Health Care Reform in the US

[DonnaP]

Example #2 (this happens weekly BTW)

You fall and think you broke your arm.

Insurance company A: You come directly to our ortho office, we x-ray you, yup you broke your arm, no complications so we cast you and send you on your way, see you next week.

Insurance company B: You have to see your PCP first. The PCP decides it may be broken and sends you to our office. We want to x-ray you, but your carrier says you have to go to the radiology office down the street. So you go there and eventually come back today or tomorrow with your x-rays. Hopefully it is the correct view, and we can tell that it is broken - we cast you and send you on your way. The patient (and insurance company) now has bills from three offices - efficient, better, cost-effective???

[DonnaP]

One more example:

You are separating frozen hamburger patties - and like many people, you are holding the patties in one hand and using a knife in the other to pry them apart. The knife slips and plunges into your palm. You go to the ER and they clean out the wound, stitch you up and send you home. A few days later, you realize you can't move your middle finger. (repeat either PCP version above or go directly to specialist - your choice) - Finally specialist determines that you have cut the tendon and need surgery.

Insurance company does not want to pay for post-operative dynamic splint - they don't feel it is necessary, but if we want, we can send documentation and they will send it for medical review. Can take up to a week. Meanwhile, you start therapy which is very intensive and can be either 2 days a week, or 5+ depending on wound, infection, swelling, etc. Biologically it takes 12 weeks before you will use the hand again "normally", but the insurance says you get no therapy after 4 weeks, because that is the "protocol". Even though all the evidence based science shows otherwise. Doctors should not have to be on the phone arguing with insurance companies about what is needed. This is science folks, not providers just being greedy and taking what they can from the insurance industry.

One final note, are there corrupt, incompetent and fraudulant practitioners out there - sure there are and they need to be weeded out. But there are also bad car mechanics, bad carpenters, bad plumbers, etc. Every profession has bad apples who are taking your hard earned money. I just don't like having a third party tell me how to treat and what I can or can't do. I am fully open to new ideas, new concepts, and ways to do something better or more efficiently - but then the insurance companies should be embracing providers and providing education, not just handing down mandates and denials (rationing) that often feel random and baseless. I am curious as to what the industry wide percentage of re-submittals for claims is?? A friend of mine in the insurance world told me that they keep very tight statistics on claims and if they can deny a claim for (I dont' remember the exact numbers) for either a certain number of times or a certain number of days, the provider or claimant will statistically give up. So for the insurance industry - they stand to profit the longer they stall.

[erik_blank]

A friend of mine in the insurance world told me that they keep very tight statistics on claims and if they can deny a claim for (I dont' remember the exact numbers) for either a certain number of times or a certain number of days, the provider or claimant will statistically give up. So for the insurance industry - they stand to profit the longer they stall.

Interesting how closely this resembles the plot of the John Grisham book/movie "The Rainmaker"

[DonnaP]

I'll have to check it out..... I like Grisham for a summer read..... though it sounds like it may be too close to the truth?.......

[dcmdale]

One final note, are there corrupt, incompetent and fraudulant practitioners out there - sure there are and they need to be weeded out. But there are also bad car mechanics, bad carpenters, bad plumbers, etc. Every profession has bad apples who are taking your hard earned money. I just don't like having a third party tell me how to treat and what I can or can't do. I am fully open to new ideas, new concepts, and ways to do something better or more efficiently - but then the insurance companies should be embracing providers and providing education, not just handing down mandates and denials (rationing) that often feel random and baseless. I am curious as to what the industry wide percentage of re-submittals for claims is?? A friend of mine in the insurance world told me that they keep very tight statistics on claims and if they can deny a claim for (I dont' remember the exact numbers) for either a certain number of times or a certain number of days, the provider or claimant will statistically give up. So for the insurance industry - they stand to profit the longer they stall.

I don't know if this was a response to my previous note or not, but...

My specific example relates more to research types in publish-or-perish faculty positions in high-end teaching hospitals, not your everyday practitioner. Peer review is a good thing, but it relies on an assumption of honesty that the experiments reported were actually done, that the methodology claimed was actually used, and that results were not manipulated.

