Health Reform Bill.........

[dcjohnson]

Oh I didn't mean I agreed with him it was just well written and I respect that.

Thanks Steve. I don't expect everyone to agree with me, because I surely won't agree with everyone on here. I do appreciate people putting forward well thought out arguments for both sides of the issue. I wish more of our country would operate in this manner.

Also, people say "government run", but at least in terms of Medicare Part D, it would be more appropriate to say government regulated. Medicare Part D is a government program, that is administered by the insurance companies. Seniors can actually shop between plans that have different formularies, they just have to play by the same rules (i.e the points of entering and exiting the doughnut hole must be the same). Each company may negotiate their own drug costs with the companies however. Therefore, Company A's plan may get lipitor for X dollars, and Company B may pay Y, but get other drugs for less. This allows for competition between plans, while maintaining some type of level playing field and minimizing the number of variables a patient has to consider between plans. Some may argue the 'leveling of the playing field' is a bad idea, but it does allow more players into the market place.

 

[Jimbo]

dcj,

I agree with your example about how the doughnut hole sucked. That should have been addressed in any reform. My Dad is going through this nonsense now and it's stupid. But, my point was that Bush did some good and he never gets any credit.

I think it was Obama's initial insistence on a public option that raised the ire of so many. If he would have concentrated on fixing these problems, like the d-nut hole, and proceeded in a bi-partisan way by including real cost cutting measures such computerization, tort reform and inter-state competition this whole thing would have been over and done with. No drama or teeth gnashing.

I'll also say this and I'll be totally frank. Knowing that Obama's (and many Democrats too) real goal and desire is a single-payer system (which he has admitted) makes EVERYTHING he does suspect. I feel like I have to read between the lines of everything he puts forth because I suspect he's laying the ground work for a true government takeover of the system.

So, because of this I'm naturally defensive of everything because these small incremental changes, over time are damn near impossible to revise or erase. I think a lot of the kickback you see to any Obama plan is because of this.

Does that make sense?

Good discussion, BTW!

 

[dcjohnson]

Jimbo!
i totally see what you are saying. I don't want a single payer system per se. I wouldn't mind seeing a very minimal base of services offered to all citizens, with ample room for improvement or supplementation available (and affordable) to citizens who would like it. I am talking very basic, like vaccinations, and a physical per year, and some other basic screenings. A true single payer, no options system is bad news.

The only drawback with the 'base system' or what is now in play is that most people would elect to only maintain base coverage until something bad is discovered, and then try to obtain insurance once they are high risk. This is the conundrum that lead to the mandatory insurance provision.

My understanding was the mandatory insurance was a compromise that was struck in exchange for putting a stop to the practice of denying coverage for preexisting conditions. I think if it was sold in this manner a lot less people would be opposed. Sure you might have to buy insurance, but its so that they can't drop one of your family members if they have a genetic condition. Constitutionally it may not be legit, but it still seems like a good trade off.

The analogy everyone using is car insurance, which is wrong. Driving is not a necessity. I think a closer, and still imperfect analogy, would be taxes for roads. You may not drive or directly receive benefit from roads, but more than likely you will receive some benefit from some activity that occurs on roads. Similarly, if you are forced to buy insurance, you may still chose not to go to a doctor, but that money will be pooled and will help to maintain the health of the citizenry, which will most likely benefit you in some manner, whether directly or indirectly.

 

[lowellhigh79]

Danny,

In addition to Tort Reform, inter-state competition there are numerous other things that would help. Most were covered in the Heritage.org link I made.

For example, doctors perform so much defensive medicine because of the fear of predatory litigation. I know this is also tied to Tort Reform but it also highlights a huge cost saving. If you don't think this is huge, just look in the Yellow Pages under Lawyers.

And just because Medicare is anchoring those rates doesn't mean you'll be able to get the service. Already we've seen Doctors and Drug stores refusing to take new Medicare patients.

Another thing to consider, health insurance can only rise so much before people simply can't afford it and stop paying.

Nothing will really change until the consumer is really involved and has a stake in the purchase of the service. Right now people don't really care if their hospital stay or drug was $200 or $2,000 because they don't have any skin in the game. Therefore it becomes a game of third-party reimbursement.

Perhaps part of the answer is Health Care Savings accounts but unless the consumer is involved with the purchase not too much will change and health care costs will continue to spiral UNTIL a significant percentage says, screw it.

.

Hey Jim!

