an uninsured situation into an insured. I have no sympathy for the guy who chooses not to be insured because he thinks he's young and healthy, then finds he can't get insurance once he is diagnosed with something. That's how insurance works. You can't buy car insurance after you get in a wreck, either.
This is not true and is a misconception of those who have only ever been covered by corporate group coverage. It is true that in most group coverage situations, there is automatic coverage as long as you join up front. or can demonstrate no lapse in coverage. In the private insurance world, that simply was not the case under ACA. You could be covered for 10 years, get cancer, and not be able to renew -- or only be able to renew with HUGE increases -- the following year.

This is one of the most frustrating parts of this debate. People assert as facts things they just don't know anything about. Look, I don't love the individual mandate. But it is absolutely ridiculous that insurance companies were permitted to profit off healthy insureds and then immediately drop them (or raise their premiums to prohibitively high levels) when they needed the coverage. The only way to get the insurance industry on-board was to assure a true spread of risk by requiring everyone to be insured. Since the GOP made it clear that a single payer system was a no-go, the individual mandate was the only alternative (or, at least, the only alternative proposed by anyone).

[boozehound]

This is one of the most frustrating parts of this debate. People assert as facts things they just don't know anything about. Look, I don't love the individual mandate. But it is absolutely ridiculous that insurance companies were permitted to profit off healthy insureds and then immediately drop them (or raise their premiums to prohibitively high levels) when they needed the coverage. The only way to get the insurance industry on-board was to assure a true spread of risk by requiring everyone to be insured. Since the GOP made it clear that a single payer system was a no-go, the individual mandate was the only alternative (or, at least, the only alternative proposed by anyone).

This statement right here is my primary reason for supporting the ACA. It may not be perfect, but it is a step in the right direction and is working to correct a serious flaw in the American health care system.

[chico]

I guess I am confused by those who choose to go into business for themselves then complain that someone else isn't paying for part of their expenses. Should we legislate that I should be able to buy apples at the same price per pound that Kroger buys them?



I'm certainly not complaining about being self-employed, even thought there are other things besides health care that the government does to hinder the self-employed and small businesses. I was fully aware of the pros and cons of having your own business when I took the leap, as I'm sure most people in my situation were. However, why can't I and other small business owners pool our resources as well? What's wrong with a government incentive that would allow us to become one large pool for health insurance coverage?

[LA Muskie]

Not to nitpick here, but I have very good friends who are retired P&Gers who are seriously considering switching over due to spiraling costs with their current coverage. It's not always so rosy being a career employee, all your eggs are basically in one basket.

That's true. It's especially true for retirees, who were accustomed to their subsidized policies and didn't appreciate the real cost of their insurance. I'm hearing that most companies are giving up the subsidy. Some are even requiring that their retirees pay an administrative premium to stay on the group plan. And still others are dropping retirees altogether.

[bobbiemcgee]

I'm certainly not complaining about being self-employed, even thought there are other things besides health care that the government does to hinder the self-employed and small businesses. I was fully aware of the pros and cons of having your own business when I took the leap, as I'm sure most people in my situation were. However, why can't I and other small business owners pool our resources as well? What's wrong with a government incentive that would allow us to become one large pool for health insurance coverage?

Oh, you mean like the gov't incentive corporations get by being able to write off the insurance contributions for employees and every other employee benefit tax free? Those benefits that the employee receives tax free? Nah. You should pay double and answer a bunch of ridiculous questions (what did your relatives die from and at what age?) to see if you qualify to be screwed by huge premiums. Then, if they don't like your answers they will cancel you in the first 2 yrs. or if you have the audacity to file a claim. Seems fair. Go work for the Post Office. Oh, whoops, their benefit program is broke and the guvment will have to pay.

[bobbiemcgee]

Congress has 75% of their healthcare premiums paid by the taxpayers. Seems fair that they don't want anybody else to have a subsidy. Ha! They are indeed the biggest pigs at the trough.

[boozehound]

That's true. It's especially true for retirees, who were accustomed to their subsidized policies and didn't appreciate the real cost of their insurance. I'm hearing that most companies are giving up the subsidy. Some are even requiring that their retirees pay an administrative premium to stay on the group plan. And still others are dropping retirees altogether.

Exactly. In a world in which the majority of retirees haven't saved nearly enough to live on, paying $1200-$1500 per month for healthcare coverage at their former employer's group rates is a lot to stomach. I think we will see more and more of those people drop insurance and go Medicare-only. You can imagine the impact that will have on Medicare costs, but I guess we will cross that bridge when we get to it.

