# Off-topic content. Click to see this comments: Repeal and Replace ...



## DanYo (Jun 30, 2007)

Hey Lumber Buds,...please keep this topic light. No hardcore politics or other goofiness . KEEP SMILING
..
Please keep your comments short. Cartoons or 75 words or less and stay on topic. This could be fun.
..








...
My opinion is … lets work with the Democrats. Affordable Care Act is written, it is started. Improvements are needed to make it work. What are they?


----------



## JollyGreen67 (Nov 1, 2010)

Man, did you jump into that mud puddle!


----------



## TedW (May 6, 2012)

Replace it… with a decent economy so I can get some decent paying work again. I'm probably going to jump the fence this time around and vote republican for the first time in my life. Force people with no money to buy into government rationed health care with money they don't have or they get fined for more money they don't have… Sorry, but I have trouble making light humor of this.


----------



## DanYo (Jun 30, 2007)

Keeping the drama out of it, ... Revise it …. what should change?
...


----------



## DonnyBahama (Jun 21, 2011)

I'm one of those rare Democrats who was/is opposed to the ACA. My wife and I are barely squeaking by on our current income. No way we can afford to pay for insurance - even if it was just $100/month (unless prescriptions would be covered with little or no deductible.) And yet, I'm confident that the law would put us over the income limit for subsidies.

The fix is simple - we need single-payer healthcare. The good news is, we already have it (for people 65 and older) - we just need to expand Medicare to cover everyone.


----------



## DanYo (Jun 30, 2007)

I agree. How do we make it happen in a smart way?


----------



## DonnyBahama (Jun 21, 2011)

There's only one way to make it happen at all - get the $$$ out of the political process.

From big pharma to insurance companies to HMOs, etc., there's an OBSCENE amount of money being made via the status quo - and they'll invest heavily to keep it that way - buying politicians and buying public opinion with hundreds of millions (out of their hundreds of billions) of dollars.

The same could be said of almost everything that's wrong in this country. We can only hope that the Citizens United ruling swung the pendelum so far to the right that it'll be responsible for a Constitutional amendment that gets big money out of politics once and for all.


----------



## CharlieM1958 (Nov 7, 2006)

DonnyBahama, I don't necessarily disagree with you about the need for a single-payer system, but I'm curious about one thing: You say you can't even afford $100 per month for insurance, but don't you think you'd have to pay at least $100 per month in extra taxes to pay for government-run health care?

Dan, to answer your question: If we have to stick with the current law and make revisions, I'd say the penalties need to be even bigger for companies who don't provide employee coverage and for individuals who don't purchase insurance. As it stands now, a family of four with a $50k income would only face a $750 penalty for not buying insurance. Not only that, but the government, by law, cannot enforce the penalty other than by reducing your refund. Since people can't be turned down for pre-existing conditions under the new law, it would be cheaper for people to just wait until they get sick, and then go buy a policy. When that happens, claims will go up, and premiums will go up for everyone who does have insurance.

Then, instead of just addressing insurance-related issues, they need to look at why the actual treatment costs are so high.


----------



## oldnovice (Mar 7, 2009)

IMHO there should NOT be a penalty for non-compliance!

There should have been a tax break (I think that John McCain actually proposed that but the GOP was against it and the entire concept) for those who buy the proper coverage! This also goes for employers and employees. The tax break can be done in a similar manner as it is done today with the medical deductions on income tax.

A little side note when I started working for one of the better known high tech companies in the bay area I had low cost insurance, low cost to me and covered my family too. That was short lived as two years later we began to get less and have to pay more out of our own pocket. That trend continued until I retired 3 years ago. I hate to see what it is today!

*AND*, this is a big *AND*, once legislators (I use that term to describe the people not what they are currently doing) leave office they are forced to comply with this mandate!

*It easier to lead a horse with a carrot than a whip!*


----------



## DonnyBahama (Jun 21, 2011)

"You say you can't even afford $100 per month for insurance, but don't you think you'd have to pay at least $100 per month in extra taxes to pay for government-run health care?"

