Health Care Reform in the US

[Inquartata]

Bah, I seem to have missed a few posts along the way!

Originally Posted by jeff

It's irrelevant because we are comparing two items that have the same regulatory burden, yet one is much more expensive than the other.

You mean...the way a Porsche and a Geo Metro share the same regulatory burden, but one is much more expensive than the other? Or a modest house and a McMansion?

I still don't see what you think this proves. The price of both is increased by the costs of regulation, probably by roughly the same amounts. And then each has other costs in addition, and those vary widely. Yes. How this shows that "there are extremely expensive parts of healthcare that have nothing to do with government " 'interference' " is still escaping me, though.

EDIT: Disregard, already settled and I dinna want to make you testy!

The difference between these is not the cost of regulation.,

But I never said it was, and if that was the question you meant it wasn't quite the one you asked...

EDIT: Never mind, again.

optional and often unnecessary cost that has nothing to do with government.

OK, I'll grant you that, but then, I don't recall ever having said that all increases in cost come from government.

The private sector is more efficient than the public sector, for many reasons, the greatest of which is the lack of the profit motive in the latter. If acknowledging that it is not perfectly efficient will appease you, then consider yourself appeased!

Other than that it's a common burden in both cases and can be factored out.

Why should it be "factored out"? It is a cost which can be reduced and perhaps even eliminated; why should we not only not do so but ignore even the possibility, and instead cheer for increasing it?

I'm not implying that people can charge whatever they want without consequences in the faces of market conditions and the law of supply and demand.

OK, since you are defining the phrase that way---rather idiosyncratically, but---very well.

If they are rational and want not only to make as much money as possible but stay in business they had better define "what they want to charge" as "what their cost and revenue equations tell them is the profit-maximizing price", too!

No it isn't! I am saying that expensive products cost more than inexpensive ones because of prices set by the manufacturer, relative to market conditions and the need to cover manufacturing, marketing, R&D, and sale costs while provide a margin, and with the observation that commodity items have smaller margins and more competition than specialized items with more "unique value proposition" components.

Good, good...

Of course there are practitioners who are not cost sensitive.

Which of these practitioners has his own MRI machine?

If there were any who truly did not care at all about costs, they could have 2 or 3 of them, and hire a PA just to light their cigars with $100 bills...

No, there really is no such thing as a producer who cares nothing about cost.

You see it all the time, with people ordering lots of tests that may not be needed (or are needed only as "defensive medicine" to fend off lawsuit),

But not EVERY test, and a dozen repetitions of each, etc.

If it doesn't come out of the practitioners pocket, he or she may really not care at all.

But it DOES cost them. If nothing else, it costs them time---that is, opportunity cost. And scheduling and billing hassles. Which require staff, computers, copy machines, filing systems, etc. Does the HMO pay for all of these, too?

Tie compensation to "productivity" and expense in either private or public sector and cost sensitivity comes back into the picture.

How exactly do you do that? I suspect that any method embarked upon would cost more in monitoring, measurement, standard-setting and compliance enforcement than ever it would save...especially if it were a government bureaucracy doing it.

All the more reason to address the issue head on rather than hope the Invisible Hand solves it.

But why? IMO to do this is to claim that a command system is a more efficient allocator of resources than the market...

If France is older and has these inefficencies, then why aren't they already more expensive than us?

Again, they are not THAT much older---and they ARE probably "paying more" in terms of the deadweight drag on their productivity growth.

"According to the Organization for Economic Co-operation and Development, the U.S. spent $7,290 per person in 2007, while Britain spent $2,992 and France spent $3,601."

It's all in the questions one asks, isn't it?

You focus on why the US has such higher per capita spending on health care than other countries. Let me focus on why health care is so much more expensive in France than in the UK? For that matter, why is it so much more expensive---and from what I've read, less effective---in Canada than in the UK, when they have fairly comparable systems?

Are these countries really paying much higher prices in the form of foregone productivity growth?

Look at productivity growth figures

http://web.worldbank.org/WBSITE/EXTE...239419,00.html

and the magnitude of the disparities you find in health care spending are reversed...

Could these countries be growing faster and increasing prosperity for all more quickly be spending less on social programs and more on growth-oriented industrial and trade policies?

We outspend them 2 to 1, but overall mortality in our country is about the same as UK and far worse than France. Maybe they should spend a little more, but their results are still as good as or better than ours.

We've discussed the many differences between the US and these other countries before. I'm still not convinced that these simplistic comparisons are that worthwhile...

Gosh, "McLaughlin’s Canadian comparison shows closely similar incidence rates for various cancers among Canada, the United States, England, Wales, and Denmark, along with a number of other Western European countries." (despite them smoking more!) What are you saying the article says?

Incidence, not survival, not cures...

I can no longer find the article which prompted this line of musing. But

http://news.bbc.co.uk/2/hi/health/7510121.stm

http://www.ncpa.org/pub/ba596

http://www.telegraph.co.uk/news/ukne...in-Europe.html

( From that latter, "Cancer survival rates in Britain are among the lowest in Europe, according to the most comprehensive analysis of the issue yet produced. England is on a par with Poland despite the NHS spending three times more on health care.

Survival rates are based on the number of patients who are alive five years after diagnosis and researchers found that, for women, England was the fifth worst in a league of 22 countries. Scotland came bottom. Cancer experts blamed late diagnosis and long waiting lists." )

But maybe...maybe?...these differences are accounted for not by per capita spending on health care but by various differences in the demographics, lifestyles and so on of these very different countries?

And if so, why not the differences in gross longevity, infant mortality, and so forth so often attributed to health care spending?

Several of us have put up on f.net quotes and links to articles where people said that they themselves did it. That's not allegation, that's confession!

O gods, now I have homework!

I don't think so, because a healthcare person and patient are only partially buyer and seller. But let's see if we get motivated enough to look it up later on.

So far, Magic Eight Ball says, "Reply hazy, try again".

I sure don't keep notes of where I've put up a particular piece of evidence, and it's a lot of work to go searching.

Don't I know it!

But just trust me - I've actually put up and seen such evidence. You know you can trust me!

"Inq, come into the Senate, Cassius and Brutus would like to offer you a crown, you know you can trust them!" ( smily )

a distinction without a difference, I'm afraid.

Not at all. Premiums do not and cannot approximate the actual price of medical care. To use them as proxies for price is like using options prices as proxies for the actual prices of actual commodities...

[Inquartata]

Originally Posted by dcmdale

Will wonders never cease? It seems that Inq is defending pernicious governmental regulation on enterprise

The DEVIL you say, sir!

Originally Posted by dcmdale

I was specifically referring to Inq's position on patents which he quite correctly identifies as a government granted limited monopoly, but then apparently defends and you, I think correctly, indicate that competition would force lower drug prices.

I am fairly sure that I was not defending regulation, though---merely saying that it can have effect A. Not the same as saying "A is a worthwhile thing"!

Not but that regulation of natural monopolies CAN result in efficiency gains, if monopoly profits are not frittered away by the regulators or their political masters on junkets and other fripperies.

[Inquartata]

Originally Posted by jeff

Obvious anti-Canada bias in Google...

Take off, eh?

They do not. One of my long-term charities is a hospital serving the Navajo rez.

What do you call the IHS, then?

"The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally-recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. The IHS is the principal federal health care provider and health advocate for Indian people, and its goal is to raise their health status to the highest possible level. The IHS provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 562 federally recognized tribes in 35 states."

The lack of medical services is shocking. Many problems go untreated.

I am sure. Many things we take for granted, like law enforcement and courts, are woefully inadequate on reservations.

However, that a public health service is not doing a particularly good job is neither evidence that it doesn't exist nor particularly surprising to me! Which is why I am dubious about expanding the government model which has been such a failure in so many ways ere now. ( But suddenly, because Mr. Obama says so, it is supposed to be wonderfully changed and will become a paragon of efficiency and effectiveness, I am sure. )

Well, we've backed away from "whatever an elected official does, we must have wanted" to "how long does a mandate last".