So far as "bad apples" among practicing doctors, I read a few years ago about an insurance industry study that indicated that some 90% of medical malpractice payouts were chargeable to about 5% of MD's known for serial malpractice. (Numbers might be off because I am going from memory). Referrals to licensing boards rarely resulted in action. I have heard similar tales from nurses (who often know who is good and who isn't) who have tried to raise concerns within their hospitals. I am not sure that I understand why bad doctors are defended within the medical community and I don't know whether it is a major contributor to overall cost, but if we could cut 90% off the cost of your malpractice insurance by removing 5% of doctors, would that be such a bad thing? Not the least of which, for the patients?

[Inquartata]

Eh, I posted links above!

Yes. I agree that it happens. But "it happens all the time" implies that it is a constant, ongoing, standard practice.

Again, if it happens on one claim in ten, you may have a point. Or even if it happens on one large claim in ten. If it happens in one claim in a thousand, probably not. And so we have to know what percentage of all claims these anecdotes represent before we can arrive at a valid conclusion...

I've posted multiple links already.

Showing that it's the rule rather than the exception? Showing that "it happens all the time", rather than "it happens enough that there are a lot of individual examples, because the sheer number of transactions is so enormous"?

Regardless, inexcusable acts should not be allowed to legally take place (whether they happen often or not).

Sure. But since when do all the prosecutions, fines, judgements and settlements constitute a finding of "it's legal"?

If murder were a rare occurence, should we cease to outlaw it?

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

This is the effect I'm talking about in the "health care horror stories" arena. Murders get splashed all over the news, and played up on TV magazine shows, and featured in TV movies, and TV series. So people get a skewed idea about the actual frequency of murders. Is 30 or 40 a year in a population of over a million statistically "commonplace", or statistically "rare"?

Maybe the same skew happens when the transgressions in the health care field get disproportionate play in the press?

Just because "it happens all the time" does not make it OK.

Who said it did?

It just doesn't make it common, or SOP, or a problem which calls for reforming the entire system, and hang the cost...

a solid method in place to stop most of it and address what does

Isn't that why we have courts? And regulatory agencies? And arbitration?

Yes, because if tort reform is instituted as well, their A/P goes much lower as well, hence they can "take the hit".

But neither Mr. Obama nor the Congress are including that in their programme. They are pushing health care reform, not tort reform. It doesn't do much good to argue that X will work fine as long as Y is included when there is no plan to include Y...

2) As I said, a favorite tactic is to hold things up in court in order to force the person to low-ball settle out of court.

So, your objection is to the way our legal system works?

Because I have news for you, that's how litigation works in ALL walks of life. These tactics are not unique to HMOs.

Good God, man! I don't agree with his plan or a public option!!! I've fought it vehemently in the past!!! GAAAAHHHHHH!!!!!!!!!!!

So, what I hear you saying is that you are in favor of a public option! SHAME on you, sir!

Because regulation DOES work.

Where?

[Inquartata]

That's fine if the so-called experts like Consumer Reports are truly reliable.

I pity anyone who relied on the financial "experts" in 2006/2007. :P

Financial advice is much more predictively oriented than medical advice. Or as Jeff might say, medicine is a science and finance is an art ( or maybe a circus act ).

[Inquartata]

I supposed we could decide to emulate the Inuit and throw elderly people onto an ice floe when they are no longer able to support themselves.

I may be wrong, but it's always been my understanding that they are not "forced", but that they choose to go of their own volition. That's it's self-sacrifice, albeit socialized self-sacrifice...

[Inquartata]

Your characterization should be "we taxpayers (and more to the point, voting citizens) - decide to provide this for our nation".

OK. So, when is the vote?

And how we get there is pretty obvious: because the current way doesn't work all that well.

I think it works just fine...so long as we don't expect that we can repeal the laws of supply and demand indefinitely, which is the baseline assumption that universal health care makes.

Do you how much a non-reusable harmonic scalpel costs? No government regulation involved in its price nor in the doctor's option to use one.

What is it that you believe this proves?

Are the makers of these devices free from government regulation, then?