Good question, Charlie. I guess I'm assuming that, under the ACA, my co-pays, deductibles and other out-of pocket expenses would be similar to what's available to me today. With that as a benchmark, it's cheaper for me to self-insure, getting basic/essential healthcare at a low cost/low income clinic at "no insurance" prices. Conversely, my assumption regarding a single-payer system is that my out-of pocket costs would be a lot lower, such that the increase in taxes would be mostly offset by the amount we pay every month for doctors visits and prescriptions. (Not to mention the access we'd have to care that we're currently forced to do without.)

Bottom line is that the government isn't going to run the program as a multi-billion dollar cash cow (which the current system certainly is), and that savings would benefit us all.


----------



## lumberjoe (Mar 30, 2012)

I have a job and have employer subsidized insurance. I still pay about 700.00 per month. With kids there is always something, so I generally spend 3000.00/year in addition to that. Either copays, prescriptions, ER visits when someone does something stupid, etc.

I also live under the umbrella of Romneycare, which is pretty much the same thing as Obamacare. I don't see any before vs after difference, other than if I do my taxes before I get my proof of insurance letter, I get a 600.00 bill in the mail.

Things I like:
You cannot be denied coverage for pre-existing conditions
Extends eligibility for college aged children (goes to 26 I think now)
Everyone HAS to have insurance

Yes, I said it. I like that part. It is irresponsible *not* to have any health insurance. You have car insurance, right? If you can't afford a 100.00/month plan, you are pretty screwed. That's 1,200/ year. Step on a rusty nail in your shop and go to the ER for a tetanus shot. Without insurance, there is a 1,400 bill right there alone. Who do you expect to pay for that? I don't want to.

That is the problem with this country today. Everyone has this HUGE sense of entitlement. Everyone is looking for someone else to foot the bill or help them along. Because it happens so often, we come to expect it. The only thing you are entitled to is what get for yourself. I don't like paying for health insurance. Hell, if I ditched my insurance and saved what I pay for two months, there is my Laguna LT14SUV. Three months after that, there is my brand spanking new Unisaw. Priorities. where are yours?

Here is the TL;DR version
AMA is not perfect, but it's better than nothing
If you don't have health insurance you should be crippled with medical bills, I'd done paying my AND your share
You don't get stuff for free just because you don't want to pay for it. There is a lot of things I don't want to pay for but I do.


----------



## CharlieM1958 (Nov 7, 2006)

Joe, you are 100% correct, IMO, about everyone having insurance.

Insurance of any type (car, homeowner, business, etc.) is made affordable by *everybody* chipping in to bail out the relatively *few* who have large claims. In the U.S. health care system, though, no one is denied emergency treatment, so a lot of folks who could afford insurance if they really wanted it opt to go without. Which means when they have a catastrophic illness or accident, those of us who *do* have insurance end up paying higher premiums because the providers raise prices to make up for the non-payers.

Even though I'm a fairly conservative free-market kind of guy, I think the fairest system would be one where the cost to the individual was handled just like social security. Everybody earning a paycheck would have a health care deduction based on a percentage of income. I'd be willing to bet that if every single wage earner was forced to chip in just a little, the amount most of us pay for insurance and/or health care services would go down.


----------



## jmos (Nov 30, 2011)

+1 with Joe also.

I think it was really sad the Republicans reacted the way they did to the healthcare bill. the individual mandate was a Republican idea, came out of the Heritage Foundation, and was pushed hard by the Rebuplicans in the 90's. I wish, when the Democrats started talking about it in 2009 they had stood up and said 'it's about time you saw things our way, let's do it!' They would have had every right to take credit for it.

I also don't understand why more politicians aren't in favor of getting the burden of paying for health insurance off of business. I don't think any other first world country has this funding mechanism, and it puts our businesses at a competitive disadvantage. European style health care systems work; they aren't perfect, but neither is our system. As the richest nation in the world it's embarrassing that we don't provide some level of healthcare to everyone.

I'd like to see a single payer system that covers basic healthcare to all, and a private insurance market that covers people for more top-of-the-line services.