[LA Muskie]

Before anyone says it, I should add that companies dropping retiree subsidies and/or coverage has little if anything to do with ACA. This phenomenon started about 10 years ago, as companies sought to cut costs. It gained speed in 2008 when the market tanked and companies had to hunker down.

[bjf123]

I'm not sure why the insurance industry does not like it, guaranteeing that millions of previously uninsured health young people will sign up is exactly what they've been saying they didn't have and what they say kept rates high.
One big flaw in the plan is that it assumes millions of previously uninsured people will actually sign up. Lots of them will run the numbers and realize it's much cheaper to pay the penalty than to pay for the insurance.




Sent from my iPhone using Tapatalk

[Kahns Krazy]

Oh, you mean like the gov't incentive corporations get by being able to write off the insurance contributions for employees and every other employee benefit tax free? Those benefits that the employee receives tax free? Nah. You should pay double and answer a bunch of ridiculous questions (what did your relatives die from and at what age?) to see if you qualify to be screwed by huge premiums. Then, if they don't like your answers they will cancel you in the first 2 yrs. or if you have the audacity to file a claim. Seems fair. Go work for the Post Office. Oh, whoops, their benefit program is broke and the guvment will have to pay.

Um, what? Self employed people are entitled to deduct the full amount paid for health insurance premiums. I am not sure what you are talking about here.

[LA Muskie]

Um, what? Self employed people are entitled to deduct the full amount paid for health insurance premiums. I am not sure what you are talking about here.
If you were self-employed you could take an above-the-line deduction. That is true. But non-self employed individuals who purchased in the private market market (whether because they were unemployed, because their employer didn't offer a group plan, or because they simply chose that alternative) could only deduct their premiums if they itemized their deductions and their total healthcare costs exceeded 7.5% of their AGI. And even then only the amount above the 7.5% limit was deductible.

[XU-PA]

What is it about healthcare costs that make it a "right" of the self employed to pay the same amount as corporate employees? There are economies of scale involved in large business.

I look at it another way. as a self employed person paying more money for the same policy, and paying more money to hospitals for the same procedure, I am subsidizing the health care costs of corporate employees, and that is something that, since I have no way to keep from being cheated, should be controlled.

[GuyFawkes38]

I look at it another way. as a self employed person paying more money for the same policy, and paying more money to hospitals for the same procedure, I am subsidizing the health care costs of corporate employees, and that is something that, since I have no way to keep from being cheated, should be controlled.

I think your missing Kahns arguement here. He is arguing that due to economies of scale, large companies are able to more efficiently administer health care benefits than small companies. Hospital payments stay the same.

Of course, the problem is that not everyone has access to a large company job (and some of those large company jobs do not pay high enough wages to include health care insurance in large part because health care is so damn expensive in the USA, which is the big issue). There are gaps.

[Kahns Krazy]

So when I buy one apple from Kroger, I should pay the same price for that apple that Wal Mart pays for apples, otherwise, I'm getting cheated?

The per person cost of administering an individual policy is much more than administering a group policy. Corporate employees subsidize each other. You are actually subsidizing other self employed or unemployed people who choose to roll the dice and not get insurance. You are part of a riskier demographic, actuarially speaking, and so it costs you more. I really don't get what is unfair about that. If you hate it so much, get a job with healthcare benefits.

My guess is that for you, the benefits of being self employed outweigh the costs. I applaud that decision, but it doesn't mean that someone else should subsidize your costs for you.

[Kahns Krazy]

And just in case I'm coming across as cold, I strongly believe that access to basic healthcare (periodic wellness checkups with a doctor, biometric screening, and access to generic medications, vaccinations, etc.) should be available for everyone that wants it at little to no cost. Beyond that, I do not believe that it is a right to have full healtcare insurance that would spend hundreds of thousands of dollars treating terminal illnesses for those that can't afford that treatment. Everyone dies of something.

[xeus]

So when I buy one apple from Kroger, I should pay the same price for that apple that Wal Mart pays for apples, otherwise, I'm getting cheated?

Now THAT is an apples to apples comparison.

[nuts4xu]

Everyone dies of something.

Amen. The world is an imperfect place, people die all the time.

I may be going to hell in a bucket baby, but at least I am enjoying the ride...

[bobbiemcgee]

I strongly believe that access to basic healthcare (periodic wellness checkups with a doctor, biometric screening, and access to generic medications, vaccinations, etc.) should be available for everyone that wants it at little to no cost.