Not really. If it is not the case that a representative's positions are our will always...then it is not the case that a representative's election means that all planks of his platform were and are favored by the people and therefore necessarily must be our will ever. IMO.

There's no hard and fast rule on that, but it eventually becomes apparent, and we're nowhere near that.

I am not so sure. I had been reading that poll numbers on support for health care reform had been dropping steadily, but that a slight majority still favored it. But I just went looking for numbers to refresh my memory, and

http://www.quinnipiac.edu/x1295.xml?ReleaseID=1361

http://www.dallasnews.com/sharedcont...1.4bca598.html

Looks like it's dropped below 50%, at least according to these two polls...

Another I found avers that only 31% of those asked supported the idea that people should be forced to buy health insurance. Yet the last time I checked that was one of the provisions that have survived the alterations to the health care bills moving through Congress...

Where is your threshhold?

I don't think we would be served by a President that rotates like a weathervane with every puff of breeze from a different quarter.

No, that's Congress' job.

Shall we use the Gallup poll or Zagats to decide on a day by day basis which way we'd like to go? Boy, would that be an opportunity for vote rigging and manipulation, too.

I recall from my university days that there was a lot of interest by political scientists in the idea that we had the technology to hold national referenda on the major policy issues of the day---to go over the heads of legislatures.

I had my doubts then, and they have not evaporated yet. Still, I think that if we the people change our minds convincingly enough, our leaders should at least be open to the idea of doing likewise, particularly in the area of domestic policy...

No, of course not. The adjective "fine" modifying "working" means something.

In my experience, the present system is doing that, too.

[Inquartata]

Originally Posted by Hauptman

Now you know better than that. There is nothing in that statistic to imply whether or not money would be saved.

I do?

I know that devoting half of all health care spending to less than a third of the population would not be made worse by adding more people to that model?!

If you take away the profit motive, and the fact that private healthcare spends significantly more money on overhead than gov't programs, then there is a reasonable argument that gov't run healthcare would be cheaper and offer savings.

Then why isn't the half of the health care system that is already run by the government doing that already?

I mean, just look at the numbers! 50% of all spending to serve 28% of the population...meaning that the other half of spending---the private half---serves what? 50% of the population? That is, it serves 22% more of the population for the same money?

Which looks more efficient to you?

[Inquartata]

Originally Posted by I_luv_saber

Agreed, since my argument is not reliant upon numbers.

But it should be.

We simply cannot take every occurrence that someone thinks is a horrible problem and spend a lot of resources on it unless it is widespread enough to justify so doing.

At the extreme, I might think that X is a terrible problem because I have run into it three times, but if it cannot be shown to have happened more than three times ( or 5, or 10 ) anywhere then it is not reasonable to expect that an agency be created and funded out of taxpayer monies to address it---or even that an existing one's powers and resources be expanded.

My argument rests on the fact that the crimes (or would-be crimes) are life altering enough that they need to be taken care of.

And, again, they are. That it's not quite up to your personal standard of the level of "taking care of" is not a good reason for adopting that standard. I suspect that a lot of analysis has already gone into balancing the costs of enforcement against their possible benefits. Why are we to substitute your analysis based on a few dozen anecdotes for the one at which society has already arrived?

1) As I said, some of them ARE NOT crimes. I'll address this below.

Looking forward to it.

more aggressive enforcement of the regulations that DO exist is necessary as well.

How do you expect we can obtain that? How do we force a regulator to do thus and such?

It rests on the fact that the crimes are harmful enough that they must be prosecuted aggressively.

Smoking is harmful enough, too, IMO. Should it then be "prosecuted aggressively"?

We can't just throw more resources at every peril in the world. We are already careening down the road to bankruptcy as it is, with all of Mr. Obama's new spending initiatives...

As an aside, I'd also like to see white collar crimes punished by actual sentences, not just fines, where warranted.

Already are, as perhaps Bernie Madoff could tell you.

Waiting someone out in court via bureaucracy is not a crime.

And again, this is a widespread tactic in all areas of the law. You want to establish this as a precedent, that a defense cannot "take too long"?!

It's not a crime because it shouldn't be.

A) I sign a contract with an insurer that says they pay for any medical bills I may incur if I pay them a monthly premium.

B) A year later, I'm found to have cancer.

Heh. Yeah, that's the contract! Never mind all those pesky terms and conditions...

They don't pay my medical bills saying that I must have had a preexisting condition I didn't tell them about hence the contract was unfair or that I had a great-great uncle who had cancer (who I may have not even known about) hence increased my risk, which they didn't know about, so the contract was unfair.

Is any of that demonstrably untrue?

If not I do not see the offense...

Would you prefer a situation where they had to pay you, and then jacked up not only your rates but everyone else's as well to offset their losses?

Regardless if it's a common occurrence, IT HAPPENS.

And occasionally someone is killed by a meteorite. IT HAPPENS! So therefore, we should...?

Don't ignore the elephant in the room because it's inconvenient!

Miniature elephant, maybe.

Way out West
( Way out West )
The story is told
( Story is told )
'Bout a bunch cowboys
Tiny and bold
( Tiny and bold )
Ridin' high
( Ridin' high )
High in the saddle
Herdin' elephants the size of schnauzers
But they're elephants...

Second, this ends up with more burden on taxpayers indirectly.

So, directly is better?

Some standard of proof or some way of increasing accountability is not too much to ask, IMO.

Like...?

They've signed a contract to pay for it.

One so full of exclusions and exceptions that it isn't anything like as cut-and-dried as that. Which you must know, I think...

Or are all those immoral, and they should be forced to sign a contract to pay for anything and everything?

Meaning many laws, like it or not, are base on morality, liberty, and justice, not just cost/benefit.

You really think that economics doesn't factor into the ways laws are enforced and crimes punished?

The additional regulation and laws are to stop practices that are currently legal, but IMO should not be.

I know. You want to alter the whole legal system, because of something which offends you about one particular practice.

I just can't see that ever happening.

In the murder scenario, if we did not really spend many resources on prosecuting them, or on the homicide units that catch the culprits, do you not think there may be an increase in murders?

I doubt it. The numbers seem to rise and fall based on other factors. One of which, you may not be surprised to find, is---the state of the economy. ( smily )

Or maybe an increase in the number of unsolved/uncaptured murderers?

I don't know.

I only know that there aren't enough resources to do everything, and that I don't feel very inclined to hand over more of my earnings so that the government can try doing so.

The bottom line is: If I don't agree with you on your particular priority, why should I pay for addressing it?

Already been given an example of the most common. Basically, claims can be denied with no proof

"No proof" of what?

the fact they can deny claims with no proof, or no accountability to any (as far as I know) organization IS legal.

I suspect that it is not, as they are bound by the same terms and conditions of the contract which bind you, no? I don't see anything in mine, for instance, saying that they can do this with impunity...meaning that doing so would BE breach of the contract, IMO.

No, my remedy is that there must be SOME standard of denying claims.

I believe there is, though it probably varies from state to state, and maybe company to company.

Why do you think that there is none?

If not a direct payout followed by investigations, then accountability to a regulatory agency that oversees claims filed.

Ech. One worse than the other, IMO. The first merely shifts what you see as an undue burden from one contracting party to the other, on ( AFAICT ) the basis of the fact that "they can afford it". The second not only imposes additional costs but brings in the whole issue of bureaucratic dysfunction and capture of the regulator by the industry...

Personally I prefer to see it handled in the courts, the existing system for the resolution of legal disputes. No surprise there, I daresay. ( smily )

A minimal standard of proof must be submitted in order for a claim to be denied.

Er...proof of what? Proof of non-sickness? You want to establish proving a negative as the new standard in civil litigation?

No, that it is NOT the runaway problem the media says it is. What leads you to believe this? The simple fact the media says it makes it a lie?

The demonstrated historical tendency to follow the principle of "if it bleeds, it leads"...and that no one can seem to come up with any numbers to demonstrate whether it's a widespread practice or an exceptional one. Why are we to assume that it's common practice when no one can show that it is?

