1. #1
    erco415's Avatar Senior Member
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    It didn't look like this would fit in the other threads...

    Using the link supplied by Slipball, I spent about 5 hours last night reading the proposed health care bill. First impressions? For the layman, to read and understand the bill is a serious undertaking. I would say that it is practically impossible without the help of lawyers specializing in legislation.

    Part of the problem is the scope of the bill, of course. 1000 pages is a lot to digest. This is made worse by the fact that much of the bill refers to other sections of the bill, that you havn't read yet, and that there is a lot of language that refers to and modifies existing legislation. That poor sap, Arlen Specter, was only being honest when he said he hadn't read the thing. I think that few people really have a good grasp of just what this legislation means.

    I've studied the Federal Aviation Regulations (now known as CFR 14) for many years, and much of the language of this bill reminds me of the FARs. I can tell you, for certain, that complying with federal regulation is expensive and reduces productivity. We have to hire lawyers, versed in aviation law, to tell us what the regulation actually means as the FAA interpretation of a regulation is often at odds with what is written. Or what is written is somewhat ambiguous. It is not clear what the bill means. But whatever it's scope, you can be sure that it will increase it's complexity and it's involvement in our lives, if passed.

    I find the language that references grant programs where money will only be disbursed to companies working with unions disturbing.

    The President constantly pushes the idea that you can keep the health care you have. Reading this legislation, I think that it is designed to make private health care more expensive, and to herd people towards the government option. The president is on record, more than once, as being in favor of a single payer system.

    My overall impression is that this bill is a lazy, sloppy way to reform the health care system in this country. It does not truly address the underlying factors that have driven costs upward. I puts too much power into a bureauracracy that will be generally unaccountable to the people being served. If we want a national plan, we can do a LOT better than this.
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  2. #2
    Originally posted by erco415:
    It does not truly address the underlying factors that have driven costs upward.
    What are these factors? How can they be controlled?
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  3. #3
    Originally posted by Friendly_flyer:
    <BLOCKQUOTE class="ip-ubbcode-quote"><div class="ip-ubbcode-quote-title">quote:</div><div class="ip-ubbcode-quote-content">Originally posted by erco415:
    It does not truly address the underlying factors that have driven costs upward.
    What are these factors? How can they be controlled? </div></BLOCKQUOTE>

    I have heard that malpractice claims (and premiums for malpractice insurance) and ever-increasing medication prescriptions and their costs are major factors.

    As for how they can be controlled? Well, Tort reform for the former and opening up the market for overseas suppliers of drugs for the latter.
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  4. #4
    erco415's Avatar Senior Member
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    Originally posted by Friendly_flyer:
    <BLOCKQUOTE class="ip-ubbcode-quote"><div class="ip-ubbcode-quote-title">quote:</div><div class="ip-ubbcode-quote-content">Originally posted by erco415:
    It does not truly address the underlying factors that have driven costs upward.
    What are these factors? How can they be controlled? </div></BLOCKQUOTE>


    You hear a lot about tort reform, and I think it could be quite useful. (Tort reform revitalized a near dead general aviation industry, it's effects can be quite stunning.) But the real problem is systemic.

    It's been pointed out, on these boards, that the US spends more per capita on health than nations that have a national health care system. And, in many cases, for lesser results. This suggests that the current system is less efficient at turning dollars into desirable health care. (The same can be said for the US education system, where vastly increased spending hasn't translated into better results. As an example of what I consider a systemic deficiency, consider the Los Angeles school district: The city spends three times, per student, as much as Catholic schools for substantially worse results by any measure. Without knowing the specific reasons for this, we can see that in LA, Catholic schools are more efficient at turning dollars into education results. The system works better.)

    The same can be said for the current health care problems. Whatever the reason, the current health care system had become inefficient at turning dollars into health care. There are many reasons for this, I'm sure, but it remains that unless the system is changed we can only expect more of the same regardless of whether it's private insurers or the federal government and taxpayers picking up the tab. And something very like the Obamacare proposal has already been tried in Massachusetts with the result of runaway costs and cutbacks in service. Massachusetts changed the payer, but not the system.

    Any hope of healthcare reform in this country must address the underlying systemic issues. The Obamacare proposal does not, or pays it lip service only.