Hmmmm, Obamacare Light? Terminal illness is generally treated in the US by ordering lots of Oxycodone and sending you home to die as soon as possible.

[LA Muskie]

So when I buy one apple from Kroger, I should pay the same price for that apple that Wal Mart pays for apples, otherwise, I'm getting cheated?

The per person cost of administering an individual policy is much more than administering a group policy. Corporate employees subsidize each other. You are actually subsidizing other self employed or unemployed people who choose to roll the dice and not get insurance. You are part of a riskier demographic, actuarially speaking, and so it costs you more. I really don't get what is unfair about that. If you hate it so much, get a job with healthcare benefits.

My guess is that for you, the benefits of being self employed outweigh the costs. I applaud that decision, but it doesn't mean that someone else should subsidize your costs for you.
I actually disagree. The per-person cost of administration at the corporate level is de minimis. The corporate/group advantage is volume purchasing. Which explains cost advantage. But it shouldn't have permitted vastly different levels of necessary coverage. There is no actuarial difference -- there are just as many corporate insureds with pre-existing conditions and who will likely suffer serious illness as the general population.

[Kahns Krazy]

I actually disagree. The per-person cost of administration at the corporate level is de minimis. The corporate/group advantage is volume purchasing. Which explains cost advantage. But it shouldn't have permitted vastly different levels of necessary coverage. There is no actuarial difference -- there are just as many corporate insureds with pre-existing conditions and who will likely suffer serious illness as the general population.

The difference is on the inflow side. In the corporate world, very few people opt out of coverage entirely. In the individual policy world, you have a much higher percentage that opt out while they are young or feeling healthier. By subtraction, the remaining population that is getting insurance tends to be percentage wise a risker group because the healthiest have opted out of the pool.

[LA Muskie]

The difference is on the inflow side. In the corporate world, very few people opt out of coverage entirely. In the individual policy world, you have a much higher percentage that opt out while they are young or feeling healthier. By subtraction, the remaining population that is getting insurance tends to be percentage wise a risker group because the healthiest have opted out of the pool.
That is true. And hence the individual mandate, since that is a circumstance outside the control of everyone who does not have access to the group market.

[XU-PA]

I think your missing Kahns arguement here. He is arguing that due to economies of scale, large companies are able to more efficiently administer health care benefits than small companies. Hospital payments stay the same.

Of course, the problem is that not everyone has access to a large company job (and some of those large company jobs do not pay high enough wages to include health care insurance in large part because health care is so damn expensive in the USA, which is the big issue). There are gaps.

I hear what you guys are saying,,, but it just doesn't jive. when the insurance company deals with your claim, it is your claim. iot gets processed one at a time just like my claim does. It doesn't come grouped in with all the claims from your company. The HR office at your company has nothing to do with processing claims, that changed long long ago. The only advantage is that payment for the group comes in a lump sum, but that has even been negated since insurance companies have moved to getting indiividual policy holders to do automatic bank withdrawl for payment, so there is no more handling, it's all on auto pilot.

[paulxu]

It's very difficult to have a reasonable discourse when faced with this type of situation.
This guy is listened to by millions of people each day. Assumedly when he brings 3 couples on to discuss the impact the ACA has on their lives, you would hope the producers would fact check.
But obviously not. So millions walked away from this program, their view reinforced that the ACA is a "train wreck" because they were given "facts" to support it.
Whether it works or not, we need to have real, intelligent, fact based discussions.
If the former aide to a governor can fact check with very little effort, why can't the news outlet?

http://www.salon.com/2013/10/18/inside_the_fox_news_lie_machine_i_fact_checked_sea n_hannity_on_obamacare/

[XU-PA]

It's very difficult to have a reasonable discourse when faced with this type of situation.
This guy is listened to by millions of people each day. Assumedly when he brings 3 couples on to discuss the impact the ACA has on their lives, you would hope the producers would fact check.
But obviously not. So millions walked away from this program, their view reinforced that the ACA is a "train wreck" because they were given "facts" to support it.
Whether it works or not, we need to have real, intelligent, fact based discussions.
If the former aide to a governor can fact check with very little effort, why can't the news outlet?

http://www.salon.com/2013/10/18/inside_the_fox_news_lie_machine_i_fact_checked_sea n_hannity_on_obamacare/

Used to be a time that news organizations had an ethic to put fact on the air, some still do, fox is not news

[Masterofreality]

Just for the hell of it, even though I don't need insurance, I went on the "Heathcare.gov" website trying to see if I could sign up and see options.