The insurance company, as far as I know, was never fined or punished in any way for unjustly denying the claim.

Was there a finding of deliberate illicit intent?

"If the act is harmful enough to a person or family, it should be a crime".

Who gets to define "harmful enough", though?

[Hauptman]

Originally Posted by Inquartata

I do?

I know that devoting half of all health care spending to less than a third of the population would not be made worse by adding more people to that model?!





Then why isn't the half of the health care system that is already run by the government doing that already?

I mean, just look at the numbers! 50% of all spending to serve 28% of the population...meaning that the other half of spending---the private half---serves what? 50% of the population? That is, it serves 22% more of the population for the same money?

Which looks more efficient to you?

Except you know absolutely nothing about the populations based on that simple statistic; how misleading!!

The Medicare population is made up of the elderly and disabled; talk about extreme need of healthcare!! Other more useful statistics show that the vast majority of healthcare needs and costs fall in that demographic.

Plus, gov't healthcare covers many of the people that the insurance companies don't want and take every opportunity to dump.

Now if you want to compare Medicare spending to private spending which is between at least slightly more similar populations, I would love to see that.

[jeff]

Originally Posted by Inquartata

Bah, I seem to have missed a few posts along the way!

Indeed you were, sir! But you eventually read ahead to a later post of mine, so I think I'll skip ahead to "new business". I ken we need na be testy (somewhere in the house I have an "English - Geordie dictionary"

Big old snip now...

Originally Posted by Inquartata

Which of these practitioners has his own MRI machine?

If there were any who truly did not care at all about costs, they could have 2 or 3 of them, and hire a PA just to light their cigars with $100 bills...

No, there really is no such thing as a producer who cares nothing about cost.

They sure do exist when somebody else pays the fee! Here's how it usually works: doctor orders a test - either because it's medically needed, or because the patient demands it or he doesn't want to get sued for a once in a blue moon circumstance, alas.. Somebody else provisions the test. Somebody else ways for it. So, that's how it can work: somebody else picks up the tab, so the practitioner doesn't give a darn.

However, you raise an interesting point. What if the practitioner owns the MRI machine (the McGuffin in this story) or an interest in the lab that owns it. Then it's even more to his advantage to order the test, as he'll make a profit - and somebody else still pays for it! So, the practitioner has gone from "does not care" to "Yay - free money for me!"

Originally Posted by Inquartata

But not EVERY test, and a dozen repetitions of each, etc.

That's called (for example) "Medicare Fraud" if done with a Medicare patient. Happens a lot (the tests are sometimes actually performed, instead of merely billed). Sometimes they get away with it, and sometimes they Go To Jail. It happens with HMOs too, but the HMOs push back, remember, on tests in the first place.

Look, it's like selling your PiL to the ref - it's gotta be at least plausible!

Originally Posted by Inquartata

But it DOES cost them. If nothing else, it costs them time---that is, opportunity cost. And scheduling and billing hassles. Which require staff, computers, copy machines, filing systems, etc. Does the HMO pay for all of these, too?

Eh? Writing a prescription takes 2 minutes. Somebody else does the test. You read the MRI report which came back negative - another 5 minutes. Might save you a day in court too.

And if it's something you yourself provide, then you pocket the fee and (hopefully) it's worth the effort. (Overheads are high and reimbursals don't always cover them, but that's actually another tangent).

Originally Posted by Inquartata

How exactly do you do that? I suspect that any method embarked upon would cost more in monitoring, measurement, standard-setting and compliance enforcement than ever it would save...especially if it were a government bureaucracy doing it.

Those procedures already exist, they're just not tied back to compensation. That's what a "utilization review board" in a hospital does.

Originally Posted by Inquartata

But why? IMO to do this is to claim that a command system is a more efficient allocator of resources than the market...

Nah, I'm no commie. But we have perverse incentives in our system - and remember the mantra "the other countries pay less, live longer". Can we not learn something from them? That should not be too much to ask.

Originally Posted by Inquartata

Again, they are not THAT much older---and they ARE probably "paying more" in terms of the deadweight drag on their productivity growth.

I dunno, I think that some of the northern European countries are older than us. But without data I'm not going to push the point and its too late right now to go search.

Originally Posted by Inquartata

It's all in the questions one asks, isn't it?

You focus on why the US has such higher per capita spending on health care than other countries. Let me focus on why health care is so much more expensive in France than in the UK? For that matter, why is it so much more expensive---and from what I've read, less effective---in Canada than in the UK, when they have fairly comparable systems?

Are these countries really paying much higher prices in the form of foregone productivity growth?

Look at productivity growth figures

http://web.worldbank.org/WBSITE/EXTE...239419,00.html

and the magnitude of the disparities you find in health care spending are reversed...

Could these countries be growing faster and increasing prosperity for all more quickly be spending less on social programs and more on growth-oriented industrial and trade policies?

I'll hold that thought for tomorrow. Seems like a loose thread. Here's another tack: wealthy societies spend more and more on healthcare because that's what wealthy people would do to extend their own lives, and as other costs get driven down (food no longer dominates our paychecks). By that theory, rising costs should be expected. But then I would want to get better results for our money.

Originally Posted by Inquartata

We've discussed the many differences between the US and these other countries before. I'm still not convinced that these simplistic comparisons are that worthwhile...

Oh, there are big factors we haven't gone into: lifestyle habits like food consumption and smoking play. But we have some data for first world countries, and we all have similar genomes - why do they do so much better at lower cost? The "do so well" is really not open to question - the issue is why? Seems logical that the healthcare system has a lot to do with it. And that's what professionals in the field say, not just us kibitzers.

Originally Posted by Inquartata

Incidence, not survival, not cures...

I can no longer find the article which prompted this line of musing. But

http://news.bbc.co.uk/2/hi/health/7510121.stm

http://www.ncpa.org/pub/ba596

http://www.telegraph.co.uk/news/ukne...in-Europe.html

( From that latter, "Cancer survival rates in Britain are among the lowest in Europe, according to the most comprehensive analysis of the issue yet produced. England is on a par with Poland despite the NHS spending three times more on health care.

Survival rates are based on the number of patients who are alive five years after diagnosis and researchers found that, for women, England was the fifth worst in a league of 22 countries. Scotland came bottom. Cancer experts blamed late diagnosis and long waiting lists." )

But maybe...maybe?...these differences are accounted for not by per capita spending on health care but by various differences in the demographics, lifestyles and so on of these very different countries?

And if so, why not the differences in gross longevity, infant mortality, and so forth so often attributed to health care spending?

Good question. They smoke like fiends, is my thought. So, how did we compare to that table?

Originally Posted by Inquartata

O gods, now I have homework!

Gosh no! This is silly distraction, not work...

[I_luv_saber]

Originally Posted by Inquartata

We simply cannot take every occurrence that someone thinks is a horrible problem and spend a lot of resources on it unless it is widespread enough to justify so doing.

Then if, as you say, murder is relatively rare, why do we spend vast resources on solving/catching murderers?

You may think this is how things should be, but the fact of the matter is, that's not how it is now

And, again, they are. That it's not quite up to your personal standard of the level of "taking care of" is not a good reason for adopting that standard.

But if it is not up to society's standard, then yes it is. This is how a democratic society works. And apparently it isn't up to the standards of at least a decent portion of our society, because we are seeing a lot of call for some sort of reform.

How do you expect we can obtain that? How do we force a regulator to do thus and such?

It generally is not a matter of "forcing" a regulator to do anything... in my experience it's all about whether or not they have the budget and resources to achieve their objectives.

Smoking is harmful enough, too, IMO. Should it then be "prosecuted aggressively"?

It has been, at least in the way of when you are possibly harming others. Many states (including California) have passed very aggressive laws banning smoking when you can harm others with second-hand smoke. If you are harming only yourself, then hey, whatever, but that's not what we're talking about in this situation, is it?

We can't just throw more resources at every peril in the world.