Hope all is well for you and your family. I agree that interstate insurance coverage is a good thing, but a standard should be set for all insurance companies engaging in this commerce. Otherwise, we will have a single or few states with the most relaxed regulations attracting all the insurance companies to their state to pitch their tent. This could potentially lead to poor health care/ abuse by the insurance companies. I believe this was touched on in the original House proposal but was "twisted" into sounding like the standards were set too high and therefore prohibitive.

I've had a MSA for over 10 years now (previously called HSAs). Aside from the tax advantages, it touches on the one facet of health care that you briefly touched on. Basically, the more removed the costs are from the actual patient, the more carefree money is spent- basically everyone (patient/health care provider/facility/goods) eating at the trough without concern about where all this money is coming from. We all talk about common sense usage/delivery of health care, but isn't that just rationing from another person's perspective. A 95 year old grandmother needing a pacemaker? Not if resources are limited and that health care dollar could be better spent elsewhere. You might find an example of someone in this situation surviving a few years, but I doubt very many 95 year old will live long enough for their next battery change.

Tort reform was enacted here in Nevada about two years ago and my premiums dropped drastically. How much of medicine is truly defensive medicine? I had a major disagreement with my best friend from med school this past Christmas and we are pretty far apart on this one. In terms of total health care dollars, the amount spent on litigation and awards was less than 1% overall. These are actually dollars counted, not what was done in the course of patient care. My friend claimed it was upwards of 30% without being able to provide any proof. I think it is more specialty specific with areas such as OB/GYN the highest. I (and my Anesthesia partners) have not changed our practice as a result of having tort reform so my own experience would be very low (<5%) before and after.

I appreciate the passion that our fellow NSX owners have expressed in this topic so far and if the rest of the country can engage in a constructive discussion, we will be heading in the right direction.

Best Regards,

Danny

 

[drtruong]

Firstly, the car insurance analogy doesn't pass muster. You don't have to own or drive a car. You're not mandated by law to purchase something. You don't have to drive. But there are constitutional issues here with this new mandate.

http://blogs.ajc.com/bob-barr-blog/2010/03/29/states-must-challenge-health-care-law/

Secondly, I don't think health care is a right or a privilege of US citizens. It is a service. Is owning a house or lodging a right or a privilege? How about Food? We just happen to live in a moral society that does its best to provide for all.

You might have lived in a big city where public transportation is convenient for you to go from your house to a workplace. In a rural areas, transportations are neccesities for farmers who to haul a trailer of hays, fruits, vegetable ect... to the markets or simply to go to work just like you and I. So they must have to have it in order to make a living.

As far as the law suit against the health care. No chance of winning
http://news.yahoo.com/s/mcclatchy/20100323/pl_mcclatchy/3459321

Yes, Health care is a service. However, this is service is necessary for everyone once they are sick. This is not like car service that one can open up a book and fix it yourself.

 

[sahtt]

Hey Jim!

Hope all is well for you and your family. I agree that interstate insurance coverage is a good thing, but a standard should be set for all insurance companies engaging in this commerce. Otherwise, we will have a single or few states with the most relaxed regulations attracting all the insurance companies to their state to pitch their tent. This could potentially lead to poor health care/ abuse by the insurance companies. I believe this was touched on in the original House proposal but was "twisted" into sounding like the standards were set too high and therefore prohibitive.

I've had a MSA for over 10 years now (previously called HSAs). Aside from the tax advantages, it touches on the one facet of health care that you briefly touched on. Basically, the more removed the costs are from the actual patient, the more carefree money is spent- basically everyone (patient/health care provider/facility/goods) eating at the trough without concern about where all this money is coming from. We all talk about common sense usage/delivery of health care, but isn't that just rationing from another person's perspective. A 95 year old grandmother needing a pacemaker? Not if resources are limited and that health care dollar could be better spent elsewhere. You might find an example of someone in this situation surviving a few years, but I doubt very many 95 year old will live long enough for their next battery change.

Tort reform was enacted here in Nevada about two years ago and my premiums dropped drastically. How much of medicine is truly defensive medicine? I had a major disagreement with my best friend from med school this past Christmas and we are pretty far apart on this one. In terms of total health care dollars, the amount spent on litigation and awards was less than 1% overall. These are actually dollars counted, not what was done in the course of patient care. My friend claimed it was upwards of 30% without being able to provide any proof. I think it is more specialty specific with areas such as OB/GYN the highest. I (and my Anesthesia partners) have not changed our practice as a result of having tort reform so my own experience would be very low (<5%) before and after.

I appreciate the passion that our fellow NSX owners have expressed in this topic so far and if the rest of the country can engage in a constructive discussion, we will be heading in the right direction.