And since countries with deeper government intervention than ours cost less, the idea that higher costs are a necessary property of government intervention is obviously wrong.

You are not considering the time dimension.

You were discussing with DCMDale the proportion of health care costs which are devoted to elder and end-of-life care. What will happen, do you think, when that state of affairs collides with the demographics of an aging population? Already this is causing a great deal of worry in those countries which provide universal health care...even more so than in the US, if what I read is correct. ( Although what with Medicare and Medicaid we have universal health care of sorts for precisely this segment of our population, so the difference may be moot. )

Well known as has been widely covered in the media,

Perhaps you meant "alleged". If it's fact, where are the mass prosecutions?

including direct statements by HMO executives and healthcare providers, and documented many times on this board. It's been witnessed and documented, let's move on. It's not about "feeling". This is real.

And yet, I am still not convinced...

In a court, I think this would qualify as "assuming facts not in evidence".

You just changed from the question you originally posed "are her interests actually aligned with those of all the agencies and forces against whom she inveighs?" You did not ask at the time if their interests were aligned with hers.

Heh.

But the question is commutative...

So, let's not dispute whether or not the HMOs ration or refuse to provide care. It's real. Patients see it. Providers see it. Stop demanding further proof for something that has already been repeatedly proven.

I resist your attempt to push this assumption through with mere assurances that it is so.

However, I will stipulate to the assumption that health care is rationed...by price. "Paid for coverage" is NOT the same as "paid for the service".

If your co-worker were to go into a medical facility and offer to pay the entire actual cost of that MRI, up front and in cash, I suspect that he would find that the service was very quickly "rationed" to him...

This is how markets work. On the other hand, when an industry oversells a service at an artificially low price expecting only X number of claims on that service, and then because quantity demanded rises due to that low price finds itself without enough capacity to meet all of that quantity demanded, of course some other method of rationing becomes necessary. ( It's not much different from overbooking plane flights, IMO. )

Teddy Roosevelt signed the law that created the FDA in 1906. What regulations did you think applied before that?[/I] You may emphasize "applied" if you wish.

I... already answered that, surely?

I've refuted that several times: the consumers did not know about the ground up rats, downer cows, etc. In fact, when those facts were revealed they sharply declined their consumption, so it did dominate when the facts were made available.

Where are the numbers reflecting this decline to be found?

The dominant factor is price only when the consumer thinks the products are safe

Very well.


-

and that's where regulation comes in as an essential part of an effective market.

IMO this does not follow.

You have argued that there were at one point "no regulations" governing these matters---or at least, not effectual regulations. Are you arguing too that there were no markets before regulation?

If markets existed without regulation, then the latter can scarcely be "essential" to their existence, can it?

And only regulation that would force that to happen...

Oh, how little you know of Uncle Miltie! ( Prohibited smily here. )

He has actually developed quite an elaborate theory on how this result could be achieved by the private market! It was the subject of much of his "Free to Choose".

Then discuss it as a point of argument. I've given supporting arguments and evidence (eg: regarding meat consumption and the NYSE). I've seen economics articles that make that statement. It's hardly a bizarre claim.

Which articles? Seriously, I'd be interested.

[Inquartata]

Y of course it's not the answer to reuse devices that are not meant to be used, and it's completely absurd for you to compare the United States to an "emerging" but still extremely poor country like India instead of first world countries.

How about to Cuba? I understand that the re-use of very basic supplies is commonplace there---where, by the reports that everyone loves to cite, they have universal health care and excellent indicators such as longevity and infant mortality rates...

[Inquartata]

They would come out with a new drug, do the minimal tests comparing it to a control group and possibly a placebo. If the drug showed statistically significant results they then marketed the hell out of it.

I have no argument with any of the rest of your post, but I must say---what?!---to that part...

I mean, surely you know the average number of years it takes to bring a new drug to market, and the number and expense of all of the required clinical trials and the NDA? What is it, 9 or 10 years even with fast track? That only about 20% of new drugs which make it to Phase I ever even reach the market? And that each of those 4 drugs which fail to reach the market may cost $500 to $800 million to develop, not counting opportunity costs?