----------



## lumberjoe (Mar 30, 2012)

Charlie, in theory that would work. I say in theory because we pretty much have Obamacare in MA. My health insurance has doubled in the past 3 years. My out-of-pocket has also gone up considerably.

This again, is an argument about the federal mandate vs the state mandate. If just one state does it, nothing happens. My Insurance company isn't exclusive to MA, and I don't think any are. If EVERYONE, like you mentioned, pays into the pool, premiums should at the very least flatten and no longer increase. I would be ok with that if my out-of-pocket decreased significantly as well.

I am a very free market kind of guy. The only problem here is I am not just footing my bill. An alternative to forcing people to carry insurance is forcing them to pay full price for medical care. As I mentioned that would be crippling to me even. My PCP bills my insurance around 500.00 for a simple wellness visit and the standard lab work. God forbid you remove a finger on a table saw and need it re-attached. You would have to mortgage your house to pay that off.

Those are the two choices:
1 Buy insurance. If everyone does it, it *should* be cheaper
2 Pay full price for all your medical bills. They should be treated as student loans where you cannot walk away from them via bankruptcy or other means


----------



## lumberjoe (Mar 30, 2012)

A quick story on the European systems. There is a ton of misinformation out there about waiting months for treatment, death lists, etc.

My boss lives in London. He tore his ACL on July 4th playing tennis. He was home from surgery on July 5th, It cost him about 120$ US.


----------



## Bertha (Jan 10, 2011)

I pay $1200/month for insurance for JUST ME, no family. My insurance is not very good either. I still oppose single payer systems.


----------



## cmaxnavy (Dec 23, 2007)

The cartoon posted is misleading. Here's why. The right panel is empty - meaning, there is no alternative plan from those who oppose the Obama Health Care…. Wonder why? There are certainly plans that reach for middle ground to solve real HC problems but, you wouldn't know that because the media hasn't informed you of any. Naturally, people assume that nothing presented to them means nothing is there! WRONG and irrationa thinking. In fact, it's NOT thinking at all. The premise of the cartoon is to say, 'Obama Care is the only play in town.' Well, it's not. Moreover, it's never been about health care. History is replete with examples of 'do-gooders' who have power and motives vastly different from yours and mine! There isn't room in this forum to say much. So, I encourage you all to pick up Friedrich Hayek's book, Road to Serfdom and read it and save your ideas about HC until you have. Note: You will all remember former Congressman Eric Massa (29th Congressional District NY) - - - I know Eric. He and I are Naval Officer peers. At a town hall meeting in 2009, Eric attempted to convince a rather large gathering of concerned citizens that the HC bill was NOT a tax and NOT leading to a single payer, government run HC system. He also held up a copy of the US Constitution and professed to know it inside out. I know Eric and I know what his politics are. He's a socialist and he has little respect for the constitution even though he has taken vows to protect it - dishonestly I might add. He's a liar and he, like his socialist progressive comrades in congress, will use their constitutional freedoms to destroy it! How do I know? I know Eric. Nuff said. The Health Care Bill is not about HC. Never has been. That's the spin you and I get. It's about gaining control for the purpose of moving towards a utopian view of the socialist state. Meaning: your constitutional freedoms are simply objects in the road to utopia. Raise your view to 30,000 feet, remove your biases and try to connect the dots from afar. Read Hayak!


----------



## lumberjoe (Mar 30, 2012)

I will gladly throw away my freedom to pay thousands of dollars a year in medical care expenses for a "socialist" HC system where I pay hundreds of dollars a year.


----------



## DS (Oct 10, 2011)

If this discussion is about affordable health care, we need to look at the causes that make it unaffordable.

*INSURANCE*: for the most part seems expensive. However, it is a relative bargain if you consider what costs you might incur if there is a catastrophic event in your life. If routine care were affordable, we'd only need to insure against catastrophees.

*DOCTOR/HOSPITAL FEES*: there is a double standard for billing that is a legal loophole. I received a "Healthcare Statement" from my insurance this week for a doctor visit last month.

