Health Care Reform in the US

[lindajdunn]

You have insurance, so what you said is wrong.

Without going back to verify, I believe I said that if I had had to pay for it myself, I would not have had the MRI.

And your health care is obviously important enough for you to have for you and your family that you are willing to pay for it. So why do you now want the government to give it to you?

I don't want the government to give it to me. I want a public option available -- as it is in my state -- everywhere. This allows those who cannot obtain insurance to obtain insurance through the government program.

You had enough coverage to get a second opinion and get treatment despite what the doctor said. Do you expect this option with government provided plans? I

Yes.

You are not royalty and health care providers are not slaves, so stop trying to make it so.

May I embroider this onto a blanket and give it to you when you are living in the street because some idiot without car insurance injured you in an auto accident and then you lost your job (due to being unable to work) and then your insurance?

[prototoast]

1. So we should pull the plug on Grandma?
The cost of my mother's care exceeds my income and if I provide for her, there will be nothing left for MY care, which means my children will be bankrupted caring for me and the cycle repeats. Elderly care is a serious problem which needs a serious resolution, not some sound bite.
1a. I note that helping my mother is what cause my knee injury and my sister's back injury. This falls under: no good deed goes unpunished.
2. I am unwilling to rob a bank to keep myself alive. What kind of idiot question is that?
3. I think we have a problem that needs a solution other than: let her die. Mother paid into medicare and social security. She and my father paid off their home, lived very frugally (wearing sweaters in a cold house, etc) and saved so they wouldn't be a burden to others. If this isn't enough, what is? What do we all need to be doing differently? Other than "don't get sick" and "if you get sick, die quickly" ?

What if everyone's mother cost $60,000 dollars per year more than they could afford to keep alive? You act as though her cost can be absorbed into the system without anyone suffering, but the reality is that there can be costs associated with keeping people alive, and they matter.

Imagine if we discovered that rocks from Mars cured cancer. One sniff of that **** and BOOM, your cancer was gone. Well, unfortunately, mars rocks are really, really, hard to get. It would be totally reasonable to say it costs a half a billion dollars to get enough rocks back from Mars to cure one person. That's a lot of money. The reality is that even if we focused the entire production of our nation just to getting those rocks, we still wouldn't have enough to cure everyone in this country with cancer. So, we'd have to ration. Option 1 is to let people who can personally pay for it get it. That seems reasonable, they can cover their own expenses. Now th government steps in and decides they'll cure 1000 cancer patients per year (less than 1% of those who die in the US). Who are they going to save? Babies are pretty worthless, they're easily replaceable. Old people are pretty worthless, they're just going to die soon anyway. You'd probably use the Mars rocks on otherwise healthy people probably between 10 and 30.

Now maybe keeping most old people alive doesn't cost quite that much, but that's the direction it's heading. As medical technology advances (good thing) it's going to cost more and more to keep people alive as long as possible (good thing) so we can either start allocating these resources efficiently now (good thing) or we can just pull the plug on all of them once we're out of money (good thing).

[jeff]

Stop pretending like I am defending the health care we have now. The only advantage to what we have now (minus medicare) is that people have a small amount of freedom and can hope for change. The model that we use now relies upon employer-provided health insurance to cover all medical expenses. That's horribly inefficient. If insurance were switched to more "major" things and people actually considered the costs of their medical procedures, the system would be more efficient.

I'm not saying you're defending US health care, but that you seem to be proposing something worse. We're apparently in agreement that employer-provided health care is problematic. It's not portable, there's little real choice (because employers typically contract with a very small number of providers - as low as 1), it has a distorting tax advantage, etc.

We disagree about the value of insurance overall. Insurance is an excellent tool for spreading risk. All are covered, but not all need the coverage. As shown by other countries it can be far lower cost and provide superior service. But to do that, you have to remove the incentives we have in the US for fee-for-service compensation on the provider side, and for denying care on the insurer side. Other countries have managed that.