AND that those which do have, supposedly, been exhaustively vetted by the very sort of regulatory efforts that Jeff believes are so effective and necessary?

[I_luv_saber]

Yes. I agree that it happens. But "it happens all the time" implies that it is a constant, ongoing, standard practice.

Again, if it happens on one claim in ten, you may have a point. Or even if it happens on one large claim in ten. If it happens in one claim in a thousand, probably not. And so we have to know what percentage of all claims these anecdotes represent before we can arrive at a valid conclusion...

How much is too much? What proof would you need? If there's bloody support groups for it, it obviously isn't THAT rare.

Showing that it's the rule rather than the exception? Showing that "it happens all the time", rather than "it happens enough that there are a lot of individual examples, because the sheer number of transactions is so enormous"?

Firstly, "It happens all the time" can still be true even if it is not the majority of cases. Secondly, I think there has been sufficient evidence put forth that it happens often enough to be a very real problem. I don't need to prove it's "the rule", only that it happens enough to warrant outside intervention.

Sure. But since when do all the prosecutions, fines, judgements and settlements constitute a finding of "it's legal"?

Forgive me, but I'm either not following you here, or I fail to see the relevancy of this...

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

Does that mean we legalize it?

I'm not really trying to argue murder in particular... just making the point that just because something is a rare occurence, does NOT mean you sit back and let it happen because "most people won't be affected".

This is the effect I'm talking about in the "health care horror stories" arena. Murders get splashed all over the news, and played up on TV magazine shows, and featured in TV movies, and TV series. So people get a skewed idea about the actual frequency of murders. Is 30 or 40 a year in a population of over a million statistically "commonplace", or statistically "rare"?

Maybe the same skew happens when the transgressions in the health care field get disproportionate play in the press?

I understand your point, but it fails to approach the fact that we can't let despicable acts happen just because they don't happen often. Rare or not doesn't matter that much in the long run.

Who said it did?

It just doesn't make it common, or SOP, or a problem which calls for reforming the entire system, and hang the cost...

Do you really call adding more regulation "reforming the entire system" ?

It seems a rather small step to me, especially considering the other plans put forth.

Isn't that why we have courts? And regulatory agencies? And arbitration?

Exactly. All of those are used. Including regulation.

But neither Mr. Obama nor the Congress are including that in their programme. They are pushing health care reform, not tort reform. It doesn't do much good to argue that X will work fine as long as Y is included when there is no plan to include Y...

Inq, please please please please please pay attention this time! I don't support Obama's plan! I don't support any plan (that I've read of) put forth thus far! This is nothing more than my opinion of what should be done to alleviate the situation.

So, your objection is to the way our legal system works?

I don't mind having long court procedings. What I do find intolerable is the fact that they can simply squelch on a deal and hold out. Regulation should be put into place to make them pay out FIRST, and if they then wish to pursue fraud, then they may.

Now, I don't this should be done in every situation... but, in this case, the insurance companies are at a huge advantage compared to the customer. Generally, if you are in a position where you need major medical coverage (which is where the slipperiness starts), you are pretty much screwed if insurance does not hold it's end of the bargain. It's an unfair "negotiating" point.

If you break your back and can't work, the insurance company basically has you in their hands. Basically, my problem is not with the legal system, but the regulation that should be in place to level the playing field.

Because I have news for you, that's how litigation works in ALL walks of life. These tactics are not unique to HMOs.

But the situation of dealing with people's health IS unique, as I said. Even in car insurance... if they don't pay me the money they should to cover a wreck, at least I can still work and make money as the court proceedings... proceed. In the situation of serious helath problems, this is not the case. I MUST have the money they should be paying out. You really don't see an issue here?

So, what I hear you saying is that you are in favor of a public option! SHAME on you, sir!

.........

Where?

This has been pointed out already. Best example is the FDA. Regulation works. Now, you can certainly have TOO MUCH regulation... but a certain amount is needed to prevent people from exploitation and things of the like.

[jeff]

Financial advice is much more predictively oriented than medical advice. Or as Jeff might say, medicine is a science and finance is an art ( or maybe a circus act ).