Total billed: $172.00
Contracted Amount: $40.00
Your insurance saved you $132.00

That means that if I paid cash, the doctor would charge me $172.00
But, he only charged my insurance $40.00

I paid my insurance company $480.00 last month.

Q: Who was it that saved $132.00 ????

If I could pay $40.00 cash out of my pocket for my doctor visit, I would only carry a high deductable insurance policy.

Similar situation for an ER visit last year;
Billed $8000.00
Contracted amount $700.00

You know darned well that the cash payor system is broken in this society.
Fix *that *and the affordable healthcare debate just simply goes away.


----------



## Sawkerf (Dec 31, 2009)

Charlie -

I'm not convinced that actual treatment costs are as high as the bills show. Those are the "list prices" but the actual payments are negotiated.

In 2010, my wife landed in the hospital for four months due to liver and kidney failure. Being self employed, our medical insurance was pretty weak but it was all we could afford. When I met with the hospital billing office to discuss paying my end of the bill (just shy of $800k), the guy knocked it down by almost 80% before I even got comfortable in the chair. When I asked him how that was possible, he told me that billed costs were total fiction and were usually several times the actual cost of the care provided. It's sort of like those signs on hotel room doors which tell you the nightly rate for the room. Nobody actually pays that much.

IMO, another problem with medical costs is our desire to provide "free" care. A few nights ago, the news was talking about Obamacare requiring free preventative care. I have no idea how that can be possible! A doctor who spends 20 minutes providing preventative care incurs the same costs (salaries, facilities, etc) as he/she would providing curative care. They're able to bill for the curative care, but will be required to write off the costs of providing preventative care?? HUH!!??

Another problem is our lack of understanding the costs of modern medicine. Those MRI and CAT machines allow much better and far less intrusive examinations and diagnoses - but they ain't cheap. In addition to the basic machine cost, they require highly trained technicians to operate and maintain them. Somebody has to pay for that.


----------



## oldnovice (Mar 7, 2009)

Here is the other half of the plan for the cartoon Dan posted in the opening of this this thread!


----------



## CharlieM1958 (Nov 7, 2006)

Sawkerf and DS251, you both hit on the other major aspect of this debate. Why are the insurance companies able to negotiate a fee that is only a small fraction of what an uninsured person would have to pay?

I suspect the whole thing has something to do with hospitals and doctors padding their books with artificially high loss write-offs. An $8,000 emergency room visit will likely never be paid for by a poor, uninsured person. So the hospital will write off the loss as $8,000 when it *really* only lost the $700 they would have billed an insurance company.


----------



## DrDirt (Feb 26, 2008)

Charlie - I wholeheartedly agree so far with one exception you made a statement -
so a lot of folks who could afford insurance if they really wanted it opt to go without. Which means when they have a catastrophic illness or accident, those of us who do have insurance end up paying higher premiums because the providers raise prices to make up for the non-payers.

That doesn't really fit - if you have CHOSEN not to be insured but have a job/house/car etc. The Hospital will set you up on a payment plan - even one that would bankrupt you.
Only the folks that are indigent have their bills "written off" by the hospitals - If you have a job you are not getting "free" healthcare at the ER that gets absorbed into everyone elses bill.


----------



## Sawkerf (Dec 31, 2009)

Charlie -
The flip side of your question is why is it illegal for a group of individuals to organize and negotiate like a single company?

As far as your padding argument, I'm not completely convinced that's the case. I suspect that the $8k for the ER visit really represents what the hospital should (theoretically) charge to make up for the "freebies" they've had to absorb.


----------



## DanYo (Jun 30, 2007)




----------



## DS (Oct 10, 2011)

I asked a doctor friend of mine a while back why the bills seem to be padded.

He told me it is because they are not allowed, by law, to charge one price to one person and another price to someone else. So, the published price is the inflated number to everyone and the adjustments are based on contracts with various insurance companies.

He said that it allowed them to get paid more money from certain groups than others and not violate the law.
"After all," he said, "we don't want to leave money on the table."

I'm just glad my barber doesn't charge that way for haircuts-I don't have haircut insurance.


----------



## CharlieM1958 (Nov 7, 2006)

Sawkerf, if the $8,000 is what they need to charge to make up for the freebies, why does the insurance company only pay $700?