We also can't ignore every injustice in the world because "Hey, it doesn't happen enough".

Already are, as perhaps Bernie Madoff could tell you.

It's definitely getting better.

And again, this is a widespread tactic in all areas of the law. You want to establish this as a precedent, that a defense cannot "take too long"?!

I was saying it was a possible solution. Other solutions were proposed, such as insurance companies having to submit reasonable proof before denying a claim (perhaps to their governing regulatory agency, or perhaps to a court).

Heh. Yeah, that's the contract! Never mind all those pesky terms and conditions...

My whole point is that many times claims are denied when terms and conditions were adhered to! Such as the case with the pregnant woman where she agreed to disclose all information to the best of her knowledge.. If she didn't know she was pregnant, she has adhered to her end of the bargain. It should not be up to her to prove she did not know, it should be up to the insurance company to prove she was indeed lying.

Would you prefer a situation where they had to pay you, and then jacked up not only your rates but everyone else's as well to offset their losses?

I would prefer a situation where they show they have at least a leg to stand on before denying a claim. Doesn't need to be concrete necessarily, just enough. Using the example of the pregnant woman again, they would have to show (whoever it's decided upon, court or whatever) that in a past conversation she said she may be pregnant, or that she has previously ordered a test, or something showing that at the time of her signing, she knew she was pregnant, in order to deny her claim.

And occasionally someone is killed by a meteorite. IT HAPPENS! So therefore, we should...?

That is not the same as a company knowingly going against their contract to save money, and killing or harming me in the process.

So, directly is better?

If we're going to pay either way, I'd rather go with the option where we may well pay quite a bit less. BTW, I still consider this method rather indirect. Direct control would be nationalized health care.

Like...?

As another example, let's say they make the claim that I had a family history of cancer from my great-aunt Ruth which I did not disclose at the time of signing up. They would have to show that I was not being truthful (perhaps like showing I did claim it on another medical record in the past).

Another example would be that they say I had a preexisting condition I did not disclose (keeping in mind the end of these all say "I agree this is true to the best of my knowledge"). They would have to prove I knew of the preexisting condition, such as records from a previous doctor visit, or test results, or what have you.

One so full of exclusions and exceptions that it isn't anything like as cut-and-dried as that. Which you must know, I think...

Which we are now cracking down on with credit card companies, making more clear and transparent business practices. This is very similar to what I'm proposing for insurance companies.

Or are all those immoral, and they should be forced to sign a contract to pay for anything and everything?

No, but it should be transparent.

You really think that economics doesn't factor into the ways laws are enforced and crimes punished?

Of course it does... but that does not mean it is the only factor, and to say otherwise is being disingenuous.

I know. You want to alter the whole legal system, because of something which offends you about one particular practice.

It isn't altering the entire legal system. Many basic necessity things, such as utilities, must adhere to more strict practices and regulation in order to make sure they aren't squeezing pennies out of people with basic life necessities. This isn't anything new or novel, it's simply applying it to a different field.

I just can't see that ever happening.

Maybe, maybe not. It would be a much smarter compromise. As it is, I have a feeling the Republicans lack of willingness to compromise is going to put the Democrats in a "fine, we'll do it without you" mood and we'll end up with the government option anyway. They need to cooperate, if for nothing else than damage mitigation.

I doubt it. The numbers seem to rise and fall based on other factors. One of which, you may not be surprised to find, is---the state of the economy.

It again seems very disingenuous to think that a large scaling back of resources on pursuing murder cases would not result in an increase of murders, or at least murderers at large.

I only know that there aren't enough resources to do everything, and that I don't feel very inclined to hand over more of my earnings so that the government can try doing so.

So who has decided that murder is important enough to pursue, and why? Stay tuned, answer coming up next!

The bottom line is: If I don't agree with you on your particular priority, why should I pay for addressing it?

There's lots of things I bet that we both pay for that we don't agree with. That's what happens in a democracy. You can't choose which you want to obey and which you don't... you cast your vote, speak your mind, but ultimately we decide what is best as a group.

"No proof" of what?

No proof of breach of any terms or conditions on the part of the customer.

I suspect that it is not, as they are bound by the same terms and conditions of the contract which bind you, no? I don't see anything in mine, for instance, saying that they can do this with impunity...meaning that doing so would BE breach of the contract, IMO.

And if they DO breach your contract, what will you do about it? Good luck sitting in court for the next 5 years while all those medical bills are piling up.

They don't have to prove that they denied your claim rightly until you take them to court. Guess what happens next.

I believe there is, though it probably varies from state to state, and maybe company to company.

Why do you think that there is none?

AFAIK, there is none, at least not until it comes down to actual court proceedings.

The first merely shifts what you see as an undue burden from one contracting party to the other, on ( AFAICT ) the basis of the fact that "they can afford it". The second not only imposes additional costs but brings in the whole issue of bureaucratic dysfunction and capture of the regulator by the industry...

Look at it this way. I've hired a contractor to add a new room to the house as long as I pay him X monthly. I pay him his money, but when it comes time to add on, he says no, due to the fact that... oh, let's say there is some soil a little ways underground that will make the work more costly, which he didn't know about (keep min mind, our contract simply says I disclosed to the best of my knowledge).

The only difference with this situation of insurance is that, due to the life-important nature of medical issues, is that they must first submit proof they have a right to not fulfill their end of the contract before not fulfilling the contract in the first place.

Unless you propose that I, as a homeowner (or insurance client) must somehow prove I didn't know, (which I'm not quite sure how that's possible (talk about proving a negative!)) rather than the contractor (or insurer) having to prove I did know.

All it has really done is sped up the whole process and cut right to the chase of the insurer having to submit proof he breached contract rightly.

Er...proof of what? Proof of non-sickness? You want to establish proving a negative as the new standard in civil litigation?

Proof that I was lying. Innocent until proven guilty and all that, remember?

[I_luv_saber]

Originally Posted by Inquartata

The demonstrated historical tendency to follow the principle of "if it bleeds, it leads"...and that no one can seem to come up with any numbers to demonstrate whether it's a widespread practice or an exceptional one.

AFAIK, these numbers don't even exist! Not to mention, I don't see how these could be tracked accurately anyway.

Why are we to assume that it's common practice when no one can show that it is?

Because there are enough of these stories surfacing that people are starting to take a second look and wonder if something sketchy isn't happening. It may be a small percentage of claims, but it's still a large amount of people being effected. For THS, 97% satisfied may be a large number of people, but we still found that 3% unsatisfied unacceptable since it was still a large number of people.

Was there a finding of deliberate illicit intent?

I'm honestly not sure. I think it was pretty much that the insurance company could simply not prove that he had breached his contract, and so he was awarded the money due to him.

Who gets to define "harmful enough", though?

We've been over this many times. We, as a society decide this. We decide what is or is not important enough to be pursued, whether or not it affect lots of people first. Murder does not affect a large percentage of people (AFAIK), but we dedicate huge resources to pursuing it compared to how many it affects. Why? Because we've decided it's vile enough and harmful enough to other people, regardless of frequency, that it should be pursued vigorously.

This is nothing new. The "who decides it" is a very clear answer.

[Inquartata]

Oooh! And I had almost caught up, too! SO close...

Originally Posted by jeff

But if the insurer is the one way to get the underlying service, it's the very same thing for those who are affected.

It's as different as that between buying 10,000 barrels of oil and buying a futures contract for 10,000 barrels of oil. One is leveraged, and one is not. One is a straightforward purchase based only supply and demand, and the other is a gimmick based on the time value of money and on a bewildering array of probabilities in addition to supply and demand. They are both economic transactions, but they're not the same kinds of economic transaction...

Indeed, and before Sinclair published his book, people believed their meat was safe. Before antics on Wall St were exposed prior to post-Great Crash regulation, many people believed it was safe too. Best to make the reality conform to the naive belief.

I dunno, I tend to have little sympathy for the naive, the gullible and the lazy...

Read the cited accounts from the period: meat consumption was indeed down post revelation of the industry practices.