[prototoast]

We disagree about the value of insurance overall. Insurance is an excellent tool for spreading risk. All are covered, but not all need the coverage. As shown by other countries it can be far lower cost and provide superior service. But to do that, you have to remove the incentives we have in the US for fee-for-service compensation on the provider side, and for denying care on the insurer side. Other countries have managed that.

And the more it covers, particularly the more "routine" things it covers, the higher the costs and the less efficient it will be. I think insurance to cover more catastrophic events is reasonable. I think separately people could choose to pay for protection against future chronic conditions, but relying on one payment for everything seems silly. Going into the doctor's office and requesting various procedures without considering the costs seems silly. Most importantly, forcing people to buy in to a failing program could have disastrous consequences. If we allow the government to take over health care, we put ourselves at their mercy, and their record on ventures into business are quite poor.

[jeff]

As many times as you need to.

Only one appendectomy per customer. You say you went to med school? What's that big throbbing thing in the middle of the torso, eh?

An old and irrelevant argument. I am always surprised when you use life expectancy as an argument. Either you are less knowledgeable than I thought or you are desperate for a justification for government provided health care. Since you don't think that other factors such as US lifestyle has any effect on life expectancy, I'm sure you won't try to regulate how we live once your plan passes. Obesity, crime, auto accidents, etc. have nothing to do with it, huh? Why not use survival rates for comparison?

Of course they do (and I've discussed those very factors at length with Inq), but it's not irrelevant, unless you're claiming that health care has nothing to do with life expectancy. And preventive care to reduce obesity, and statins to compensate for its effects, are part of what we don't provide to all. Besides: the rest of the first world is fattening up, and they smoke more than we do. You claim that we have more risk factors then everyone else - go back that up. And go back up the "statistics" you waved around just a little while ago.

Here's a fact for you: the UK has similar obesity levels as the US, and smokes more, and they have very similar morbidity and mortality rates as the US. But, they spend about 1/2 what we do per capital to achieve that result. It should not be a hard concept for you to understand that our system overcharges and under delivers.

The cost could be lower because if you wait long enough to treat someone, they might die waiting and save you a bundle! We pay for research and subsidize new drugs in the US that once proven cost efficient are used in other countries. Tort reform would also cut our cost of health care dramatically.

The cost isn't lower because they live longer than us, and they get that treatment instead of dying first.

I'm all for not subsidizing other countries use of new drugs. I guess you oppose GWB's forbidding Medicare from negotiating with pharma then.

You must be desperate if you're bringing up that old chestnut of tort reform. I'm all in favor of it too, but it's only about 2% of the total cost of healthcare. Caps on payouts in places like Texas haven't made health care cheaper there.

Comparing infant mortality is like comparing apples and oranges. The reporting is different in other countries. Do you really believe that your unborn baby has a better chance anywhere else in the world? I doubt it!

You're wrong - on the reporting and everything else. Completely wrong.

Unless we're talking about a preemie who needs advanced neonatal intervention, the average unborn baby in (say) France, Sweden, Switzerland, etc does in fact have a better chance than in the US. That's a simple fact.

More like those that take care of themselves and others and those that demand others to take care of them.

So, what you're saying is that somebody who gets sick deserves it? And if they lose their job and their insurance, then that's their fault too? What a nasty mind set.



So, let's go back to your claim that use don't use an HMO. You didn't answer the questions I put to you yesterday. Sure, you can pay a few thousand out of pocket for an MRI. Now what do you do if the MRI comes back and says you have a spinal tumor that will require a bunch of pricey operations? Or liver mets or pancreatic ca. Can you pay for all that out of pocket? Do you have an indemnity policy that will keep paying and paying? When they refuse to renew your policy - just what do you plan to do at that point?

[jeff]

And the more it covers, particularly the more "routine" things it covers, the higher the costs and the less efficient it will be.

Why should that be so, other than your asserting it?

I think insurance to cover more catastrophic events is reasonable.

Definition of "catastrophic"?

I think separately people could choose to pay for protection against future chronic conditions, but relying on one payment for everything seems silly.