DrDirt: I could be misinformed, but it's my understanding that even small token payments, if made regularly, are enough to keep the doctors/hospitals from being able to take legal action against you. That being the case, I'm pretty sure they would be able to use that outstanding debt on their books to offset profits and reduce tax liability.

Admittedly, I'm just speculating. It doesn't seem like there would be enough people actually *paying* that $8,000 sticker price to really make a dent in their bottom line, so why wouldn't they just charge everyone a price that is closer to what the insurance companies pay?


----------



## Sawkerf (Dec 31, 2009)

Charlie -
I'm far from an expert in hospital accounting and billing practices, but it's my understanding that the $8k ER visit includes the total "raw cost" of the ER visit. That's the actual cost of the treatment plus all of the other costs (burden, overhead, etc) incurred to provide that treatment - without any other sources of income.

Since hospitals usually have other sources of income such as donations, government subsidies, etc, their "raw" operating costs are partially offset by the other income streams.

Another factor in the ER visit is that the costs are accrued at the time of service. Payment is theoretically accrued when the bill is presented, but the reality is that actual receipt of those funds can take months, or even years. Insurance companies take weeks to review and process claims. People on payment plans may take years to make the final payment - or just stop paying. And, of course, there are the uninsured who must be treated by law, but will never pay a dime of the cost. That's a major (and growing) burden on the whole system. All of these put the hospital in the position of having to "borrow" money so they can pay today's bills while waiting to get paid.

Another cost is upgrading the facility. A few years ago, we lost a county supported hospital because the cost of renovating the building to meet new seismic requirements was prohibitive.

You mention insurance company payments and I doubt if any insurance carrier would only pay $700 on an $8k bill. They certainly won't pay $8k, but not even the biggest carrier will get a $7300 discount. The largest carriers have the horsepower to negotiate the lowest rates, and Medicare pretty much says "We'll pay $X - take it or leave it". Many doctors in private practice are refusing (or limiting) Medicare patients because Medicare doesn't even cover their cost of providing treatment.

This post represents my imperfect (possibly incorrect) understanding of the system. It would be really great if a "for real" hospital accountant type would chime in with some better explanations. - lol


----------



## CharlieM1958 (Nov 7, 2006)

Sawkerf, you may be totally correct. As far as my $8,000/$700 example, I took that straight from DS251's experience related in his post above. Of course he's a violin maker, so he probably cannot be trusted. 

I do know that I get blood work done every six months, and the insurance company only pays about 10% of the lab's billed expense. (About $50 as opposed to $500) Once there was a mixup and the insurance company accidentally rejected the claim, and the lab was definitely wanting me to pay them the whole $500 until I got it straightened out.


----------



## jeepturner (Oct 3, 2010)

Getting back to the original post. 
What would replace the ACA? Where could the repulicons work with the democrats? If we look at the act it is almost the same as the Ma. plan, introduced by a republicon governer, touted by Heritage Foundation. But that was when the republicons were looking for an alternative to the single payer option. That was then and this is now of course, and ideas change. Now that we have the alternative to the single payer the corporatist in congress wanted, they now want it repealed with nothing to take it's place.
On a personal note, I don't like the ACA. I think it is more corporate welfare for the insurance industry. Doctors will not benefit from it. Patients will have their insurances and may not have to worry about loosing their financial well being to maintain their well being. I would prefer that we have a single payer system, because it would take the profit out of one segment of the economy and transfer that to our manufacturing businesses, enabling them to be able to compete with businesses who don't have to pay directly for the cost of health insurance.


----------



## Sawkerf (Dec 31, 2009)

Charlie -
Hell, that's nothing! - lol

When SWMBO was hospitalized in 2010, I was juggling with bills from two hospitals, a nursing home, a dialysis center, and god-knows-how-many doctors. When it started, we only had our marginal private insurance. Later on, I got her on Medi-Cal, and then on Medicare Disability. When I wasn't dealing with medical bills, visiting her in a hospital, and keeping friends and family updated on her condition, I was trying to keep my business afloat.

