What’s good for the country is good for General Motors, and vice versa

[sabreur]

Ouch....

http://news.yahoo.com/s/ap/20090305/..._annual_report

[lindajdunn]

IMHO, GM slashed their own wrists.

I loved my Saturn and it was undoubtedly the best car I ever owned. I drove it from 1996 through last month and the odometer was at 239,422 miles when I replaced it.

GM eliminated the station wagons and opted for VUEs. A VUE does not meet our needs; it's too big. GM replaced the Saturn Ion with a German import and when we checked it out, we were very disappointed.

[tchwojko]

I also had a Saturn station wagon that I was extremely happy with. We switched to a Honda Odyssey when we needed more space. (A minivan handles better, has more interior space, better safety rating, better mileage, and is less expensive than most SUVs. I never understood why SUVs were more popular.) We looked at Saturn last year when we were thinking of downsizing. They haven't really done anything innovative since I bought my wagon.

I wonder what happened to Saturn's original design people. I can't believe that after they got Saturn going they sat around for years and all they came up with was a mediocre SUV.

[Hauptman]

The bailout of the auto industry was scary to begin with. At least when we bailed out Wall St. we were bailing out companies that had always been profitable before the current downturn.

But our domestic auto makers have been dying a slow death even through the good economic times. Giving them money now isn't just helping them over a rough spot because they are in a deep hole.

[Inquartata]

Might be better to let them close and start over---without the onerous union contracts and pension burdens.

[tchwojko]

Might be better to let them close and start over---without the onerous union contracts and pension burdens.

Aren't the pensions already sufficiently funded separately? I might be thinking of a different company, but I thought I heard that the pensions were safe regardless...

I also don't believe that just because GM goes bankrupt, all that capacity will disappear. There will be lots of infrastructure that could get bought on the cheap, and lots of labor ready and waiting to run it. *Someone* has to make the cars.

There will be a big short term pain while the auto market finds its equilibrium again.

[Inquartata]

Bankruptcy doesn't even mean that the companies stop operating. They'd just restructure and go on as before, minus a bunch of debts...

[tchwojko]

Bankruptcy doesn't even mean that the companies stop operating. They'd just restructure and go on as before, minus a bunch of debts...

My foggy head (cold I caught from kids) was thinking worst case, where GM gets sold for parts.

[lindajdunn]

Bankruptcy doesn't even mean that the companies stop operating. They'd just restructure and go on as before, minus a bunch of debts...

Union agreements would be null and void. Pensions would be lost and those who relied upon them would be looking to the Pension Benefit Guarantee Corporation, which we'll need to bailout (again, if we've already given them a bailout).

http://gangbox.wordpress.com/2008/12...ing-insolvent/

Additionally, every single one of those UAW workers is going to be uninsured. The retirees may be old enough for Medicare but most workers are not.

I used to be opposed to universal health care but we've already got a crazy form of universal health care that's called go-to-the-emergency-room-and-let-the-insured-pay-more-for-their-treatment-to-cover-yours. IMHO, we might as well recognize we have a crazy universal health care system and develop one that makes sense. Affordable health insurance/subsidized health insurance makes more sense.

[Inquartata]

Oddly, workers at American plants manufacturing "foreign" automobiles seem to be getting by under those conditions. Which is a big competitive advantage for those companies. That advantage needs to disappear if the Big Three are to be viable in the long term...

Also, although your version of how health care works for the uninsured is widely assumed to be accurate, I am not sure it really is.

[jessicasimpson]

I used to be opposed to universal health care but we've already got a crazy form of universal health care that's called go-to-the-emergency-room-and-let-the-insured-pay-more-for-their-treatment-to-cover-yours. IMHO, we might as well recognize we have a crazy universal health care system and develop one that makes sense. Affordable health insurance/subsidized health insurance makes more sense.

The way it works is that uninsured people go to the emergency room, and they can not be turned away legaly. then they get billed for there visit, usually at rates up to 3 times higher than insurance companies pay, then they file for personal bankrupcy, and the hospital (and or community if it is a public hospital) takes the loss, not the "insured" people

[fatfencer]

The funny thing is SUV's have sometimes less interior room than that old Honda or Saturn station wagon of a few years ago. Yet they are heavier and gas-hoggish.

When the big 3 makes a car that is practical, lots of room, good on gas, great reliability, low priced, and has a cheaper labor force, they will be viable again.

This means they will never be viable.

FF

PS; Minivans blow the biggie since mechanics charge more to work on them due to the way the engine mounts in that tight space. Minivans need a more car-ish front end.

PPS: Best car I ever owned in terms of reliability was a 1980 Honda civic. I put 120k miles on it when it had 215k when I bought it. During that time it had a faulty headgasket that kept getting worse. I never repaired it. Just added a quart of oil to it a day.

[lindajdunn]

The way it works is that uninsured people go to the emergency room, and they can not be turned away legaly. then they get billed for there visit, usually at rates up to 3 times higher than insurance companies pay, then they file for personal bankrupcy, and the hospital (and or community if it is a public hospital) takes the loss, not the "insured" people

Private hospitals are not required to provide non-emergency medical treatment to people who cannot pay. If the person goes to the emergency room in this area with an emergency that is deemed not a real emergency, they'll turn that person away.

On the other issue, I still contend that when patients cannot pay their bills, the result is higher fees, which means that those of us who can pay their bills are in effect paying not only for our health issues, but for those unable to pay.