I'm not sure what you're trying to say here. Does "one payment" mean "single payer" (which is not being proposed in the US health care reform).

So what do you propose when the insurance company looks at your family background, or requires a DNA test - and says - "you are genetically predisposed to future chronic condition XYZ. We won't insure you"?

Going into the doctor's office and requesting various procedures without considering the costs seems silly.

I agree. However, it's the doctor that prescribes procedures, not patients, and the right answer is to say "that's not medically indicated". Fear of lawsuit is a motivator to give the patient what they want so they don't get pissed off, but that can be handled by addressing medmal better.

Most importantly, forcing people to buy in to a failing program could have disastrous consequences.

Hold your horses. What failing program do you have in mind? Medicare works - so well that Republicans frightened seniors all over the country by insinuating that it would be reduced by health care reform. Sure it can be improved in a number of ways - but it's not a "failing program" in the least.

If we allow the government to take over health care, we put ourselves at their mercy, and their record on ventures into business are quite poor.

Which is a red herring, as we're talking about a public option not a mandatory government health care system.

[prototoast]

Why should that be so, other than your asserting it?

Once people no longer have to consider the true marginal cost of a procedure, they will demand more than if they did.

Definition of "catastrophic"?

I'm do know where it is, but as long as we recognize there are routine medical procedures, and severe, unpredictable medical needs, it's reasonable to claim that we can put a cutoff in between.

I'm not sure what you're trying to say here. Does "one payment" mean "single payer" (which is not being proposed in the US health care reform).

So what do you propose when the insurance company looks at your family background, or requires a DNA test - and says - "you are genetically predisposed to future chronic condition XYZ. We won't insure you"?

I mean the lump sum you pay for insurance, which covers "whatever you need." The more information an insurance company has on your health, the more accurately they can price. They would never not insure you, it just might cost you an arm and a leg (rimshot).

Hold your horses. What failing program do you have in mind? Medicare works - so well that Republicans frightened seniors all over the country by insinuating that it would be reduced by health care reform. Sure it can be improved in a number of ways - but it's not a "failing program" in the least.

And, if I may be perfectly blunt, Republicans are full of ****. Medicare sucks, Social Security sucks, the USPS ain't doin' so hot, saving General Motors was a load of crap.

Which is a red herring, as we're talking about a public option not a mandatory government health care system.

And should the public option start hemorrhaging large amounts of money, I'm sure the government will just shut it down, and not prop it up with outside funds.

[Philistine]

And the more it covers, particularly the more "routine" things it covers, the higher the costs and the less efficient it will be. {snip}

Not necessarily.

Routine and preventative care often cost a fraction of what it would cost to treat the condition that results from not getting such care--even when such routine care is near-universal.

Vaccines are a clear example.

My concern about your proposal to impose costs on patients for "routine" care is that patients are generally not good at determining what is "routine" and what is not--and a cost-cutting decision by a patient that arises because he made a wrong guess about the seriousness of the condition can often result in a catastrophic cost or death.

Someone who lets an infection turn into gangrene because he doesn't want to spend the money is going to cost the insurance company (and society) a whole lot more than the doctor's visit and antibiotic that would have taken care of the infection if he hadn't had to make a cost choice.

How many people already delay going to the hospital when there are signs of heart attack or stroke? Add in financial calculations of not being able to eat or pay the rent if it really is just heartburn, and there will likely be signficantly more people dieing and having more serious (and costly) complications.

--Philistine

[jeff]

Once people no longer have to consider the true marginal cost of a procedure, they will demand more than if they did.

But it doesn't, or this would be viewed already in in-plan HMO service with negligible co-pays, or in socialized medicine systems. This claim keeps getting made when there is evidence to the contrary. Patients don't prescribe their own treatments - the provider does and ought not prescribe treatments that are not medically indicated. Public or private - same non-story.

If this is really a show stopper, it can be handled by higher co-pays or deductibles.

I'm do know where it is, but as long as we recognize there are routine medical procedures, and severe, unpredictable medical needs, it's reasonable to claim that we can put a cutoff in between.