It was horrifically tedious and I kept getting "timed out". I never even got to the page where I could compare plans...but they got all of my personal information, which, for me is no big deal because the IRS has it anyway. Some who have income to hide will probably be pissed about it.

I'm fairly computer savvy as proven by my aplomb on this message board. I can imagine how bad it is for toothless half-wits from dayton.

if the Republicans were smart, they should have just let this stupid healthcare law implode on itself.

[Masterofreality]

"people die all the time."
.

Quoth the philosopher -- OJ Simpson

[Masterofreality]

That's true. It's especially true for retirees, who were accustomed to their subsidized policies and didn't appreciate the real cost of their insurance. I'm hearing that most companies are giving up the subsidy. Some are even requiring that their retirees pay an administrative premium to stay on the group plan. And still others are dropping retirees altogether.

There are very, very few companies that have any post retirement health benefit anymore. My company does not.

About the only workers that have any type of post retirement health coverage are, SHOCKINGLY, government employees. Hmmmmmmm,.

[boozehound]

There are very, very few companies that have any post retirement health benefit anymore. My company does not.

About the only workers that have any type of post retirement health coverage are, SHOCKINGLY, government employees. Hmmmmmmm,.

Right. So the majority of people's lifetime healthcare benefits reside in, essentially, a single payer system. Which is where we should have gone in the first place with healthcare reform. Everybody gets Medicare and/or Medicaid at 65 anyways, why not just create one giant pool so that the young and healthy can subsidize the older and sicker.

I still find it strange that we continue to fund a single payer system for people 65+ while allowing insurance companies to profit on them during their healthier working years. The shift from employers providing lifetime benefits for employees to employers essentially cutting retirees loose when they are done working is going to add an enormous amount of cost to Medicare. We can either borrow the money to fund it, which is what we will likely do, or we could find a way to raise more revenue. Adding more healthy people to the risk pool would seem to be a good way to go about that.

[bobbiemcgee]

There are very, very few companies that have any post retirement health benefit anymore. My company does not.

About the only workers that have any type of post retirement health coverage are, SHOCKINGLY, government employees. Hmmmmmmm,.

At 65, you can buy a guaranteed issue medigap plan that pays virtually everything for under $200 a month.

[Masterofreality]

Uh oh.

Looks like Barry was a bit off on his projections.

http://freebeacon.com/obamacare-raising-premiums-hurting-middle-lower-class/

[Masterofreality]

At 65, you can buy a guaranteed issue medigap plan that pays virtually everything for under $200 a month.

That's on top of the Medicare premiums, right? And the $200/mo is for one individual right?

Gotta cover the Trophy Wife too.

[XU-PA]

Uh oh.

Looks like Barry was a bit off on his projections.

http://freebeacon.com/obamacare-raising-premiums-hurting-middle-lower-class/

hahahahahaha The Washington "Free" Beacon, according to it's own site is funded by the "Center for American Freedom" which according to it's own website is "The Center For American Freedom is a conservative not-for-profit organization"
As credible a news source as The Onion or Fox News.
http://www.salon.com/2013/10/18/inside_the_fox_news_lie_machine_i_fact_checked_sea n_hannity_on_obamacare/

[Masterofreality]

hahahahahaha The Washington "Free" Beacon, according to it's own site is funded by the "Center for American Freedom" which according to it's own website is "The Center For American Freedom is a conservative not-for-profit organization"
As credible a news source as The Onion or Fox News.
http://www.salon.com/2013/10/18/inside_the_fox_news_lie_machine_i_fact_checked_sea n_hannity_on_obamacare/

Well, is anything in that article not true?

Please refute at will. It's already been published by "credible" news orgs that Ohio's premiums are going to rise- hugely.

[GuyFawkes38]

I've been pondering this and wondering how it is going to play out.

Lets say a single guy loses his job in January. He is not sure when he will get a new job. As a result, this guy, with zero income, enrolls in medicaid. Three months late he gets a job earning 50K a year. He no longer qualifies for medicaid, even though he is still receiving benefits from medicaid.

How does this work? So would that guy have to immediately end his enrollment in medicaid after getting his new job? If he doesn't, will he face a penalty or tax bill at the end of the year.

This seems even more complicated for workers who have difficulty predicting their incomes. What if they guess too low. Will they have a large tax bill at the end of the year so the government can recover subsidies that, in retospect, the persson should have not received?