I've never had the courage to add it up, but I estimate that the total "list" cost of her treatment was around $3M. I do know that our out of pocket costs were just over $50k.

There's a bankers box in the closet stuffed full of the bills, insurance paperwork and my letters to various providers. I haven't needed to open it for almost a year now, but I'm keeping it handy.


----------



## Sawkerf (Dec 31, 2009)

Jeep -
I'm not thrilled with the ACA either, but have reservations about a single payer system too.

I like the concept of "everybody participates" because insurance is a gigantic risk pool. Essentially, we're betting that something bad will happen to us and we'll receive more in benefits than we'll pay in premiums. If that happens, we "win" the bet.

The insurance companies OTOH are betting that they'll collect more from us than they'll pay out for us. If that happens, they "win". They don't get to keep the "winnings" however. Much of that has to cover the cost of the bets they lost. More people in the "game" spreads the risk over a larger group which reduces the cost of the bets for all involved.

The model for the single payer system is most often Medicare (which I'm on, BTW). It's biggest downside is that it pretty much dictates what it will pay and that's forcing some doctors to limit (or refuse to accept) Medicare patients. Some of them are giving up their practices and others are going to different business models which eliminate (or limit) their dealings with Medicare. How good is a single payer system if it limits the number of medical people willing to take it?

I sure wish I was smart enough to know the answers. - lol


----------



## DS (Oct 10, 2011)

Of course he's a violin maker, so he probably cannot be trusted.

I can see I'm gonna hafta scan the EOB's for you guys. The numbers were rounded off, but they are not misrepresenting what happened.

*Charlie*, I had a similar experience as you at the dentist. I had to drill through a crown to redo a root canal that got infected. When it was time to do the closure, the dentist office insisted that it wasn't covered and that I had to prepay $175.00 cash before they'd make the appointment.

A couple weeks after the appointment I get an EOB from my insurance for the closure. They billed the insurance $175.00 and accepted $82.00 as full payment. I am still trying to get my $175.00 back from the dentist's office double billing.


----------



## Sawkerf (Dec 31, 2009)

DS251 -
Your story about the charges for the doctors visit may have been different if you had talked to the doctor (or his billing office) about paying directly instead of going thru your insurance. You might have paid more than $40, but I'll bet that it wouldn't have been $172.

Before going on Medicare and an HMO for Part B, we had a PPO plan. When we went to the doctor, we showed our insurance card but paid nothing until we received a statement from the doctor showing the charge for the visit, the amount covered by the insurance and a balance due. The doctor didn't actually get paid until he received payment from us and the insurance company. I once talked with him about this process and he told me that he could actually charge me much less for a visit if he could avoid filing insurance claims and not having to wait to get paid. There's a time cost of money that most people don't realize.

When we went on Medicare, we lost our dental coverage. Since we really like the dentist we've used for 30 years and he doesn't do Medicare or HMO patients, I asked him about which Dental plans we could get and keep him as our dentist. I was really surprised when he said that none of the dental plans were very good and that he would continue to see us at rates we would "work out". I had a tooth extracted a few months ago for $150 - well below his insurance rate. He pulled the tooth and I wrote a check. No paperwork and he had his money the next day. Pretty good deal all around, I think.


----------



## CharlieM1958 (Nov 7, 2006)

I think this thread illustrates that it's a multifaceted problem and there are no easy answers.

Jeepturner, don't try telling anyone in the insurance industry this is corporate welfare. Sawkerf's explanation of insurance a couple of posts up is excellent. But read it, and now consider what the ACA does to the insurance companies:

1. It forces them to bet on a lame horse (accept people with preexisting conditions).
2. When they lose a bet (an insured group has claims paid out exceeding premiums paid in) they just lose. When they win a bet (a group has much less in claims than premiums paid) the insurance company has to give most of the winnings back!


----------



## oldnovice (Mar 7, 2009)

TedW,

You said "I'm probably going to jump the fence this time around and vote republican for the first time in my life."