I don't think you've made a compelling case for this distinction, and it being expressed vaguely isn't helping.

I mean the lump sum you pay for insurance, which covers "whatever you need." The more information an insurance company has on your health, the more accurately they can price. They would never not insure you, it just might cost you an arm and a leg (rimshot).

This is contrary to fact. They certainly do refuse coverage to people with preexisting conditions. Or they let them sign up for insurance but then deny coverage for claims made against the condition, or anything they construe to be related to that condition, so the poor b*stard thinks he's covered when he isn't. Or they provide an exclusionary period where you can't make a claim against that problem for a year or 18 months. Hm, a breast cancer tumor doubles every 6 months. Not good for surviving if treatment is delayed 80 months.

Besides - there's no real difference between "deny outright" and "price so high that only Bill Gates can afford it". It's the same thing, and a system that permits this condemns people to die.

Literally. From Kristof's OpEd in today's NYT: "a very recent peer reviewed article in the American Journal of Publish Health finds that nearly 45,000 die annually as a consequence of not having insurance" So let's stop kidding around with hypothetical costs in the face of actual experience.

And, if I may be perfectly blunt, Republicans are full of ****. Medicare sucks, Social Security sucks, the USPS ain't doin' so hot, saving General Motors was a load of crap.

I agree heartily with the first. Not at all with the next few, and have mixed feelings about the last.

And should the public option start hemorrhaging large amounts of money, I'm sure the government will just shut it down, and not prop it up with outside funds.

Eh? It should be subject to less bailout than private institutions? I don't follow this at all.

Nor do I see why this is a necessary consequence of having a public option. Just look at all the countries that have public options, or completely public systems and don't go belly up or leak money.

Remember - we pay more than all of them right now so if it's costs you're worried about, you should suggest we emulate those countries.

[Capt. Slo-mo]

1. You probably expect others to pay for everything you can't afford!

2. Yes, you did ask me to pay for it. You want government provided health care. Just where do you think the money comes from?

Yet: you expect the government to pay for restoring the levees and helping New Orleans recover from Katrina? Just where do you think the money comes from?

I don't go to Louisiana. Why should my tax dollars go to government funded relief for people who insist on living in the bayou during hurricane season? I don't drive on the interstate highway system or the US highways in Louisiana, and may never do so. Why should my tax dollars support your driving ease, if you're not personally paying to build and maintain all the roads you're using?

Not your strongest argument here...

[jessicasimpson]

It seems like alot of conservatives think the gov. should only provide military, police, prisons, and highways. So if you believe in public schools, or health, or safety, you are a "bleeding heart liberal bastard"

[prototoast]

But it doesn't, or this would be viewed already in in-plan HMO service with negligible co-pays, or in socialized medicine systems. This claim keeps getting made when there is evidence to the contrary. Patients don't prescribe their own treatments - the provider does and ought not prescribe treatments that are not medically indicated. Public or private - same non-story.

And the providers provide more than the patient would want were he or she responsible for his own costs. I'm not making the claim like some that this should go to infinity, just that it would go to some quantity that is higher. How much higher? That depends, but it's higher.

If this is really a show stopper, it can be handled by higher co-pays or deductibles.

That's a very good start.

This is contrary to fact. They certainly do refuse coverage to people with preexisting conditions. Or they let them sign up for insurance but then deny coverage for claims made against the condition, or anything they construe to be related to that condition, so the poor b*stard thinks he's covered when he isn't. Or they provide an exclusionary period where you can't make a claim against that problem for a year or 18 months. Hm, a breast cancer tumor doubles every 6 months. Not good for surviving if treatment is delayed 80 months.

They wouldn't refuse if you paid them enough money, but if you go to an insurance provider when you already have cancer, you're not asking to be protected against risk, you're asking to pay them some quantity of money and for them to pay out some quantity of money that's greater than you've just given them.

Besides - there's no real difference between "deny outright" and "price so high that only Bill Gates can afford it". It's the same thing, and a system that permits this condemns people to die.