And what happened to consumption of substitutes? I'd be willing to bet that they went up commensurately.

Yet those substitutes were probably no more "safe", intrinsically, than the products they replaced. "Ignorance is bliss"?

Originally Posted by jeff

Nope, I've never calculated NPV on kids.

Hey, why not? We tried it for slaves, remember?

[jeff]

Originally Posted by Inquartata

Oooh! And I had almost caught up, too! SO close...

Dang! By answering this I'm out of sequence. Ow!

Originally Posted by Inquartata

It's as different as that between buying 10,000 barrels of oil and buying a futures contract for 10,000 barrels of oil. One is leveraged, and one is not. One is a straightforward purchase based only supply and demand, and the other is a gimmick based on the time value of money and on a bewildering array of probabilities in addition to supply and demand. They are both economic transactions, but they're not the same kinds of economic transaction...

Uh, yeah, fer sure. And, I'm not seeing how this applies and need to get another beer.

Originally Posted by Inquartata

I dunno, I tend to have little sympathy for the naive, the gullible and the lazy...

I have some sympathy, and want to give the suckers at least an even chance (PT Barnum notwithstanding)

Originally Posted by Inquartata

And what happened to consumption of substitutes? I'd be willing to bet that they went up commensurately.

Yet those substitutes were probably no more "safe", intrinsically, than the products they replaced. "Ignorance is bliss"?

Probably? Maybe maybe not. These were early days of mass manufactured convenient factory foods. If they reverted to the neighborhood butcher for a while that might have been a Good Thing.

Originally Posted by Inquartata

Hey, why not? We tried it for slaves, remember?

Uh, because I've never owned either? (gotta go now, places to go, hurled shoes to duck!)

[Inquartata]

Originally Posted by Hauptman

The Medicare population is made up of the elderly and disabled; talk about extreme need of healthcare!!

And yet all of the horror stories we hear, about people without insurance who get sick or injured and running up hundreds of thousands of dollars of medical bills, are neither. I wonder why that is, and what it might say about your assumptions?

It seems to me that if you are looking to reduce costs the last thing you'd want to do is to add millions of additional potential risks to the sort of system that Medicare represents.

I was watching one of those John Stossel ( I think ) pieces last week. He went to a Florida retirement community, where the average price to buy in was $300,000 to $500,000, thus establishing that the residents he followed were relatively well off financially. Then he looked into their health care use. They were all on Medicare, and they all went to the doctor for something at least weekly and sometimes almost daily. One lady said that "this is our social life"...

At first they were all quite defensive when it was pointed out to them that they were enjoying all of this medical care almost for free, even though they were affluent, while the young working people who were paying for their care often struggled and went without. There were the usual comments about how it was just recompense for all the years they paid into the system themselves, for example. Having it pointed out that the average retiree uses about 4 times more in benefits in a few years than they paid in over a lifetime seem to make a few of them thoughtful, at least. Most, though, still seemed to be of the "I got mine" mentality.

Clearly there is a lot of unnecessary or voluntary use of medical services under Medicare. This is what we'd expect when prices for something are held artificially low. So the question is not "Do old people cost more because they're old?", but rather "What will happen if we add 50 million people to a system which distorts the price mechanism and creates additional demand"?

Plus, gov't healthcare covers many of the people that the insurance companies don't want and take every opportunity to dump.

And why should it?

[Inquartata]

Originally Posted by jeff

Here's how it usually works: doctor orders a test - either because it's medically needed, or because the patient demands it or he doesn't want to get sued for a once in a blue moon circumstance, alas.. Somebody else provisions the test.

]

A-ha, I sez!

If a practitioner were truly "not cost sensitive", he would simply indulge his own convenience and get his own machine, do the tests himself and keep all the proceeds, rather than share them with "somebody else". He would hire as much staff and buy as much building space as he needed to do this, because the cost would mean nothing to him. He'd spend hours with each patient, because he would not be sensitive to the ( opportunity ) cost of his own time. Or more likely he'd hire others to do the work and spend his days on the golf course---and naturally he'd pay them all lavishly, because the would not be sensitive to costs...

What if the practitioner owns the MRI machine (the McGuffin in this story) or an interest in the lab that owns it. Then it's even more to his advantage to order the test, as he'll make a profit - and somebody else still pays for it! So, the practitioner has gone from "does not care" to "Yay - free money for me!"

Why, then, do we see none of these imaginary fellows? I mean, if costs were truly of no consequence to them, why are these not proliferating and dominating the marketplace? They should have an insurmountable competitive advantage---they are impervious to price! They should soon drive all those who still faced cost constraints out of business altogether...

sometimes they Go To Jail. It happens with HMOs too, but the HMOs push back, remember, on tests in the first place.

So, then...they are in fact "sensitive to the cost" of getting caught?

Eh? Writing a prescription takes 2 minutes. Somebody else does the test. You read the MRI report which came back negative - another 5 minutes. Might save you a day in court too.

How much is a doctor's time worth? You'd know better than I! But unless it's zero, using some of it is still a cost...

(Overheads are high and reimbursals don't always cover them, but that's actually another tangent).

Overhead? What overhead? That implies cost, and these guys don't have costs, remember?

Those procedures already exist, they're just not tied back to compensation. That's what a "utilization review board" in a hospital does.

How are they working?

we have perverse incentives in our system

Indeed we do, indeed we do...

And IMO most of them have been either created or enabled by some act of government, whether it be the construction of tax incentives or the regulation of drugs or what have you!

The market, in its unhampered state, does not create "perverse incentives" in the markets for normal goods. It takes government meddling if you want perverse done right!

I dunno, I think that some of the northern European countries are older than us.

All of them, I think, unless you count Iceland. But as I said they are all within a few percentage points of us. Sometimes these things are measured in pretty narrow margins, and I'm not sure what they demonstrate about very different cases.

wealthy societies spend more and more on healthcare because that's what wealthy people would do to extend their own lives, and as other costs get driven down (food no longer dominates our paychecks).

Assuming for the moment that this is correct, would you then expect to see the lists of (a) countries ranked by GDP per capita and (b) countries ranked by spending on health care mirror each other? That shouldn't be hard to check...

But we have some data for first world countries, and we all have similar genomes - why do they do so much better at lower cost?

Define "similar". Japan and Sweden? Spain and Canada?

Seems logical that the healthcare system has a lot to do with it. And that's what professionals in the field say, not just us kibitzers.

Yes. But still, I wonder what their assumptions are...

Good question. They smoke like fiends, is my thought.

What, more than the French and Italians?!

So, how did we compare to that table?

Top of the chart for both men and women. Survival rates for men were 66.3%, the next highest was Sweden at 60.3%. England came in at 44.8%, Scotland at 40.2%...

Again, I'm not sure how much we can conclude from isolated statistical comparisons of very different populations.

And now, off to fencing.

[jeff]

pooh! I'll never get the order right now.

First - I have to chime in with Hauptmann here. Despite the fact that seniors may use their doctor visits as their social outings also, it is simply the factual case that the population covered by Medicare (over 65, or permanently disabled, or on dialysis) has higher medical needs than the general public, and therefore it is unsurprising that they consume more $ per capita.

Have I not been referring to this effect in the past few weeks? Come to think of it, didn't you also do so?

Originally Posted by Inquartata

A-ha, I sez!

If a practitioner were truly "not cost sensitive", he would simply indulge his own convenience and get his own machine, do the tests himself and keep all the proceeds, rather than share them with "somebody else". He would hire as much staff and buy as much building space as he needed to do this, because the cost would mean nothing to him. He'd spend hours with each patient, because he would not be sensitive to the ( opportunity ) cost of his own time. Or more likely he'd hire others to do the work and spend his days on the golf course---and naturally he'd pay them all lavishly, because the would not be sensitive to costs...

This gets us both shallow and deep waters. I'm going to be as informative and open (rather than disputatious in our normal manner!) as I can.

