Health Care Reform in the US

[Bayou Bum]

Health insurance for a family is seriously $1000 a month? That's an insane amount of money.

I also saw that the CEO of Whole Foods thinks that people don't have a right to health care. I can't believe people actually think like that.

At what point in history did people earn the right to health care?

[Bayou Bum]

The problem with many localized plans though, is the "in-network" vs "out of network" pricing tiers. The difference in reimbursement rates can be staggering.

The same goes for pricing negotiations with Big Pharma and providers. The regional co-op is the mom and pop store. The much larger Public Option is the nationwide SuperMegaMArt store chain. Which one can get better prices from its suppliers?

So, the only problem with state plans is that a federal plan might be able to get better prices, while there are several problems with the federal plan. If the federal government's ability to set prices is the answer, then why not do the same with food, gasoline, wages ...

[Bayou Bum]

http://www.huffingtonpost.com/2009/0..._n_266589.html

The rapid rise in health insurance premiums has severely strained U.S. families and employers in recent years. This analysis of federal data finds that if premiums for employer-sponsored insurance grow in each state at the projected national rate of increase, then the average premium for family coverage would rise from $12,298 (the 2008 average) to $23,842 by 2020--a 94 percent increase.


Here's another source with a similiar article:

http://www.afscmeinfocenter.org/

Here's the original study:

http://www.commonwealthfund.org/Cont...s-Incomes.aspx

On a personal note: I sometimes wonder how much of an impact the cost of health insurance has upon offshoring.

I can't help but notice that Mass. and Ind. are at the top of the list for highest costs and both have government plans. As much as I would love to use this to blast government plans, is there a reason or explanation for this?

[prototoast]

I also saw that the CEO of Whole Foods thinks that people don't have a right to health care. I can't believe people actually think like that.

Things which inflict tangible costs on others can't be rights.

[thereom4]

At what point in history did people earn the right to health care?

You can only earn what you've worked for.

But if we are to take the lead from the FF in this case where they said:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

then healthcare certainly should be a priority for us.

Welfare

1. the good fortune, health, happiness, prosperity, etc., of a person, group, or organization; well-being: to look after a child's welfare; the physical or moral welfare of society.

http://dictionary.reference.com/browse/welfare

[Bayou Bum]

Speaking of Constitutional Rights:

What about the health care proposal violating our rights by requiring everyone to purchase health care insurance? Since when did the federal government obtain the right to force us to buy something.

And, what about the violation of search and seizure buy maintaining a database of all our medical records, not to mention the part about access to financial information in order to determine ability to pay?

[lindajdunn]

I can't help but notice that Mass. and Ind. are at the top of the list for highest costs and both have government plans. As much as I would love to use this to blast government plans, is there a reason or explanation for this?

I don't know where you're seeing they're at the top of a list. Which list?

http://www.statehealthfacts.org/compare.jsp doesn't indicate Indiana being near the top but perhaps I'm looking at different types of costs than you're considering.


http://healthinsurance.about.com/od/.../a/indiana.htm

[Bayou Bum]

I don't know where you're seeing they're at the top of a list. Which list?

http://www.statehealthfacts.org/compare.jsp doesn't indicate Indiana being near the top but perhaps I'm looking at different types of costs than you're considering.


http://healthinsurance.about.com/od/.../a/indiana.htm

It was in the data files for the link you posted from the huffington post. I would have thought you actually read the link you posted, I did.

http://www.commonwealthfund.org/~/me...ures_FINAL.pdf

[Philistine]

Things which inflict tangible costs on others can't be rights.

Don't most rights inflict tangible costs on others--at least in requiring tax dollars to fund programs or services that provide them?

--Philistine

[NGV]

Things which inflict tangible costs on others can't be rights.

Huh, I guess the right to due process doesn't exist then, as legal proceedings cost money. Thanks for clearing that up.

[Inquartata]

Also interesting is the countries that you are referring to have never been big on emigration. Very few French and Arabs in this country, relatively speaking.

Hmm...I don't know how to respond to that. On the one hand, I know 5 French emigres here in the unlikely Arizona deserts. I know fewer Brits than that, even.

On the other hand, anecdotal evidence is not very probative. Are there statistics kept on this sort of thing?

[Inquartata]

Sure, you're free to ignore logical explanations in order to support your points.

Ah, so you prefer to accept positions on the basis of which is more "logical", rather than on which is better supported by research, statistics, and evidence?

Excellent. I can stop citing facts and just erect wholly unsupported but logical edifices instead!

Thus: Logically, it makes no sense that a country can achieve better longevity and infant mortality results than another country which spends much more money on its health care system. Therefore, all of the citations posted so far which show that to be the case are wrong! Our results are better than those of every other major industrialized country, because logically they simply must be!

Thanks, I have seen the light and shall adopt your methodology henceforth!

[Inquartata]

The hammer was for the SR-71 Blackbird, which is Titantium.
The "toilet seat" was a complete toilet for an aircraft (I forget which one).

Do you have more evidence for these being as you say than reading on a blog that it's so?

[Inquartata]

Maybe some of the states could run programs and we could consider which ones are most suitable.

No, I still prefer my own suggestion. States, for one thing, are subject to constraints from which the federal government is free. Nor is a state health care system likely to be as motivational to politicians as knowing that they themselves are going to be the first guinea pigs of whatever schemes they themselves concoct...

[Inquartata]

It would be more efficient to have one national plan than to have 50 plans

1) Why?

2) Should we also have one national school system, one national motor vehicle department, one national court system, one national prison system, one national library system, etc., etc., etc....?

and a national plan would also provide coverage for those who travel.