Best Regards,

Danny

Hey Danny, long time no see old friend. I'm going to get that ride eventually; don't blow the motor before i get my chance

This issue is interesting for the same reason why we (a group of primarily smart and educated individuals) can't simply reach an "intelligent solution"-due to its complexity. I won't bore this forum with the amount of articles/publications on topics that are intertwined with the health care problem I've read over the past few months. Just about every noteworthy economist has said their peace by this point, the vast majority of which have relevant knowledge that greatly surpasses my own. As usual, my concerns are macroeconomic in scale and are not about tomorrow, but decades from now. My primary concern after relentlessly evaluating the fiscal stability of the PIGS nations of Europe, most notably Greece, is our ability to service our debt in the future.

Part of this synthesis coincides with drastic measures to lower health care costs as a percentage of discretionary income and to get all unfunded liabilities under control asap. You nor I wants to be in the situation the PIGS are currently in. Even with good intentions, the 50+ trillion in unfunded liabilities may only get substantially worse without a concise plan to get them under control. I could not be less confident that this bill will alleviate my concerns. I don't have a plan that doesn't involve substantial pain for large numbers of people. Either does anyone else without major tax reform and or restructuring both our defense and justice systems (major cuts in the military, privatizing prisons, legalizing marijuana, etc.)

I am glad that students already saddled with enormous college debt and a bleak job market can stay on their parents' insurance until they are 26 and hopefully have some form of decent income. The preexisting conditions element is going to remove massive stress from many people's lives which is fantastic. I just wish it was able to tackle the root of the problem and lower costs in real terms, not by raising taxes elsewhere to compensate for increased costs and therefore make it 'budget neutral'.

 

[sahtt]

You might have lived in a big city where public transportation is convenient for you to go from your house to a workplace. In a rural areas, transportations are neccesities for farmers who to haul a trailer of hays, fruits, vegetable ect... to the markets or simply to go to work just like you and I. So they must have to have it in order to make a living.

As far as the law suit against the health care. No chance of winning
http://news.yahoo.com/s/mcclatchy/20100323/pl_mcclatchy/3459321

Yes, Health care is a service. However, this is service is necessary for everyone once they are sick. This is not like car service that one can open up a book and fix it yourself.

Those mentioned in that article have actually taken a huge amount of heat since its publication. The issue is not completely settled as that-now famous-article suggests. Due to the bold Supreme Courts of late and the massive broadening in Congress's powers, people more or less assume Congress has the power to levy such legislation/taxes in a constitutional manner. I am not an expert in constitutional law by any stretch, but if you take the constitution for what it says, there is not quite enough wiggle room for Congress to pull something like forcing everyone to buy health care coverage.

 

[swerve2007]

I've not posted anything until now but... the logic behind this statement confuses me beyond words?

How does putting the federal govt. in charge of anything reduce bureaucracy? Isn't bureaucracy by it's very definition government?

Also, why would you assume that the govt. is a more efficient method to lend money? I can't think of a single govt. run program (post office, Amtrak, etc.) that isn't f*d up beyond words.

you are forgetting that by eliminating the banks from the loop, the government is not adding additional burocracy to replace it, that fed burocracy already exists and is controlling the loans anyway. all that happened is taking bank profits out of the equation= less burocracy.

 

[swerve2007]

The analogy everyone using is car insurance, which is wrong. Driving is not a necessity.

could not agree more- we are all going to get sick etc, we have no alternative in that. talk about 'captive audience' without a choice. thats why healthcare needs to be regulated.

 

[steveny]

could not agree more- we are all going to get sick etc, we have no alternative in that. talk about 'captive audience' without a choice. thats why healthcare needs to be regulated.

There is a big difference between getting sick and taking your kids to the ER for a runny nose, often just because the parents have nothing else to do that day.

Oh and lets not forget about the drug seekers that go to the ER for a hang nail and insist on getting a handful of pain killers to take home to either sell or use.

 

[swerve2007]

c'mon, i am not talking about a runny nose but the fact that we are all going to die so unless you can come up with a way to cheat death, we will all be 'clients' sooner or later and not by choice.
hipochondriacs do exist, agreed, just like other losers you keep on mentioning but thats the price you pay for being a member of a society.

 

[steveny]

c'mon, i am not talking about a runny nose but the fact that we are all going to die so unless you can come up with a way to cheat death, we will all be 'clients' sooner or later and not by choice.
hipochondriacs do exist, agreed, just like other losers you keep on mentioning but thats the price you pay for being a member of a society.

What I was getting at is if people stop abusing the hospitals it would be cheaper for everyone. Maybe a doctors office needs to be installed in front of every hospital entrance so if someone goes to the ER they are filtered through a less expensive option before they are let into the hospital.