First, the shallow part: on a given transaction, the practitioner incurs no cost for sending a patient out for an unneeded diagnostic procedure (or a cost so negligible that it has no effect on the sunk cost of maintaining an office. The time to write a prescription, read the faxed report, and stick it in the patient's folder is negligible, and he/she incurs no other billing or ovehead costs). Or, to use our Yugo:Lexus::cautery:harmonic scalpel example - it costs a surgeon not one cent more to use the expensive device than the inexpensive one. Not one red cent.

That in fact is what I'm talking about. Nothing more, nothing less. If I'm your doc, and have no incentive to not use something pricey, it's fair to say I'm insensitive to it.

The other part is deeper. What you're saying is "if something has no cost, why doesn't the guy bring that business in for himself". That's deeper water, and really is saying "why doesn't every doctor go into a different business".

Well, there are lots of reasons. For starters, the doctor really has no means to go into the harmonic scalpel business. Oh, if we're talking about the MRI there are barriers:

1. Figure maybe $1M to buy the machine.
2. Build a shielded room for it - it has powerful magnets
3. Hire a tech to operate it.
4. Hire a radiologist to read the results (and not all of them do).

So, it's really "why doesn't every doctor go into a completely different business that requires a large outlay of money". All very interesting, but actually not what I was talking about, which was purely the transactional aspect where I don't give a monkey's if I send you for an MRI or use a fancy tool - because somebody else pays the freight. The other topic is an entirely different subject.

And there's another thing: the Stark Laws which prohibit self-referral
http://en.wikipedia.org/wiki/Stark_Law
http://starklaw.org/


Cute, eh?
But wait a sec...

Originally Posted by Inquartata

]Why, then, do we see none of these imaginary fellows? I mean, if costs were truly of no consequence to them, why are these not proliferating and dominating the marketplace? They should have an insurmountable competitive advantage---they are impervious to price! They should soon drive all those who still faced cost constraints out of business altogether...

Actually, despite the above, this really does happen, and there are loopholes you can drive a truck through. Remember the Texas city with exorbitant medical costs that I referred you to a week or two ago? That's exactly what happened.

Here's the loophole: a physician can partially own a medical facility (eg: with such diagnostic equipment) and others can refer patients to it. In fact, in some states the physician can refer to his own facility too. How that works despite Stark, I do not know. Or note Kaiser, which owns the hospitals and labs, but has a subsidiary from which all the doctors work - and of course they send patients to the hospital facilities and take profit sharing from the company at large. Go figure.

Originally Posted by Inquartata

So, then...they are in fact "sensitive to the cost" of getting caught?

And the golf course at the jail aint so good either...

Originally Posted by Inquartata

How much is a doctor's time worth? You'd know better than I! But unless it's zero, using some of it is still a cost...

Sure, but it's a negligible cost - a few minutes, perhaps, a sunk cost, and independent of the cost of the procedure's expense.

Say I'm Dr. Fell (or Feelgood - pick yer poison) and you demand an MRI. I write a prescription for it on the grounds that it removes one low-probability cause for a potential lawsuit or shuts you up. Takes me a minute.

Originally Posted by Inquartata

Overhead? What overhead? That implies cost, and these guys don't have costs, remember?

Of course they do - but writing a prescription that you take to another building to get an MRI is not part of it. Nor is using the platinum-and-diamonds Michael-Jackson special edition $9,000 surgical glove (specify L or R) instead of the 8 cent one - if both are provided by the hospital at no cost to me whatsoever.

Originally Posted by Inquartata

How are they working?

They ask "why is this patient still in the house after 9 days?" Yes, it has an effect. There's also the M&M - Morbidity and Mortality reviews. Oops - Mr. Gomer (there's a pun here) croaked after you removed half his stomach and all of his wallet in a bariatric procedure. Bad you. But you still get EXACTLY THE SAME FEE for the procedure, and will continue to do so unless you get sued so much you can't afford malpractice coverage, or lose your license. Those evil licenses we've talked about...

So, as I said - the procedures exist but are not tied to compensation.

Originally Posted by Inquartata

Indeed we do, indeed we do...

And IMO most of them have been either created or enabled by some act of government, whether it be the construction of tax incentives or the regulation of drugs or what have you!

The market, in its unhampered state, does not create "perverse incentives" in the markets for normal goods. It takes government meddling if you want perverse done right!

Well, yes there is a genius for doing so - but the incentives I'm referring to in the vast majority are unrelated to the government. I've just explained why!

Originally Posted by Inquartata

All of them, I think, unless you count Iceland. But as I said they are all within a few percentage points of us. Sometimes these things are measured in pretty narrow margins, and I'm not sure what they demonstrate about very different cases.

I'll save that for another day. Time to wind down and research is "work"

Originally Posted by Inquartata

Assuming for the moment that this is correct, would you then expect to see the lists of (a) countries ranked by GDP per capita and (b) countries ranked by spending on health care mirror each other? That shouldn't be hard to check...

I don't know - and partially because "more expenditure on medical care" does NOT imply "better outcomes". There are definitely diminishing and sometimes negative returns after a certain point. Throwing money at a problem is not always the answer (hah- you never expected a liberal to say that!)

Originally Posted by Inquartata

Define "similar". Japan and Sweden? Spain and Canada?

Let's keep things simple: North American and European countries have pretty similar genetic backgrounds.

Originally Posted by Inquartata

Yes. But still, I wonder what their assumptions are...

Like all good scientists - they have to validate assumptions!

Originally Posted by Inquartata

What, more than the French and Italians?!

Not all of them, but certain classes sure do. And the Latins are cutting down believe it or not. They all still smoke far more than us Yanks.

Originally Posted by Inquartata

Top of the chart for both men and women. Survival rates for men were 66.3%, the next highest was Sweden at 60.3%. England came in at 44.8%, Scotland at 40.2%...

Again, I'm not sure how much we can conclude from isolated statistical comparisons of very different populations.

And now, off to fencing.

Enjoy! My next workout tomorrow.

[lindajdunn]

http://www.youtube.com/watch?v=xNuCf...layer_embedded

Pirates of the Health Care-ibean.

[Inquartata]

Originally Posted by I_luv_saber

Then if, as you say, murder is relatively rare, why do we spend vast resources on solving/catching murderers?

I did not say that it was rare, I said that media coverage exaggerates its prevalence.

I will also point out that most murders all but sole themselves. Many are 'dead bang' cases, for instance being committed in front of witnesses or ending in suicide; many are 'heat of passion' killings, with no planning and shoddy attempts at cover-up, or just flight instead; many more are committed by culprits simply too stupid to get away with it under any circumstances...

And thus we don't spend "vast resources" on them. There's seldom the need.

Now, prosecuting, convicting, imprisoning and executing the perpetrators---on that we spend vast amounts.

But if it is not up to society's standard, then yes it is. This is how a democratic society works. And apparently it isn't up to the standards of at least a decent portion of our society, because we are seeing a lot of call for some sort of reform.

I suspect that we'd see a lot of call for free pizza, free beer and free cable, too...

"Society" is composed in the main of malleable idiots, you know.

But seriously, that politicians and media figures can gin up a public hue and cry for a policy does not make the policy a good one.

It generally is not a matter of "forcing" a regulator to do anything... in my experience it's all about whether or not they have the budget and resources to achieve their objectives.

You might want to rethink that. It has more to do with politics than budgets. If Senators and Governors and Secretaries are pressuring them to do, or not to do, something; if there may be career repercussions over investigating a powerful firm or individual; if the tenor of the times is laissez-faire; etc. Regulators, like everyone else, can get caught up in a bubble mentality.

I had a couple of articles on the subject, but this molasses-slow library server
is taking forever to pull them up. Grrr!

It has been, at least in the way of when you are possibly harming others. Many states (including California) have passed very aggressive laws banning smoking when you can harm others with second-hand smoke.

"Passing laws" is not the same as "prosecuting aggressively".

We also can't ignore every injustice in the world because "Hey, it doesn't happen enough".