Literally. From Kristof's OpEd in today's NYT: "a very recent peer reviewed article in the American Journal of Publish Health finds that nearly 45,000 die annually as a consequence of not having insurance" So let's stop kidding around with hypothetical costs in the face of actual experience.

You can put a monetary value on a life. I know "how horrible" for me to say such a thing, but you can. Sometimes the cost of keeping someone alive just isn't worth it. Death is not something which should be prevented at all costs.


I agree heartily with the first. Not at all with the next few, and have mixed feelings about the last.

Eh? It should be subject to less bailout than private institutions? I don't follow this at all.

Nor do I see why this is a necessary consequence of having a public option. Just look at all the countries that have public options, or completely public systems and don't go belly up or leak money.

Then clearly their governments are better at running things than ours. Have you seen the medicare and social security predictions? It's not good, they're not going to have enough money to cover future obligations. Old people (and politicians who are both old people and love to cater to old people) will be dead by the time this happens, so they don't give a damn about the rest of us. You'll get your social security checks. I won't, but I will have already paid for yours. If I am responsible for my own health care, at least I know what I'm working with.

Remember - we pay more than all of them right now so if it's costs you're worried about, you should suggest we emulate those countries.

I don't see high costs as inherently bad. I see long term public debt as inherently bad. I see loss of freedom as inherently bad, and I see putting one's well-being in the hands of others as inherently bad.

[prototoast]

And I'll add, http://www.washingtonpost.com/wp-dyn...100703048.html here a pretty smart guy has written up a decent rough proposal for a system that is better than what we have now, and better than anything congress is currently considering. I wouldn't go so far as to make the claim that this is somehow the "best" hypothetical system, but it's better than what we're working with, and shows what you might come up with if you try to be smart about this instead of just brute forcing it.

EDIT: Just to be clear, I am not advocating for this proposal. I just think it is illustrative of some ideas that could be incorporated into the system that would try to allocate dollars more effectively.

[jeff]

And the providers provide more than the patient would want were he or she responsible for his own costs. I'm not making the claim like some that this should go to infinity, just that it would go to some quantity that is higher. How much higher? That depends, but it's higher.

I'm not convinced at all of the first sentence. The rest is hard to quantify, because insurers also deny things that people want.

Let me be very clear: 99.44% of the time, the decision to provide care should be whether or not it's medically indicated. While we all like to focus on the megabuck exceptions, most care is in less exciting financial situations.

That's a very good start.

That might be a means to handle your objections.

They wouldn't refuse if you paid them enough money, but if you go to an insurance provider when you already have cancer, you're not asking to be protected against risk, you're asking to pay them some quantity of money and for them to pay out some quantity of money that's greater than you've just given them.

The alternative is simply not acceptable. People die when it could have been prevented. Really. And I'm not just talking about the indigent or cases with million-dollar treatments.

The situation you described involves costs that are offset by the actuarial fact that other people will require payouts of less than they paid in (plus investment income the insurer derives, which is enormous). The numbers can and are worked so that the insurance company is profitable - or do like the Swiss and make them be not-for-profit. It obviously works.

You can put a monetary value on a life. I know "how horrible" for me to say such a thing, but you can. Sometimes the cost of keeping someone alive just isn't worth it. Death is not something which should be prevented at all costs.

Are you saying that those 45,000 were not worth keeping alive, or that their costs we grotesquely out of whack? Since it's a figure I provided, how do you know the nature of those people's situations?

This is not about somebody being given exorbitantly expensive efforts to hold off an inevitable death - these are bread and butter curable situations that we blow off because people did not get basic care.

Then clearly their governments are better at running things than ours. Have you seen the medicare and social security predictions? It's not good, they're not going to have enough money to cover future obligations.

I don't subscribe to "our government is less competent than the French" The financial issues can be handled by minor adjustments in eligibility and rates. Really. As I mentioned previously and I'll bold font now because nobody wanted to discuss this: the costs sides are high because we provide medical care on a fee for service basis. Providers do more because that's how they get paid. As long as we ignore that fact we'll have rising health care costs.