In neither case are they completely predictable, alas ("the body doesn't read the book"). But in both cases there are practices expected to have beneficial or harmful effects in the majority of cases. Which, in fact is where regulation has been very successful (to answer the rhetorical question you pose just above the one I'm responding to). Or their would have been no equities market following the lesson of the Great Depression. Let's see if the current lesson is lost on us.

[jeff]

I may be wrong, but it's always been my understanding that they are not "forced", but that they choose to go of their own volition. That's it's self-sacrifice, albeit socialized self-sacrifice...

Apparently you're wrong http://www.straightdope.com/columns/...e-floes-to-die

But neither of us are Eskimo experts! In any case, I was referring to societies that discard their old people when they're no longer productive. We don't do that, or we would bump off everybody right after they got their retirement gold watch (bonus: we would get to reuse the same watch for every retiree.)

[jeff]

OK. So, when is the vote?

You do recall we live in a republic, not a direct democracy, right? We already had the vote, and the candidate who wanted to put in universal healthcare was elected.

I think it works just fine...so long as we don't expect that we can repeal the laws of supply and demand indefinitely, which is the baseline assumption that universal health care makes.

Wrong!

It doesn't work just fine, as has been observed by parties on every side of the political spectrum (the disagreement is what to do about it, not that we have a working 'just fine" system.) We have the "pay MUCH more than comparable 1st world countries while still having far worse health" for starters.

That is not a baseline assumption of universal healthcare, either. If it were, then Germany and France would be spending much more than we do.

What is it that you believe this proves?

What it does prove is that there are extremely expensive parts of healthcare that have nothing to do with government "interference", and could be eliminated by changes in procedures.

The disposable portion of a harmonic scalpel costs several hundred bucks (IIRC $300-500 range). Surgeons elect to use them because they are convenient. In almost all instances the same job can be done by cautery, which has a disposable per-use cost about 1/10th that. The government does not mandate the use of it, it's entirely discretionary. Now go look at the reimbursal for an appendectomy and figure what happens when a single part of the procedure cost $300+ more than necessary.

Let's bear this in mind next time somebody points at some waste in government care - the issue is unique to neither private nor public sector. Word for today: "Orthogonal"

Are the makers of these devices free from government regulation, then?

Irrelevant - that's not what makes them expensive. They are protected by patent and there's a small market, so the manufacturers charge whatever they want. Practitioners who are not cost sensitive use them because it's not coming out of their pockets. They are frequently unconcerned about the costs of equipment or tests. Not part of the culture. Again, neither a private nor public sector issue.

You are not considering the time dimension

That sounds very SciFi. Or syfy, as the nitwits on the cable TV station renamed it.

You were discussing with DCMDale the proportion of health care costs which are devoted to elder and end-of-life care. What will happen, do you think, when that state of affairs collides with the demographics of an aging population? Already this is causing a great deal of worry in those countries which provide universal health care...even more so than in the US, if what I read is correct. ( Although what with Medicare and Medicaid we have universal health care of sorts for precisely this segment of our population, so the difference may be moot. )

I mostly agree with the last sentence, and partially with the sentence before that (only because I don't know if they worry more than we do, and would want evidence of that before I accepted the conjecture).

Here's what the time dimension does tell us: many European countries have older populations that the US does (see http://upload.wikimedia.org/wikipedi...Median_age.png for one cite) yet they still cost less now. Our healthcare system disproportionately spends money on last 6 months of life is further cost disadvantaged. We have the technology, pay for it, and spend it even when it doesn't particularly add to longevity or quality of life.

Perhaps you meant "alleged". If it's fact, where are the mass prosecutions?

I do not mean alleged at all. I reiterate that this has been acknowledged by HMO executives and revealed in the press. And sometimes there has been prosecution, though not en-masse. A pity

And yet, I am still not convinced...

In a court, I think this would qualify as "assuming facts not in evidence".

If you had said "I'm convinced now", I would fall right out of my chair!

When executives make such statements in public, and in fact when there are cases that have been proven in court, it's "facts".

Heh. But the question is commutative...

(Caught ya!)

I don't believe so, but offer you the chance to prove that tangent!