Nope. But our responses can be proportional to the seriousness and prevalence of the problem. And in most cases, that's what we do. Though occasionally we fly off the handle over a spotted owl or something.

insurance companies having to submit reasonable proof before denying a claim (perhaps to their governing regulatory agency, or perhaps to a court).

Ah, another cost! And up go everyone's premiums again! And the regulatory agencies must expand their staffs and budgets to keep up, of course!

The Law of Unintended Consequences cannot be overturned by the Supreme Court or overturned by act of Congress. ( Or circumvented by regulatory agencies. )

My whole point is that [i]many times claims are denied when terms and conditions were adhered to!

Tsk! Assertion is not evidence!

Such as the case with the pregnant woman where she agreed to disclose all information to the best of her knowledge..

You mean, the hypothetical case? Or was there a real one which can be examined?

And---is it the law that you must know that you have a pre-existing condition to have a pre-existing condition?

I would prefer a situation where they show they have at least a leg to stand on before denying a claim.

Move to strike as unresponsive, Your Honor!

This is one of the "reforms" moving through Congress, you know: Prohibit denial of coverage because of pre-existing conditions, but permit charging higher premiums in those cases---which is likely to translate to charging much higher premiums in those cases. And probably charging more across the board. Do you think that preferable to the current state of affairs?

That is not the same as a company knowingly going against their contract to save money, and killing or harming me in the process.

Nothing is the same as anything else. But both are risks. If we are to ignore the remoteness of their occurrence when deciding how much resources to devote to preventing them, then it is no different from any other risk...

But luckily that's not how we decide to allocate resources, generally speaking. We use some sort of cost-benefit evaluation, even if it's not a formal or even an active one.

If we're going to pay either way, I'd rather go with the option where we may well pay quite a bit less.

"May"? You are willing to gamble with other people's money, then?

As another example, let's say they make the claim that I had a family history of cancer from my great-aunt Ruth which I did not disclose at the time of signing up. They would have to show that I was not being truthful (perhaps like showing I did claim it on another medical record in the past).

I find this an unreasonable requirement, myself. It rewards people for concealing relevant facts, too. It promotes dishonesty.

Frankly, if you have such a history, why should it not be relevant unless "they" can prove that you knew about it? That's an enormous invitation to dissembling...

Which we are now cracking down on with credit card companies, making more clear and transparent business practices. This is very similar to what I'm proposing for insurance companies.

Chasing a will-o-the-wisp, you mean. Do you really think that these companies won't just find ways around the laws? ( They have the example of the very legislators who make the laws before them in this respect, after all! I mean, how effective have all of the campaign finance reforms been? )

No, but it should be transparent.

What does that mean?

Of course it does... but that does not mean it is the only factor, and to say otherwise is being disingenuous.

We might be a lot better off if it were! Of course, I could be biased here. ( smily )

It isn't altering the entire legal system.

It's a basic precept of the law that we need not prove that we are NOT committing a crime before we are defendants...

Many basic necessity things, such as utilities, must adhere to more strict practices and regulation

Utilities are natural monopolies. HMOs are not. I realize that when all one has is the hammer of regulation one is tempted to treat everything like a nail, but different things call for different approaches.

I have a feeling the Republicans lack of willingness to compromise is going to put the Democrats in a "fine, we'll do it without you" mood and we'll end up with the government option anyway. They need to cooperate, if for nothing else than damage mitigation.

At the risk of Godwining the thread... what's the famous quote by Pastor Niemoller?

You recommend that they go along to get along, and toss principle into the dustbin?

Did you feel the same way about the Democrats when the Republicans were in charge?

It again seems very disingenuous to think that a large scaling back of resources on pursuing murder cases would not result in an increase of murders, or at least murderers at large.

See discussion at the top of the post.

So who has decided that murder is important enough to pursue, and why?

Moses. Many times I tried to talk to him about cost vs benefit and functionalism in human praxeology, but would he listen? Noooo. Unless it was on some stupid stone tablet, he couldn't see it. Stubborn old coot!

No proof of breach of any terms or conditions on the part of the customer.

I still don't understand whence comes this insistence that there should be a burden to prove that one is acting legally before the fact.

And if they DO breach your contract, what will you do about it? Good luck sitting in court for the next 5 years while all those medical bills are piling up.

Why don't they do it with ALL claims? That would be the most profitable way, if your theories about how "they" think are correct...

That it's a business model rather than an occasional breakdown of oversight or what have you seems pretty far-fetched to me.

AFAIK, there is none, at least not until it comes down to actual court proceedings.

Maybe you should read the terms and conditions of your policy. I know it's dry stuff, but I suspect that you'll find SOMEthing.

Look at it this way. I've hired a contractor to add a new room to the house as long as I pay him X monthly. I pay him his money, but when it comes time to add on, he says no, due to the fact that... oh, let's say there is some soil a little ways underground that will make the work more costly, which he didn't know about

I don't get it.

(keep min mind, our contract simply says I disclosed to the best of my knowledge).

Why do you keep saying this as though it were an underlying assumption?

Proof that I was lying. Innocent until proven guilty and all that, remember?

Except that in this case YOU are the accuser, and THEY are the defendant. The right therefore accrues to them, not you...

[Inquartata]

Originally Posted by I_luv_saber

AFAIK, these numbers don't even exist! Not to mention, I don't see how these could be tracked accurately anyway.

Oh, I'm sure they exist. But they are probably internal to each company, and proprietary, therefore not released and certainly not aggregated for purposes of statistical evaluation. Alas.

Because there are enough of these stories surfacing that people are starting to take a second look and wonder if something sketchy isn't happening.

"Enough"? By whose arbitrary and subjective standard?

We're back to reporting bias again, too.

Meanwhile, are you familiar with the tenacity of legends? Of how common it is for "people" to believe things that aren't true?

Maybe Snopes or Factcheck could look into this one...

It may be a small percentage of claims, but it's still a large amount of people being effected.

How d'ye know? I mean KNOW, as opposed to believe?

For THS, 97% satisfied may be a large number of people, but we still found that 3% unsatisfied unacceptable since it was still a large number of people.

What you mean 'we', paleface?

My main objection was on the grounds of foreclosed freedom of choice and undue cost, not on the grounds that 'THS sucks'...

Anyway, the numbers themselves were suspect on several methodological grounds. I doubt that that 97% figure was accurate.

I'm honestly not sure. I think it was pretty much that the insurance company could simply not prove that he had breached his contract, and so he was awarded the money due to him.

We, as a society decide this.

Which amounts to "opinion leaders, the media and the politicians currently in power decide this". Great...

If only some of then had the first clue about economics, I'd feel a little better about that.

[Inquartata]

The articles finally loaded. ( Geez! )

http://www.businessinsider.com/the-m...ulators-2009-7

http://www.becker-posner-blog.com/ar...ial_regul.html

Now off to fencing.

[I_luv_saber]

Originally Posted by Inquartata

I did not say that it was rare, I said that media coverage exaggerates its prevalence.

Really?

It IS a rare occurrence, compared to the size of the population.

Which you are quite right about, and was my point.

I will also point out that most murders all but sole themselves. {snip}

And thus we don't spend "vast resources" on them. There's seldom the need.

However, some don't, and that's not counting:

Now, prosecuting, convicting, imprisoning and executing the perpetrators---on that we spend vast amounts.

It's all part and parcel of the "pursuing crimes" gig. Catching a murderer doesn't do much if he's turned right back around. Again, this is all part of my point.

I suspect that we'd see a lot of call for free pizza, free beer and free cable, too...

I haven't so far, have you? People are idiots, but on the whole I guess we turn out to be somewhat reasonable idiots.

But seriously, that politicians and media figures can gin up a public hue and cry for a policy does not make the policy a good one.

I see your point, but at what point do we stop simply deferring our responsibility and choices (along with their consequences, good or bad) to the media and politicians because of their influence?

Influence matters, surely, but in issues the people feel strongly enough about they will be heard, and it's ultimately their responsibility. If you feel people are idiots and hence no policy passed by them can be good, then that's great, but that's not a democratic society, is it?