    As to specific issues, there are two that stand out to me. The first is the ratio of teeth to tail. Looking at everyone employed in the health care industry, how many are people who actually care for patients/customers (teeth) and how many are involved in services other than that (tail). It can be seen that nearly everyone employed by an insurance company is in the tail category. The more tail, the less efficient the system is as a whole at turning dollars into healthcare. It is particularly bad when 'tail' people make decisions that should be made by 'teeth' people. And that leads me to the second point: There is incredible waste in the American health system that is brought on by the rules set by government and private insurers. My wife worked as a CNA, a certified nurses' assistant, and she saw this everyday. Under medicare, every doctor who sees a patient gets reimbursed. So it was common to never release a patient on a Friday, so that a stream of doctors could come in over the weekend, having never been there before, and 'see' another patient and thus collect the fee. It's also seen in how medical tests are administered.

    My wife had early onset gall bladder disease, and after years of misdiagnosis, she managed through research (yay internets!) to determine that that was what probably was happening and this is the test that's conclusive. She took her findings to her PCP (primary care physician), who agreed with her research, but he was unable to order the test she needed until she had three other tests (at considerable cost), none of which would be of any use, and all because of the insurance companies' rules. (As it turned out, she beat the system by calling the doctor's office, impersonating a nurse, and getting a referral to a specialist who could order the test without all the unneeded tests first. It turned out she was right about what ailed her.) This is just one example of waste, and nearly everyone in the American system can tell similar stories.

    There are many other reasons, I'm sure, that the system we have isn't working. These are just two that I'm very confident could be changed with good results. I am positive that the Obamacare plan will change very little, really, with how we do health care in this country. And if they don't change the system, then it is insane to expect any different results.
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  5. #5
    erco I don't have time to get into all your points but I'll try to later on maybe.

    Read this article for a good discussion about why health care in the US is so damn expensive:

    http://www.newyorker.com/repor...a_fact_gawande?yrail

    - as I said in the other topic, states with medical malpractice caps (aka tort reform) DO NOT have lower health care costs than states without the caps. And medical malpractice insurance is a very low percentage of the costs of health care. I'll try and find some articles on this if you want.

    Why is health care so expensive?

    - too many tests and no incentive to do the same job with less tests (read the article I posted for a discussion of this)

    - private health insurance is...FOR PROFIT.

    - No focus on preventative medicine. If someone is uninsured or underinsured and has a chronic but easily treatable condition like diabetes that would cost more than they can afford to treat, they are going to wait until they are near death with complications and go to the ER. Then they can't pay the bill, because guess what, it's $50,000 for a few days in hospital and treatment to rescue them from death. Then the patient goes bankrupt while guess who eats the bill? The private or public hospital, which often use public county money to pay for these ER bills. Now wouldn't it make more sense to use that money to provide the patient public insurance that would encourage them to get treatment that would keep him out of the ER?

    Again read this to see what a public-private hybrid system that works, a system SIMILAR TO WHAT OBAMA WANTS would look like:

    http://en.wikipedia.org/wiki/H...e_in_the_Netherlands

    Also read this for a description of the Massachussetts system. It has been a sort of bumpy rollout but now 97% of people in MA have health insurance.

    The state’s experience so far suggests that it is more than possible to insure almost all citizens and stay within planned budgets — although it will take great creativity and political will to hold down rising costs so that the program is sustainable.

    Three years after the program began, 97 percent of Massachusetts residents have health insurance — by far the highest rate in the nation. That has been achieved without huge increases in state spending.

    The Massachusetts Taxpayers Foundation, a non-partisan research group, recently concluded that the cost of achieving near universal coverage “has been relatively modest and well within early projections of how much the state would have to spend to implement reform.” That is heartening news given that the major features of the Massachusetts reforms are similar to those under consideration in Washington.