Old people (and politicians who are both old people and love to cater to old people) will be dead by the time this happens, so they don't give a damn about the rest of us. You'll get your social security checks. I won't, but I will have already paid for yours. If I am responsible for my own health care, at least I know what I'm working with.

As soon as (and I hope this never happens) you run into a medical problem you can't afford, or can't afford to buy insurance against afterwards, you'll see how your ability to be responsible for your own health care costs is illusory. A risk pool of 1.

I don't see high costs as inherently bad. I see long term public debt as inherently bad. I see loss of freedom as inherently bad, and I see putting one's well-being in the hands of others as inherently bad.

I see things from a different perspective. I think we should be able to live longer and better for less money than we do today.I believe that people confuse being required to pay into a health care system that will almost certainly benefit them as being a meaningful infringement on their freedom.

[jeff]

And I'll add, http://www.washingtonpost.com/wp-dyn...100703048.html here a pretty smart guy has written up a decent rough proposal for a system that is better than what we have now, and better than anything congress is currently considering. I wouldn't go so far as to make the claim that this is somehow the "best" hypothetical system, but it's better than what we're working with, and shows what you might come up with if you try to be smart about this instead of just brute forcing it.

EDIT: Just to be clear, I am not advocating for this proposal. I just think it is illustrative of some ideas that could be incorporated into the system that would try to allocate dollars more effectively.

His problem statement reads well. I like parts of the suggested solution but I'm troubled by other parts. The voucher with (essentially) a 15% of income deductible is okay, but: It's not mandatory, so "young invincibles" can opt out completely until they get sick or older, thus weakening the risk pool and raising insurance rates or lowering reimbursals for the rest. There is no discussion about requiring insurers to take all applicants, so we're back at square 1 with preexisting conditions used to deny coverage or price it so high it has the same effect. I don't get the credit card part at all - that seems like a potentially large set of obligations. But still, it's a novel idea with some obvious merits

[lindajdunn]

They wouldn't refuse if you paid them enough money, but if you go to an insurance provider when you already have cancer, you're not asking to be protected against risk, you're asking to pay them some quantity of money and for them to pay out some quantity of money that's greater than you've just given them.

Yes, they would. They have. I was an officer in a non-profit organization that tried desperately to find insurance for our US members. It proved impossible at any price. Additionally, a neighbor's insurance company exercised to option to deny coverage to his son when he was born with a minor heart condition. No coverage at any price. Nada. Another woman in the neighborhood was told by her small business employer to purchase an insurance policy and they'd reimburse her for the premiums. No policy available at any price and she was of normal height and weight, did not smoke, had no history of medical problems nor family history of medical problems, etc. No coverage. Not at any price.

And in 8 states, being the victim of domestic violence allows an insurance company to deny coverage as this is a pre-existing condition. I'm not talking about someone still with an abuser. I'm talking about divorce the bum and you're still unable to get insurance. Violence is a pre-existing condition.

[prototoast]

I'm not convinced at all of the first sentence. The rest is hard to quantify, because insurers also deny things that people want.

Let me be very clear: 99.44% of the time, the decision to provide care should be whether or not it's medically indicated. While we all like to focus on the megabuck exceptions, most care is in less exciting financial situations.

What is medically indicated? It is essential to consider the costs and benefit. What if I got my little toe chopped off and went to the hospital to reattach it? Would it be worth it for $100? Probably. Would it be worth it for $1,000,000? No, I'd personally be happier with 1 million dollars and no little toe.

The alternative is simply not acceptable. People die when it could have been prevented. Really. And I'm not just talking about the indigent or cases with million-dollar treatments.

People should be responsible for their own health. If they didn't think it was worth it, why should I tell them it is. Exception: I don't think it's unreasonable to provide health care to children. They are at the mercy of their parents who may or may not be responsible, and are generally a good investment. So sure, let's pitch in and make sure children are covered. In fact, seems like kind of a dick move to decide that elderly are more deserving than children of government provided health care. Sounds like selfish old people again.