My plan, for one, already does. This is not something which requires a mandatory federal "solution".

[lindajdunn]

[QUOTE=Bayou Bum;819393]It was in the data files for the link you posted from the huffington post. I would have thought you actually read the link you posted, I did.

I read the article, yes. I noted Indiana was among the top ten states but I didn't realize it was 4th. [I'm wearing trifocials and the font is small.]

I note Indiana's family insurance premiums rose by 45% between 2003 and 2008 while surrounding states rose by 20%-30%. I do not know why. Not yet.

[Inquartata]

In case no one clicked the link and followed it the first time 'round, here is my beef with the profit thing (which Inq is wanting to ignore).

Some insurance companies claim they only make as little as a 3% profit. This is true... sort of. You see they are claiming profit from money they never invested, money from the pool of people who have purchased insurance.

Or so saith some guy on a blog. ( IIRC; I cannot find the link. Perhaps it was in another thread. )

Seriously...I think that it's preferable to stick with generally accepted accounting standards and measure everything by the same yardstick than for us each to invent our own yardstick.

You can insist that "It makes more sense! Really!" until you're blue in the face, but no one is going to buy it unless they are as eager to find a way of measuring profit that agrees with their existing biases as you are...

[Inquartata]

But if we are to take the lead from the FF in this case where they said:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

then healthcare certainly should be a priority for us.

Again, you need to read the Founders' other writings, to get a sense of what they meant---as opposed to relying upon the modern senses of words in isolation.

For example, this:

"‘With respect to the two words "general welfare," I have always regarded them as qualified by the detail of powers connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by its creators." - letter to James Robertson from James Madison

Or this, from Thomas Jefferson:

"‘Congress has not unlimited powers to provide for the general welfare, but only those specifically enumerated."

Madison again:

"‘The powers delegated by the proposed constitution to the federal government are few and defined."

Jefferson again:

"Aided by a little sophistry on the words "general welfare," [the federal branch claim] a right to do not only the acts to effect that which are specifically enumerated and permitted, but whatsoever they shall think or pretend will be for the general welfare."

More available on request, but you can find it as easily as I.

Also, you will note that the preamble used the word "promote". Not "guarantee", not "furnish", but merely "promote"...

[Inquartata]

I stumbled onto an interesting site recently. It ranks "payers" for health care ---eg health insurers---according to performance in a number of areas. While it doesn't provide any raw numbers of the sort I have been seeking ( eg number of claims, number of denials, etc ), it does purport to have measured those and presents them in percentage forms.

I cannot vouch for either its reliability or its honesty. For all I know its a subsidiary of one major provider, or a pet industry organ. I am also not quite sure what all of its statistics actually measure. But for what it's worth, here's an example of the sort of thing it reports.

I'll take the bottom-ranked national "payer", #8, Coventry Health Care. ( Humana is ranked #1, followed by Aetna, Cigna, and United Health Group. )

"Percentage of claims that are successfully resolved on the initial submission": 92.8%

"Percentage of claims requiring back-end rework ( eg denial rate )": 9.3%

"Percentage of denied claims that close with only 1 additional resubmission": 86.3%

"Percentage of claims requiring medical documentation to justify payment": 2.4%

"Percentage of claims not receiving payment as a result of payer's departure from national coding standards": 1.2%

"Percentage of bills transferred to patients' responsibility": 8.9%

In terms of this debate what I have been seeking is what appears to be reported by the first and third percentages. That is, of all claims handled through this group---which I trust is a large enough number that we can extrapolate similar findings overall---92.8% are paid when submitted, and of those which are 'kicked back', 86.3% are paid on the second try. Which means that...someone check my math here...86.3% of 9.3%...only 1.274% of claims have still been denied after two submissions?

So only 1.274% of all claims denied, and presumably some of those are paid eventually.

And this is the WORST performer on the list...

Anyway, here's the site:

http://www.athenahealth.com/our-services/PayerView.php

Feel free to play with it, or present any objections you might have to its findings or methods. I just wanted to see if we could get some rough sense of the magnitude of the problem which has I Luv Saber, Jeff and others so concerned that it's a widespread and intentional practice. 1.274% for the worst performer doesn't look to me on first blush to confirm this belief...


PS Some denials are certainly correct. For instance, I had an echocardiogram done last year, on doctor's orders. I got a letter from the insurance company saying that it couldn't pay for it because I hadn't "pre-certified" the procedure. This was quite right, it was a failure on my part to do something required in the terms and conditions of my policy. ( Fortunately they went on to say that if I did not call to "pre-certify" it within 30 days the claim would be denied. That is, their understanding of what "pre-" means is rather peculiar, but to the patient's benefit. So I pre-certified post-procedure, and they paid it without further difficulty. )

[lindajdunn]

Some time ago, my daughter had bone grafts to her jaw to repair an injury from an auto accident. Blue Cross-Blue Shield didn't deny the claim... they just kept requesting more and more documentation that became more and more impossible to produce until I called the state's governiny body for insurance companies and suddenly BCBS no longer needed "a cost made of her jaw before the injury occurred". [Lacking a time machine, I'd been unable to supply their final documentation request.]

I paid the $1,000 plus bill about 90 days after they failed to pay it and they finally paid the bill about 10 months after it was incurred and then the provider reimbursed me some time later.

I note that by the time BCBS paid this claim, I'd already incurred about $300 in long distance phone calls, mailings, and lost wages due to the scavanger hunts they's sent me upon.

I'd be interested in knowing how many of those quickly paid claims were for small amounts and how many of the denied claims were for much larger amounts.