I resist your attempt to push this assumption through with mere assurances that it is so

It's not an assumption - it's an assertion. And I further assert that I've already provided more than adequate substantiation for it! I won't play "debate by demanding evidence that has been provided repeatedly over the last 5 years"

However, I will stipulate to the assumption that health care is rationed...by price. "Paid for coverage" is NOT the same as "paid for the service"

Eh? That doesn't follow at all. The insurance coverage specifically is for getting covered services, which the HMO then drags their feet on actually approving and paying.

If your co-worker were to go into a medical facility and offer to pay the entire actual cost of that MRI, up front and in cash, I suspect that he would find that the service was very quickly "rationed" to him...

Precisely what the HMO is counting on. Having pocketed the premium, they would rather the patient pay out of pocket for the service they've already paid for.

Insurance is always about paying for services you may not need so that you get the service if you're unlucky enough to subsequently need it. Auto insurance, house insurance, flood insurance.... What you're suggesting is akin to telling people that after paying premiums for insurance they shouldn't expect to receive what that insurance buys.

This is how markets work. On the other hand, when an industry oversells a service at an artificially low price expecting only X number of claims on that service, and then because quantity demanded rises due to that low price finds itself without enough capacity to meet all of that quantity demanded, of course some other method of rationing becomes necessary. ( It's not much different from overbooking plane flights, IMO. )

Let's put it another, more accurate way. The insurance premiums are priced to cover expected claims for services (plus overheads and profits), with the expectation that a number of claims will be denied even when they are medically justified and are covered services according to the terms and conditions of the insurance. It is a part of the business model of these firms to (essentially) refuse contracted-for services, knowing that they can mostly get away with it.

I... already answered that, surely?

I've lost the number of back and forth replies. Did we just agree to something?

(BTW, did you ever notice that the Brits drop the "to" in sentences like the preceding one?)

Where are the numbers reflecting this decline to be found?

I believe I cited them in this thread. Or maybe in the Korean thread. In any case, I've posted this in the last month or so.

Very well

Hooray - an agreement! Let's not pass over this too quickly. What this historic moment signifies is that in this example price becomes the dominant factor only for products that are safe - a result provided only by government regulation.

IMO this does not follow.

You have argued that there were at one point "no regulations" governing these matters---or at least, not effectual regulations. Are you arguing too that there were no markets before regulation?

If markets existed without regulation, then the latter can scarcely be "essential" to their existence, can it?

This is not a binary "exist" vs. "not exist", so let's not overstate. The food example is not as happy as the trading one. People have to eat - yet when it was revealed that their foods were tainted, they stopped consuming as much. The market in meat suffered. The example with stock markets is much stronger: regulation made it possible for the market to grow and be effective on dramatically larger scales than ever before. Regulation fosters the engine of capital formation. Funny, aint it?

Oh, how little you know of Uncle Miltie! ( Prohibited smily here)

I'm not surprised Miltie would take on so - I just think he's fundamentally wrong, here and in many other beliefs.

And, before there's healthcare rationing, look at the effects of smiley rationing!

He has actually developed quite an elaborate theory on how this result could be achieved by the private market! It was the subject of much of his "Free to Choose".

Theories, theories. Hah! See my signature. When academics come up with elaborate theories that coincide with their ideological beliefs its time to count the silver.

Which articles? Seriously, I'd be interested.

Oh, crap, a homework assignment! Okay, I've seen 'em, but I may not have saved 'em. I'll try to dig that up again. It's quite an interesting premise


(as far as economics can be interesting! )

[jeff]

How about to Cuba? I understand that the re-use of very basic supplies is commonplace there---where, by the reports that everyone loves to cite, they have universal health care and excellent indicators such as longevity and infant mortality rates...

Which proves that preventive medicine - which they emphasize - can provide excellent results. In our country, we compensate for "stuff done", so the incentive to prevent things from happening doesn't come to play as much as it should.

It may also indicate that more things can be reused than are indicated by manufacturer's instructions. After all, they don't have an economic incentive for product reuse...