*DON'T DO IT, YOUR TOO YOUNG, YOU HAVE THE REST OF YOUR LIFE AHEAD OF YOU!*


----------



## Sawkerf (Dec 31, 2009)

Charlie -
I actually have no problem with requiring insurance companies to accept pre-existing conditions - as long as they're allowed to make their charges appropriate to their added risk.

Using my wife's case as an example (She would be really pissed if she knew I'm doing this - lol), she has a pre-existing condition of renal failure. She was lucky enough to recover enough to quit dialysis, but her nephrologist told us that she would probably have to go back on it sooner or later. I like free as well as anyone, but find it absurd to require an insurance carrier to ignore the increased risk my wife brings to the table. If I can't run my business giving away my services, why should I expect an insurance company to?

Insurance companies are experts at statistical analysis of a population and determination of the probabilities of the various risks within that population. They know better than anyone what the financial impact might be with a change in the probability of those risks occurring. To require them to assume increased risk without allowing a mechanism to recover the added cost is insanity. The ADA is requiring them to drink that cool-aid and people are surprised that they protest?

Another problem I have with ADA is the idea of "free" preventative care. I discussed this in post #15, and will only add that free is a myth. If the insurance companies have to cover it, we'll probably see higher premiums. If the government pays, we'll get higher taxes. As Robert Heinlein said "There Ain't No Such Thing As A Free Lunch".

There are enough insurance companies out there to ensure that they'll keep their statistical pencils as sharp as possible so it's in their best interest to keep their costs as low as possible and stay in business. The politicians need to get out of the way and let them do their job.


----------



## CharlieM1958 (Nov 7, 2006)

There are something like 80 major industries with higher profit margins than health insurance. Roughly 85 cents from every dollar of premium is already being paid out in claims. Out of that other 15 cents come all the administrative costs of doing business (which someone would still have to do even if there were no private insurers).

The new law focuses too much on insurance. A lot of people think that the insurance companies and their "huge" profits are the main problem, but only about 7 cents of every dollar you pay in premiums goes to profit (and that's in a good year for the company). Take that away completely and everyone will lower their insurance costs by 7%. Is that *really* solving this crisis? And that's making the HUGE assumption that the government can handle the administrative end as efficiently as the private companies.


----------



## Sawkerf (Dec 31, 2009)

As much as it pains me to say this, the government just might do a good job of administering a single payer system. Apparently, Medicare is one of the most cost effective government programs in existence. If that model were used in a single payer system, it just might work.

Of course, Medicare doesn't discriminate for pre-existing conditions and includes almost everyone over age 65. That gives them a large customer population which helps keep costs down. OTOH, their control over what they'll pay is really hurting the medical profession.

The whole argument about "greedy corporations" and "excessive executive compensation" gets tiresome. For profit corporations either make money or they die. They don't offshore their operations just for the hell of it. If they don't stay competitive, they're going down.

Top level executives are highly trained, highly skilled, and in great demand. There just aren't enough of them to go around so supply and demand jacks up their pay. For all of his bluster, Joe Sixpack would probably be a complete disaster trying to fill a CEO's shoes. He screams and yells that they're grossly overpaid then screams and yells that his union benefits are totally justified and should be increased. Oh Puleeeze!! - lol


----------



## jmos (Nov 30, 2011)

Another thing to keep in mind is that the government already has a lot more control and influence over healthcare than many realize. First, between medicare, medicaid, military, veterans, and federal workers the Government spends almost half of all healthcare dollars spent in the country, and their share is projected to increase as more Boomers retire. Also, most insurance companies will only cover what medicare covers, and won't pay any more than medicare pays. That's why it is such a big deal for a drug, test, procedure… to be approved by medicare, because most insurers will then cover it. Likewise, when medicare cuts reimbursements for something, it effects more than just medicare, most all insurers follow suit.

One of the benefits of single payer is fairness. We currently ration care in the US, we just do it in a very haphazard way. At least a single payer system that provides basic healthcare to all would ensure access. Allowing a private health insurance market to cover services over an above the single payer system will still allow those that wish to the option of buying better coverage.