    http://www.nytimes.com/2009/08/09/opinion/09sun1.html
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  6. #6
    Here's an article from AARP:

    http://www.aarpmagazine.org/he...alth_care_costs.html

    Doctors say their worries about lawsuits drive them to order costly tests and procedures that their patients do not actually need. Malpractice reform will help save money, but not as much as some people believe. The Congressional Budget Office estimates that while tort reforms could lower malpractice-insurance premiums for physicians by as much as 25 to 30 percent, the overall savings to our health care system would be a minuscule one-half percent.
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  7. #7
    BoCfuss's Avatar Senior Member
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    If the health care system in Mass, is working, why don't we emulate that? All I heard from Democrats a few years ago was how Romney messed Massachussetts up with that plan, I guess now it is a success? What I see is President Obama pushing a National HC plan, not a state run one. The states in this country have been ruined by fiscal federalism. I would much rather have state officials running my HC plan as opposed to someone in Washington or wherever. There is a problem with HC, this monster coming out is not the answer. Being covered is like having a warranty, it is only worth what you can get out of it. Should everyone have good and affordable healthcare? Yes. Is it possible? Not if it is run by the U.S. Government.
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  8. #8
    Bearcat99's Avatar Senior Member
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    Originally posted by erco415:
    <BLOCKQUOTE class="ip-ubbcode-quote"><div class="ip-ubbcode-quote-title">quote:</div><div class="ip-ubbcode-quote-content">Originally posted by Friendly_flyer:
    <BLOCKQUOTE class="ip-ubbcode-quote"><div class="ip-ubbcode-quote-title">quote:</div><div class="ip-ubbcode-quote-content">Originally posted by erco415:
    It does not truly address the underlying factors that have driven costs upward.
    What are these factors? How can they be controlled? </div></BLOCKQUOTE>


    You hear a lot about tort reform, and I think it could be quite useful. (Tort reform revitalized a near dead general aviation industry, it's effects can be quite stunning.) But the real problem is systemic.

    It's been pointed out, on these boards, that the US spends more per capita on health than nations that have a national health care system. And, in many cases, for lesser results. This suggests that the current system is less efficient at turning dollars into desirable health care. (The same can be said for the US education system, where vastly increased spending hasn't translated into better results. As an example of what I consider a systemic deficiency, consider the Los Angeles school district: The city spends three times, per student, as much as Catholic schools for substantially worse results by any measure. Without knowing the specific reasons for this, we can see that in LA, Catholic schools are more efficient at turning dollars into education results. The system works better.)

    The same can be said for the current health care problems. Whatever the reason, the current health care system had become inefficient at turning dollars into health care. There are many reasons for this, I'm sure, but it remains that unless the system is changed we can only expect more of the same regardless of whether it's private insurers or the federal government and taxpayers picking up the tab. And something very like the Obamacare proposal has already been tried in Massachusetts with the result of runaway costs and cutbacks in service. Massachusetts changed the payer, but not the system.

    Any hope of healthcare reform in this country must address the underlying systemic issues. The Obamacare proposal does not, or pays it lip service only.

    As to specific issues, there are two that stand out to me. The first is the ratio of teeth to tail. Looking at everyone employed in the health care industry, how many are people who actually care for patients/customers (teeth) and how many are involved in services other than that (tail). It can be seen that nearly everyone employed by an insurance company is in the tail category. The more tail, the less efficient the system is as a whole at turning dollars into healthcare. It is particularly bad when 'tail' people make decisions that should be made by 'teeth' people. And that leads me to the second point: There is incredible waste in the American health system that is brought on by the rules set by government and private insurers. My wife worked as a CNA, a certified nurses' assistant, and she saw this everyday. Under medicare, every doctor who sees a patient gets reimbursed. So it was common to never release a patient on a Friday, so that a stream of doctors could come in over the weekend, having never been there before, and 'see' another patient and thus collect the fee. It's also seen in how medical tests are administered.

    My wife had early onset gall bladder disease, and after years of misdiagnosis, she managed through research (yay internets!) to determine that that was what probably was happening and this is the test that's conclusive. She took her findings to her PCP (primary care physician), who agreed with her research, but he was unable to order the test she needed until she had three other tests (at considerable cost), none of which would be of any use, and all because of the insurance companies' rules. (As it turned out, she beat the system by calling the doctor's office, impersonating a nurse, and getting a referral to a specialist who could order the test without all the unneeded tests first. It turned out she was right about what ailed her.) This is just one example of waste, and nearly everyone in the American system can tell similar stories.

    There are many other reasons, I'm sure, that the system we have isn't working. These are just two that I'm very confident could be changed with good results. I am positive that the Obamacare plan will change very little, really, with how we do health care in this country. And if they don't change the system, then it is insane to expect any different results. </div></BLOCKQUOTE>

    Originally posted by Ba5tard5word:
    erco I don't have time to get into all your points but I'll try to later on maybe.