[jeff]

[QUOTE=Inquartata;811191AND that those which do have, supposedly, been exhaustively vetted by the very sort of regulatory efforts that Jeff believes are so effective and necessary?[/QUOTE]

It may be exhausting, but I don't know if it's exhaustive.... I'm troubled by limited regulatory oversight for issues that are discovered after a drug has been on the market and then found to have lethal side effects (eg: the Vioxx situation), or for off-brand use and combinations of otherwise approved drugs - Fen-phen being an example. The wikipedia article is interesting http://en.wikipedia.org/wiki/Fen-phen

So, there's room for improvement, both in speed and cost of approval, and in prevention of lethal drugs.

[Inspector Gadget]

I like the current system and several of your ideas are good, such as expanding the current system, while at the same time cleaning it up a bit. If I may add, I wish we could put more money into the system, it all works out in the long run. By taxing us like the 21st century instead of the 13th century, we'd have more money available for medical expenses. And I won't even touch the space program which I think has basicially broken the bank - but it's the new icon.

The other part to this, and this will always be a problem, so it's almost moot to talk about it; is that the doctors themselves charge so much money that it's the actual reason why the costs are so high, and it's simply because we continue to bow down to those people as if they were little Gods or something, and it dates back to earliest times when men and women were awed by the sheer amazement of being cured of a death grip disease.

There's something about people that wants to keep healthy, and does so not by prevention, but by medication. The human mind is the most interesting thing in the world, it is the most difficult thing in the world to correct this simple idea: prevention versus medication but we seem to be making progress.

Mind diseases - which cost the public fortunes are more difficult because they also add to other social problems such as homelessness. I almost wonder if we spend more money on psychotropic medications than anything else. The pitiful thing about it is that some of the recent diagnosis that I have come across have it's roots in street drug addiction, and the one or two people that I've met with other issues than street drugs, could possibily benefit more from weekly counseling sessions rather than just being 'dosed'. But...a really really good Md, Phd shrink is not only very very expense, about 180/hour - but they're not all very good.

-now for the smiley face.

[Inquartata]

How much is too much? What proof would you need? If there's bloody support groups for it, it obviously isn't THAT rare.

There are supports groups for diseases which are called rare by medical science. You'll have to do better than that.

Firstly, "It happens all the time" can still be true even if it is not the majority of cases.

I didn't say "majority", did I? I said a large enough proportion of the total number of claims. Unless it is possible to identify a pattern of some sort, in which case it might be a large enough proportion of certain types of claims.

I haven't seen anything like that, though. I've seen scattered anecdotes, which don't hang together in such a way as to signal a pattern indicating intent or policy.

I'll say it again: given the doubtless enormous number of claims for health insurance use each year---and I am not sure how to find that number, if it's even tracked---even a few thousand annual instances of abuse or shady behavior by insurers is probably not sufficient to demonstrate a pattern or a deliberate policy of denial/delay intended to escape paying large claims.

Secondly, I think there has been sufficient evidence put forth that it happens often enough to be a very real problem. I don't need to prove it's "the rule", only that it happens enough to warrant outside intervention.

You haven't done that, either, though.

IMO it has to be a significant problem in comparison to the entire market, or the costs of additional regulation will far outweigh the benefits.

Forgive me, but I'm either not following you here, or I fail to see the relevancy of this...

You were saying that the sorts of abuses against which you are railing ought not to be "legal". If they are prosecuted, as they are, clearly they are not "legal". I was pointing this out, so that you don't go on thinking that somehow HMOs are getting away with illegal practices. That is not a reason for "more laws" or more regulatory resources to be thrown at the problem.

Now, you can argue that some of their practices are immoral and OUGHT to be illegal. But I don't see how you can allege that anyone is being allowed to "get away" with currently illegal acts when in fact there are numerous prosecutions and settlements attending them.

Does that mean we legalize it?

No. It means that there is not a crying need for additional laws. The ones we have generally suffice.

The choices are not limited to the extremes of "legalize it" or "devote huge amounts of new resources to investigating and prosecuting it". It's not the runaway problem which the media leads us to believe it is.

I'm not really trying to argue murder in particular... just making the point that just because something is a rare occurence, does NOT mean you sit back and let it happen because "most people won't be affected".

Great, since that has never been either your argument or mine.