[bobbiemcgee]

That's on top of the Medicare premiums, right? And the $200/mo is for one individual right?

Gotta cover the Trophy Wife too.

Yes, you have to pay your Part B which is $104.90 this yr. (will change) or you can get a Medicare Advantage plan with 0 premium. Some of them in Fla. actually give you back the Part B, so zip per month.

[GuyFawkes38]

The future is Medicaid:
http://krugman.blogs.nytimes.com/2013/09/21/i-have-seen-the-future-and-it-is-medicaid/

Good luck selling that, but that is exactly what we need.

[GuyFawkes38]

Boom:
http://investigations.nbcnews.com/_news/2013/10/28/21213547-obama-admin-knew-millions-could-not-keep-their-health-insurance?lite

It was wrong for the Obama administration to lie about this. But it was an obvious lie. It's how the law is written.

[XU 87]

The Obama Administration just didn't lie, Obama himself lied.

[GuyFawkes38]

The Obama Administration just didn't lie, Obama himself lied.

That is true.

Here is a good post by Ross Douthat of the NYTimes:
http://douthat.blogs.nytimes.com/2013/10/28/obamacares-losers-and-why-they-matter/?_r=0

If your young and healthy, make more than 50k, and work for yourself, your a big Obamacare loser. This is just bad policy. Shouldn't the burden of this type of safety net program fall mostly on the wealthy.

I'm increasingly getting the feeling that this will turn into a giant mess.

[kmcrawfo]

The disaster continues:

Many Americans Reporting ACA “Sticker Shock.”
For the first time since the government shutdown drama subsided, the Affordable Care Act is garnering coverage for something unrelated to troubles with its online insurance marketplace. However, the reports are also negative, with many sources highlighting news that some Americans are learning they can’t keep their current plans because of provisions in the law.
Monday night, NBC Nightly News reported on “sticker shock” resulting from the ACA, as many Americans learned this week that “they must buy new policies that cover more but cost more as well.” NBC’s Peter Alexander explained that “one of President Obama’s key selling points for the new healthcare law” was that, “If you’ve got health insurance, it doesn’t mean a government takeover. You keep your own insurance. Keep your own doctor. If you like your plan you can keep your plan.” Alexander went on to report, though, that many are finding that’s not the case. Moreover, the fact that “millions will lose or will have to change their individual policies is not a surprise to the Administration.” As NBC News Senior Investigative Correspondent Lisa Myers found, “buried in the 2010 Obamacare regulations,” was “language predicting ‘A reasonable range for the percentage of individual policies would terminate is 40% to 67%.’’”
USA Today (10/28, Eversley) reports that the NBC News story showed that “the Obama administration has known for about three years” that “millions of Americans [would get] their health insurance cancelled under the Affordable Care Act.” However, Politico (10/29, Haberkorn) reports that the Administration “is strongly pushing back” against the NBC report.
Still, The Washington Post (10/29, Eilperin) “Post Politics” blog reports, White House press secretary Jay Carney on Monday “acknowledged that some consumers would lose their ‘substandard plans’ and have to pay higher premiums because of the new health-care law.” Or as the Washington Times (10/29, Boyer) puts it, the White House “admitted” Monday that President Obama’s “oft-repeated promise that everyone can keep their health-insurance plans under Obamacare just isn’t true.”

[Masterofreality]

Uh oh.

Looks like Barry was a bit off on his projections.

http://freebeacon.com/obamacare-raising-premiums-hurting-middle-lower-class/


hahahahahaha The Washington "Free" Beacon, according to it's own site is funded by the "Center for American Freedom" which according to it's own website is "The Center For American Freedom is a conservative not-for-profit organization"
As credible a news source as The Onion or Fox News.
http://www.salon.com/2013/10/18/inside_the_fox_news_lie_machine_i_fact_checked_sea n_hannity_on_obamacare/

I'm still waiting for any refuting of what the article said, as opposed to snarkily demeaning the source.

Shoot the Messenger rather than accepting the message?

[blobfan]

Count me among those who's premiums are going up. I have insurance through my employer, a large company with plenty of leverage. My premium is going up by 15% and both co-pays and deductibles are going up. I'm sure this is in part to account for the requirement that co-pays be counted towards the annual deductible but it will still increase overall spending next year on basic healthcare. I know this isn't huge and I'm in much better shape than those with individual plans. But combined, this is the biggest overall increase I've seen in plan costs in the 12 years I've had insurance through my company.