The situation you described involves costs that are offset by the actuarial fact that other people will require payouts of less than they paid in (plus investment income the insurer derives, which is enormous). The numbers can and are worked so that the insurance company is profitable - or do like the Swiss and make them be not-for-profit. It obviously works.

You have to consider each person individually, and each person pays in according to his or her own expected risk. To force a patient who will knowingly cost more than he or she will pay in is not about offsetting risk, it's stealing from the other customers and the provider.

Are you saying that those 45,000 were not worth keeping alive, or that their costs we grotesquely out of whack? Since it's a figure I provided, how do you know the nature of those people's situations?

This is not about somebody being given exorbitantly expensive efforts to hold off an inevitable death - these are bread and butter curable situations that we blow off because people did not get basic care.

Either they analyzed the costs and determined it was better to die, or they were wrong and made a mistake. Why should I worry about their mistake more than they did for themselves?

I don't subscribe to "our government is less competent than the French" The financial issues can be handled by minor adjustments in eligibility and rates. Really. As I mentioned previously and I'll bold font now because nobody wanted to discuss this: the costs sides are high because we provide medical care on a fee for service basis. Providers do more because that's how they get paid. As long as we ignore that fact we'll have rising health care costs.

Didn't you say before that the doctors should be the judge of what is an is not medically necessary? This seems to call that into question.

As soon as (and I hope this never happens) you run into a medical problem you can't afford, or can't afford to buy insurance against afterwards, you'll see how your ability to be responsible for your own health care costs is illusory. A risk pool of 1.

Well, I would hope I can take precautions to be able to get by in that situation. I'll do the best I can in whatever system is in place, but that doesn't mean I can't hope for a better system.

I see things from a different perspective. I think we should be able to live longer and better for less money than we do today.I believe that people confuse being required to pay into a health care system that will almost certainly benefit them as being a meaningful infringement on their freedom.

It clearly is an infringement on our freedom. You think it's worth it, I think it's not. Beyond that, I think that any of the health care proposals currently being considered by congress will only further serve to institutionalize a system that neither you nor I is fond of.

[jeff]

What is medically indicated?

"medically indicated" is about medical appropriateness, not financial.

in·di·ca·tion (nd-kshn)
n.
1. Something that points to or suggests the proper treatment of a disease, as that demanded by its cause or symptoms.
2. Something indicated as necessary or expedient, as in the administration of a drug.
3. The degree indicated by a measuring instrument.

It is essential to consider the costs and benefit. What if I got my little toe chopped off and went to the hospital to reattach it? Would it be worth it for $100? Probably. Would it be worth it for $1,000,000? No, I'd personally be happier with 1 million dollars and no little toe.

Me too. How about your liver vs. $250K? We can play irrelevant comparisons all day long.

People should be responsible for their own health. If they didn't think it was worth it, why should I tell them it is.

Are you really under the impression that people who don't have medical coverage are irresponsible? This is just for frivolous idiots? That is so disconnected from reality.

Anybody at all (except for the "so rich I never will want for anything") can have:

1. Get sick or get hit by a bus.
2. Lose job because can't go to work.
3. Therefore lose insurance.
4. Can't afford new insurance or will be rejected due to preexisting condition.

Or 1. Lose job in a layoff, and then get sick, etc.

While there are indeed irresponsible people who don't prepare for their health either fiscally or medically, it's a grave injustice to label those who don't have care as somehow deserving it.

You have to consider each person individually, and each person pays in according to his or her own expected risk. To force a patient who will knowingly cost more than he or she will pay in is not about offsetting risk, it's stealing from the other customers and the provider.

So, a person who has had a heart attack, and loses their job - to hell with them?

I fundamentally disagree with your position, and find it very troubling. Any of the "other customers" can wind up in the same boat at any moment - and be given the same opportunity. That's what makes it fair.