You might want to rethink that. It has more to do with politics than budgets. If Senators and Governors and Secretaries are pressuring them to do, or not to do, something; if there may be career repercussions over investigating a powerful firm or individual; if the tenor of the times is laissez-faire; etc. Regulators, like everyone else, can get caught up in a bubble mentality.

I agree there are other factors involved, but the greatest influence (again, in my experience) has always been budget (along with authority and other resources).

"Passing laws" is not the same as "prosecuting aggressively".

Both need to be done. And "pursuing" I think fits the description of both.

Nope. But our responses can be proportional to the seriousness and prevalence of the problem. And in most cases, that's what we do. Though occasionally we fly off the handle over a spotted owl or something.

Emphasis mine.

Exactly, and this is what it rests on. The problem may not be prevalent when you compare what percent of people are treated unjustly to what percentage of people are not; but 1-5% of hundreds of thousands of people is still a lot of people. Coupled with the seriousness of the effect, I think it warrants attention.

Ah, another cost! And up go everyone's premiums again! And the regulatory agencies must expand their staffs and budgets to keep up, of course!

Not if their profits are capped. I'm in favor of profit caps on insurance companies similar to what is done to utility companies. I can't see how we can classify electricity as a resource necessary for the basic function of life (hence government protection), but not consider health care! I'd rather live in a house with no electricity because I couldn't afford the bill and be healthy than die in a fully powered home from influenza because I couldn't afford to see a doctor.

Tsk! Assertion is not evidence!

I have shown you the only evidence I believe to be available that points to the fact that it does happen, at least sometimes. Until now the debate was only over how often.

You mean, the hypothetical case? Or was there a real one which can be examined?

I posted it awhile ago. I don't really feel like digging it up now, but I may (hopefully) have it bookmarked at home.

And---is it the law that you must know that you have a pre-existing condition to have a pre-existing condition?

I wasn't referring to law, simply the contract. Every insurance contract (or even contract outside of insurance, government docs have it a lot) I have ever read, has you sign an area that says "I agree all the information I have provided is true to the best of my knowledge" or something similar.

Move to strike as unresponsive, Your Honor!

Overruled.

This is one of the "reforms" moving through Congress, you know: Prohibit denial of coverage because of pre-existing conditions

While I may be in support of that, that's not what I said here. I said that they should not be denying people's claims based on the fact that they had a pre-existing condition if they did not know they had a pre-existing condition and they did provide all of their information to the best of their knowledge.

Insurance companies are basically gambling. They are gambling that you are going to pay them more money than you will use over the course of using the service. Many of the practices now are like "rigging" the games. This is one of those situations. They want to rig it so the House always wins at the expense of people's health, and that's the problem I'm having.

but permit charging higher premiums in those cases---which is likely to translate to charging much higher premiums in those cases. And probably charging more across the board. Do you think that preferable to the current state of affairs?

More likely they would just jack the prices up on people with pre-existing conditions so exorbitantly high that no one could practically get coverage anyway.

Regardless, as I said, I'm in favor of profit caps in this situation.

Nothing is the same as anything else.

Yes, but that analogy wasn't even remotely close.

One is an entity acting to make money off of another entity at their expense. i.e. there is motivation to do harm. I don't think meteors have much motivation to strike a particular person...

But luckily that's not how we decide to allocate resources, generally speaking. We use some sort of cost-benefit evaluation, even if it's not a formal or even an active one.

Cost-benefit is a factor, that I agree with. The only, or even the main factor, not necessarily.

"May"? You are willing to gamble with other people's money, then?

If it's a forced gamble, then yes, I will pick the one I think is going to cost less in the long run.

I find this an unreasonable requirement, myself. It rewards people for concealing relevant facts, too. It promotes dishonesty.

Why? If I have concealed facts, and it can be proven (which is what it would come down to in court), why is it so hard to submit that proof? Unless I am somehow supposed to prove I did NOT know (which I still don't see how that's possible).

Frankly, if you have such a history, why should it not be relevant unless "they" can prove that you knew about it? That's an enormous invitation to dissembling...

Because it's rigging the game! No matter how hard they try, they cannot prepare for EVERY variable. If they could, we would see their clientel filled purely with people who would never have to cash out.

As long as I entered into the contract in full honesty and full disclosure, why I am I to shoulder the burden for every variable? It's like saying that if a man invests in a company and the company goes belly up because no one likes the product, that he should get all his money back because he didn't know the product wouldn't succeed!

Sheesh, the alternative you propose is mind-bogglingly bad, and huge encouragement for dishonesty on the part of insurance companies.

Chasing a will-o-the-wisp, you mean. Do you really think that these companies won't just find ways around the laws?

Some of them, yes. But to argue all regulation is ineffectual so we just shouldn't pursue it is folly. That's like saying "All laws will be broken anyway, so why have any?".

What does that mean?

You tell me, you were the one harping on transparency regulation as opposed to direct regulation, earlier.

We might be a lot better off if it were! Of course, I could be biased here. ( smily )

Again, that's your opinion, so have at it. Most of us do not feel that way (thankfully)

[I_luv_saber]

It's a basic precept of the law that we need not prove that we are NOT committing a crime before we are defendants...

If the company is not fulfilling a contract, they are the ones who have breached it and should have to show probable cause for doing so (especially when we keep in mind we are not talking about adding a room onto a house, but possibly whether I live or die.

Utilities are natural monopolies. HMOs are not. I realize that when all one has is the hammer of regulation one is tempted to treat everything like a nail, but different things call for different approaches.

Why is the situation different? Utility companies provide a service that people must have (mostly, at least it's what's been decided by society). As such, it is regulated in order to prevent selling water for $100 a glass, in a desert. Medical care should be in that same category. We're talking life or death here, not whether or not I have electricity, if utilities classify there than health care sure as hell should. As such, how people get medical care should be regulated.

The fact of the matter is that health care is far too expensive for 90% of people to pay for directly. One accident is all it takes to bankrupt one if one is not insured. Now, tort reform would lower prices... but I have heavy doubts if even then it would be enough. If that is the case, insurance is the only *practical* way people can get health care (unless we start talking of a government plan). The service is, basically, necessary for most people to stay in good health.

You recommend that they go along to get along, and toss principle into the dustbin?

I'm a pragmatist. Aside from a precious few set of issues, if I see the end result will be worse by being stubborn instead of compromising and at least partially getting what I want, I'll go with the latter.

Heck, if we never compromised at all, where would we be today? Principle and stubbornness only go so far... cooperation fills the gap.

Did you feel the same way about the Democrats when the Republicans were in charge?

I can't think of a particular situation off the top of my head, but yeah, there were times the Democrats were sticking sternly by issues that needed compromise and as such got nowhere. It was part of the reason they were/kinda are so ineffectual when they finally controlled Congress. They weren't willing to compromise.

Republicans seem to be worse about stubbornness now though. It seems like every single issue is met with a stone wall. Which is their prerogative, I'm just saying that it's going to be their undoing.

I still don't understand whence comes this insistence that there should be a burden to prove that one is acting legally before the fact.

Squelching on a contract is legal?

Why don't they do it with ALL claims? That would be the most profitable way, if your theories about how "they" think are correct...

Why doesn't the media blatantly spin? If they stay subtle, fewer people catch on and they get away with it for longer.

Maybe you should read the terms and conditions of your policy. I know it's dry stuff, but I suspect that you'll find SOMEthing.

I read my TOS pretty closely and didn't see anything. I could be wrong though. Since it's your assertion maybe you could post some proof of it?

Why do you keep saying this as though it were an underlying assumption?

Because this is almost always the case.

Except that in this case YOU are the accuser, and THEY are the defendant. The right therefore accrues to them, not you...

Depends on how you look at it. By denying me THEY are accusing that I have somehow breached the contract. My accusal of foul play on their part is after the fact. AFAIK, if you don't keep your end of a contract, you have to justify why in court. This would simply make the justification come first hence avoid a lot of mess.