    Read this article for a good discussion about why health care in the US is so damn expensive:

    http://www.newyorker.com/repor...a_fact_gawande?yrail

    - as I said in the other topic, states with medical malpractice caps (aka tort reform) DO NOT have lower health care costs than states without the caps. And medical malpractice insurance is a very low percentage of the costs of health care. I'll try and find some articles on this if you want.

    Why is health care so expensive?

    - too many tests and no incentive to do the same job with less tests (read the article I posted for a discussion of this)

    - private health insurance is...FOR PROFIT.

    - No focus on preventative medicine. If someone is uninsured or underinsured and has a chronic but easily treatable condition like diabetes that would cost more than they can afford to treat, they are going to wait until they are near death with complications and go to the ER. Then they can't pay the bill, because guess what, it's $50,000 for a few days in hospital and treatment to rescue them from death. Then the patient goes bankrupt while guess who eats the bill? The private or public hospital, which often use public county money to pay for these ER bills. Now wouldn't it make more sense to use that money to provide the patient public insurance that would encourage them to get treatment that would keep him out of the ER?

    Again read this to see what a public-private hybrid system that works, a system SIMILAR TO WHAT OBAMA WANTS would look like:

    http://en.wikipedia.org/wiki/H...e_in_the_Netherlands

    Also read this for a description of the Massachussetts system. It has been a sort of bumpy rollout but now 97% of people in MA have health insurance.

    The state’s experience so far suggests that it is more than possible to insure almost all citizens and stay within planned budgets — although it will take great creativity and political will to hold down rising costs so that the program is sustainable.

    Three years after the program began, 97 percent of Massachusetts residents have health insurance — by far the highest rate in the nation. That has been achieved without huge increases in state spending.

    The Massachusetts Taxpayers Foundation, a non-partisan research group, recently concluded that the cost of achieving near universal coverage “has been relatively modest and well within early projections of how much the state would have to spend to implement reform.” That is heartening news given that the major features of the Massachusetts reforms are similar to those under consideration in Washington.


    http://www.nytimes.com/2009/08/09/opinion/09sun1.html
    All this is a part of it.. but I think the insurance companies thyemselves are the biggest reason.. and one of the main reasons why , unless the whole industry is revamped... it will only work so well in the U.S.

    Also some say that it is the technology.. and it is to an extent.. but my question is this... a lot of this technology is actually cheaper to manufacture today than it was say 10 years ago.. and the equipment is better.. take MRIs for instance.. Yet it still costs more..
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  9. #9
    VW-IceFire's Avatar Senior Member
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    Why can't you guys just get a proper public healthcare system and get on with it? Sounds like the private corporations and insurance companies own the game right now and everyone thinks its a good system.

    On the other hand it sounds like complicated legislation will probably make things even worse there than better. Make no mistake...from the outside it looks and sounds like US healthcare is horribly ineffective and outdated (unless you can afford to pay the massive sums upfront - then its golden).
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  10. #10
    jayhall0315's Avatar Banned
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    I think also that the service sector of the US economy is large in proportion to other countries with "alot of little piglets sucking at the tit" so to speak. And those folks like living in the soft underbelly of the US health care system. It is really hard if you get paid $75,000 as a nurse's assistant with a 2 year degree to consider a career change when your other main option may be sales at a retail store for $27,000 a year.
    For example, my wife's good friend became pregnant last year and delivered her baby in June. One of the first things she did was make sure she visited a 'lactation consultant', which is a nurse who holds a full time job on advising breast feeding mothers how to better supply milk to their babies. So my fiance (who is a doctor in the same hospital) asked the business office how much someone like that might get paid and the startling answer was $42,000 with a nurse assistant's degree to $87,000 for a fully registered RN who has taken extra lactation classes. As many of you can guess, this type of job either does not exist in many other countries or is done by a mid-wife pro bono. And this is only one of countless tech/support like jobs in the health care industry that pay really well for service related skills.
    I cant speak about all countries, but I have been treated in France and I did notice that the support staff at almost all levels was less than in the USA. This may part of the complex equation that makes it so difficult to change the direction of health care....any direction... no matter whether conservative or liberal driven.
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