All of this is unrelated to reality, which is that HMOs have teams of people whose jobs are specifically for the purpose of contriving reasons to deny coverage to people who thought they have paid for it - especially including people who "had coverage" but then had their claims denied.

I think your sense of injustice is misplaced, and ask you to reconsider where the injustice actually lies. I think you're focusing on the wrong side of the telescope.

Either they analyzed the costs and determined it was better to die, or they were wrong and made a mistake. Why should I worry about their mistake more than they did for themselves?

You're saying they had the opportunity to live, didn't take it, so deserved to die and it's of no relevance to society. That's just not the case.

Didn't you say before that the doctors should be the judge of what is an is not medically necessary? This seems to call that into question.

Yes it does. "Over allocation" is well known to be a serious problem that drives costs. They have a financial incentive to do things and generate revenue. It's a conflict of interest.

It need not be the case that they deliberately seek to do truly unneeded work. It can be a bit more subtle. Here's a common scenario: patient presents in ER with a mild gallbladder attack. Surgeon evaluates patient and (a) says 'here's some cheap meds to ease your discomfort now and if it flares up once in a while. Go home, lay off the fatty foods, and see if the problem comes back again'. Or (b) surgeon figures that patient will just show up in somebody else's ER two days later and somebody else gets the case and money, so he says "I'll take that gallbladder out for you now".

A while back I related the story of a Texas city with the highest costs in the nation - and the story was all about doctors who owned the medical facilities and had every reason in the world to prescribe every treatment that could plausibly be justified. Highest cost in the nation, and not due to demographics or immigrants (neighbor city with different hospital setup was among lowest in the country). Yup, Ms. Smith is definitely gonna get that echocardiogram, MRI, etc, and I'll bill it out.

This is why the argument in this thread has the "who drives cost up" equation backwards. Providers with the financial incentive to bill more are a much bigger problem than people with Münchausen syndrome hopping from hospital to hospital. Just as the financial incentive for HMOs to deny care (and the inflation of costs for all the people they hire for implementing that purpose) is also a perverse incentive. Focusing on imaginary people who chose to die is dealing with stuff that is not central to the real problem.

Well, I would hope I can take precautions to be able to get by in that situation. I'll do the best I can in whatever system is in place, but that doesn't mean I can't hope for a better system.

I don't understand your resisting a system that would permit you lower risk and better care than the current system or anything you could personally control on your own.

It clearly is an infringement on our freedom. You think it's worth it, I think it's not. Beyond that, I think that any of the health care proposals currently being considered by congress will only further serve to institutionalize a system that neither you nor I is fond of.

There are a lot of restrictions on "freedom" if you live in a society. You have to pay taxes, you can't drive without insurance, license and registration, you have a whole bunch of laws. You can't even play music as loud as you like in the middle of the night. Frankly, I can't get worked up about these "infringements on freedom" any more than I can get worked up over the idea that there might be a public option or that insurance companies might be prevented by law from screwing the consumer in a very unequal contest of power.


Looking at this post, I see that almost everything I'm saying here is a point I've made in the last few weeks. It's boring me and a waste of time so I'm taking a break from this topic for a while. Anyone who really thinks that the problem is dummies who passed up the opportunity to protect their health, that insurance companies eagerly pay off legit claims, and that fee-for-service doesn't lead to unneeded services - y'all go on thinking that a little longer without me trying to talk you off your ledge.

[jessicasimpson]

Looking at this post, I see that almost everything I'm saying here is a point I've made in the last few weeks. It's boring me and a waste of time so I'm taking a break from this topic for a while. Anyone who really thinks that the problem is dummies who passed up the opportunity to protect their health, that insurance companies eagerly pay off legit claims, and that fee-for-service doesn't lead to unneeded services - y'all go on thinking that a little longer without me trying to talk you off your ledge.

I will now be taking over for Jeff, but with less facts and much more snark....
so......Why are you people satisfied with having such crappy healthcare?

[prototoast]

That's not very nice. I've tried very hard to explain my point of view while acknowledging that you have a different set of priorities, and I've been respectful of that.