I am saying, the present system ( whether of health care delivery or prosecution of abuses ) suffices because the abuses are exceptional cases. You seem to be arguing that it is not because the abuses are matters of policy and are so numerous that more resources need to be devoted to stopping them. Can we agree on this much at least, and that "abuses should be legalized!" is a red herring?

we can't let despicable acts happen just because they don't happen often.

D'oh! See previous paragraph!

Rare or not doesn't matter that much in the long run.

Is it your contention that the current state of policing constitutes a state of "letting murders happen"?

Do you really call adding more regulation "reforming the entire system" ?

I see no calls in Congress or the White House for "more regulation". I see call for reforming the system. What are you seeing?

Not but that I think "more regulation" is seldom the answer to anything, either. Unless it's the answer to "How can we get more jobs for government bureaucrats and larger budgets for government agencies, and more work for lawyers figuring out how to circumvent everything we may do?"

It seems a rather small step to me, especially considering the other plans put forth.

"A million here, a million there, pretty soon we're talking about real money".

Everyone wants to take "a small step" in their particular pet area. Name me an industry or practice in which someone doesn't think that expanding regulation is a great idea. Now add them all up.

To me, the prevalence of abuses is not a large enough problem to warrant still more government action ( with its attendant costs not only for taxpayers but for the industry ), no...

Exactly. All of those are used. Including regulation.

And again, I am arguing that the present state of things suffices. "Suffices" leaves no room for "increase regulation", you see.

Inq, please please please please please pay attention this time! I don't support Obama's plan! I don't support any plan (that I've read of) put forth thus far! This is nothing more than my opinion of what should be done to alleviate the situation.

So what I hear you saying is that you are pulling for Mr. Obama's reforms to succeed. ( Forbidden fifth emoticon here---I leave it to you to imagine which one. )

I don't mind having long court procedings. What I do find intolerable is the fact that they can simply squelch on a deal and hold out. Regulation should be put into place to make them pay out FIRST, and if they then wish to pursue fraud, then they may.

So, if your neighbor slips on your icy sidewalk ( yes, I know, but bear with me, this is a common example ) and sues you, you should have to pay right away, before you even have your day in court? So that you don't get to show, let us say, your surveillance video of him looking around and then throwing himself down on the concrete? Before your lawyer can find the 5 previous cases of insurance fraud on his record? Pay first, then try to get the money back later if the court rules in your favor?

This would be a complete remodeling of our system of civil justice, and it could not long be limited to insurers, given the way precedents advance the law, I don't think. Would that be a good thing?

Think about the possible consequences of what you ask. Beware of getting what you want...

Now, I don't this should be done in every situation... but, in this case, the insurance companies are at a huge advantage compared to the customer.

And if you should slip on Warren Buffet's icy sidewalk, so would he. That is not a good reason to change the way the civil law works, IMO. People ( and businesses ) have disproportionate powers and advantages in court proceedings, but changing the basic rules on the basis of who you are and whom you face is not the answer, IMO. This would no longer be equality before the law, it would be favoring whichever side seemed to be the "underdog"...

But the situation of dealing with people's health IS unique, as I said. Even in car insurance... if they don't pay me the money they should to cover a wreck, at least I can still work and make money as the court proceedings... proceed.

Really? Even if you break your back?

So we should bypass the courts, make the auto insurer---or maybe the guy who hit you---pay you enormous sums up front and then, AFTER a court rules that you were negligent, try to get the money back from you?

Is that what you are really advocating? Why is this any more fair than the way things work now?

This has been pointed out already.

No, it's still being argued. It is not a settled point, to be used as a ground assumption for further advancing a position!

Naughty.

Personally I side with Milton Friedman: everything presently accomplished by regulation could be accomplished by the private marketplace, under the proper framework of laws. ( Well, except for larger payrolls and budgets for regulatory agencies and law firms, that is. )

[Inquartata]

In any case, I was referring to societies that discard their old people when they're no longer productive. We don't do that, or we would bump off everybody right after they got their retirement gold watch (bonus: we would get to reuse the same watch for every retiree.)

Sir, have you tried the Soylent Green? The chef says it's fresh today.