As more hospitals switch from not-for-profit to profit, charity care declines.

http://www.consumersunion.org/health/hospitalwc599.htm

From another article:

http://www.bizjournals.com/milwaukee...05/story1.html

Quote: While charity care is a more altruistic idea, it impacts a hospital’s budget the same way bad debt does, prompting hospitals to find other ways to increase revenue, such as by cost-shifting to people with commercial health insurance, Quinn said.
http://data.opi.mt.gov/legbills/2007...s/aph56b01.pdf

Hospitals have no choice but to recover these unpaid Medicaid costs. And, their only recourse for doing so is to raise charges, which, in turn, has contributed to the steady increase in health insurance premiums.

and this

When Aurora Health Care, Milwaukee, announced it would increase prices at all of its 13 hospitals in 2009, spokesman Jeff Squire pointed to bad debt and charity care increases.

[jessicasimpson]

[QUOTE=lindajdunn;780200]

On the other issue, I still contend that when patients cannot pay their bills, the result is higher fees, which means that those of us who can pay their bills are in effect paying not only for our health issues, but for those unable to pay.


Quote: While charity care is a more altruistic idea, it impacts a hospital’s budget the same way bad debt does, prompting hospitals to find other ways to increase revenue, such as by cost-shifting to people with commercial health insurance, Quinn said.
QUOTE]

I agree with the first point, but not the second
insurance companies will pay what they pay, not what the hospital charges.
if hospital A charges $200 for a prostate exam, then the insurance company will pay $70. If hospital B charges $500 for a prostate exam, the insurance company will pay $70. If you do not have insurance they will bill you for the full amount, and will expect it, if you have insurance they will bill the insurance company and take what they get and be happy. if a hospital has more charity care, the insurance will not pay any more.

[lindajdunn]

I agree with the first point, but not the second
insurance companies will pay what they pay, not what the hospital charges.
if hospital A charges $200 for a prostate exam, then the insurance company will pay $70. If hospital B charges $500 for a prostate exam, the insurance company will pay $70. If you do not have insurance they will bill you for the full amount, and will expect it, if you have insurance they will bill the insurance company and take what they get and be happy. if a hospital has more charity care, the insurance will not pay any more.

The evidence substantiating this claim is overwhelming. Google on cost shifting and health care and you'll find numerous reports.

http://www.wha.org/newsCenter/pdf/nr...waterhouse.pdf
Report Shows Cost-Shifting Major Component of
Rising Health Care Costs
Accounts for 26 cents of every dollar spent on hospital care in Wisconsin

MADISON (June 30, 2008) --- A recent report by PricewaterhouseCoopers on medical cost trends for 2009 lists cost-shifting from Medicare and Medicaid recipients, as well as the uninsured, as one of the major factors behind rising health care costs for consumers.

[Capt. Slo-mo]

If hospital B charges $500 for a prostate exam, the insurance company will pay $70. If you do not have insurance they will bill you for the full amount, and will expect it, if you have insurance they will bill the insurance company and take what they get and be happy.

Can I have the address of this miracle hospital B? Because the way it works in the rest of the country is that the hospital then tries to collect the other $430 from the patient directly and inexorably.

[Hauptman]

[QUOTE=jessicasimpson;780245]

On the other issue, I still contend that when patients cannot pay their bills, the result is higher fees, which means that those of us who can pay their bills are in effect paying not only for our health issues, but for those unable to pay.


Quote: While charity care is a more altruistic idea, it impacts a hospital’s budget the same way bad debt does, prompting hospitals to find other ways to increase revenue, such as by cost-shifting to people with commercial health insurance, Quinn said.
QUOTE]

I agree with the first point, but not the second
insurance companies will pay what they pay, not what the hospital charges.
if hospital A charges $200 for a prostate exam, then the insurance company will pay $70. If hospital B charges $500 for a prostate exam, the insurance company will pay $70. If you do not have insurance they will bill you for the full amount, and will expect it, if you have insurance they will bill the insurance company and take what they get and be happy. if a hospital has more charity care, the insurance will not pay any more.

True, the insurance companies can determine what they will pay for a procedure, but only to a certain degree.

Hospitals contract with insurance companies to serve those patients covered by that insurance. If the insurance companies and hospitals cannot agree on the reimbursement rates hospitals can and will stop accepting that insurance.

So hospitals do pass on various costs in the rates they negotiate with the insurance companies, although the insurance companies do their best to hold the costs down for their own bottom line and not necessarily to pass the savings on to their customers.

[jeff]

Fairly accurate description for the most part. Bear in mind that some states prohibit 'balance billing' for the portion of the bill not paid by insurance, and that non-employee 'providers' (which may include the doctors involved) also are subject to the same issues. In the case of the uncovered, it is quite common for everybody providing services to do the work for free and never get compensated. In many hospitals, a doctor has to take ER call (depending on specialty) and/or clinic in order to have hospital privileges, and may take on "freebies" whether they like it or not. Or, as has been pointed out, a hospital may refuse to provide services to those who can't pay for them one way or the other.

[Inquartata]

My father's last hospital stay included a $3500 charge for a certain procedure. Medicare paid $560 or so, if I remember the figures correctly.

I suspect that hospitals have figured out what percentage of all procedures Medicare will pay, and have raised their charges so that what Medicare pays approximates their actual marginal cost for doing said procedures...

In other words, they never expected to get $3500, and $3500 would have been a huge windfall profit for them if they had. It's probably like that throughout the healthcare industry.

This is borne out by the fact that hospitals will negotiate on bills to patients which are not covered by insurance. They will often drop half or more of large bills, if the patient asks long enough and piteously enough...

Medicare and other insurance programs distort the free market, and this sort of thing is the result.

[Hauptman]

Medicare and other insurance programs distort the free market, and this sort of thing is the result.

I agree with this, but I'm not sure what your point was.

Is this an indictment of medical insurance in general? What effect would universal coverage have?

Maybe it would be better if the providers and the insurers were not separate entities?

Obviously, the current system has issues; I am always interested in hearing alternatives.