----------



## Sawkerf (Dec 31, 2009)

John -

I don't dispute your statements about Medicare's influence on the entire healthcare industry, but would like to know why insurers would be in lock step with Medicare. Sure seems like covering conditions that Medicare doesn't cover would be a winner for increasing their customer base.


----------



## DanYo (Jun 30, 2007)

...


----------



## DanYo (Jun 30, 2007)




----------



## DanYo (Jun 30, 2007)




----------



## waho6o9 (May 6, 2011)




----------



## jeepturner (Oct 3, 2010)

Having a single payer option will not preclude companies from offering health insurance, but it will insure that everybody is covered. Should a single payer system pay for every medical procedure, no. Will a single payer be a panacea that will immediately reduce cost for everyone, no. The one thing it will do is get every one in the pool. It would mean that health care cost will not be the leading cause for bankruptcy. It would foster small business and allow entrepreneurs less risk starting a business.
Under the AHA insurance companies have to pay out eighty percent o the premiums collected. If they don't they have to send out refunds of the difference. I don't buy the argument that the insurance industry operates at a small margin, unless you are comparing them to the oil companies or big agribusiness. But that is like saying a thief is not a thief if he only takes some of what belongs to you.
If we could eliminate insurance for routine visits to the doctor and dentist for those who can afford it, and a safety net for those who can't, then maybe we could bring down costs. The single payer and or the employer could offer catastrophic health insurance. That would reduce the doctor's billing costs and they could lower the cost for routine visits.


----------



## jmos (Nov 30, 2011)

Sawkerf, the skeptic in me can only assume it because they want to pay for as little as possible. I could be wrong, and am interested to hear from those who are more knowledgeable, But it seems to work that way.

The relationship isn't 100%, but my Wife is a Doc, and I know she watches everything medicare does around her specialty as she's well aware medicare's changes will impact her from both the medicare and private insurance sides.


----------



## Sawkerf (Dec 31, 2009)

If you don't buy the argument that profit margins are low, can you explain the numbers on their balance sheets

"....for those who can afford it, and a safety net for those who can't,...."

Isn't this a variation on rationing health care? Who decides who can and can't afford to pay for routine doctor and dentist appointments?

I totally support getting as many as possible into the pool, but not at the expense of creating a myriad of rules and exceptions that will run up the cost of administration. Everyone needs to have some skin in the game.


----------



## Sawkerf (Dec 31, 2009)

John -
I kinda doubt that it's just about paying as little as possible. Businesses operate to make a profit and if some additional cost can be incurred that will generate a profit, they would be all over it.


----------



## jmos (Nov 30, 2011)

I just don't see normal free market forces working the same with health insurance since most folks get it through their employer.

My experience with health insurance through employers is that you get one real option. One plan is far cheaper, and it's obvious the company wants you to pick that one. They might offer one or two other plans, but they are way more expensive, in both premiums and co-pays. So everyone picks the cheaper one. At my Wife's employer they are pushing everyone on to high deductible plans; even warned that in a year or two it will be the ONLY option they offer.

If the insurance market was really open to most folks, and you could comparison shop for price and coverage, they might cover more to get more customers. But the real negotiation is between the insurer and the employer; the employer wants to lower their costs and the insurer wants large blocks of customers.

Perhaps it's more accurate to say they don't cover extra stuff because employer pressure is to keep costs at a minimum, and they aren't interested in paying any extra for bells and whistles.

I think another issue is that they use medicare approval to indicate a treatment is effective.

Again, just speculating.


----------



## Sawkerf (Dec 31, 2009)

John -
Your experience with employer medical plans sounds like a preview of a single payer system - a "so-so" plan designed to minimize cost for basic coverage. For those who can/will pay more, there are more expensive options which probably include better benefits. It's a "real" option only if you're all about the cost. If better benefits are important, they're available but at a higher price. Isn't that fair?

Your wife's experience sounds like a catastrophic-only plan where the high deductibles and high co-pays essentially make her self-insure for routine doctor visits. Talk to your providers and find out what your actual cost would be for the routine stuff. They may be able to pass on some significant savings for "cash and carry" service.

I think that free market forces have always been a factor in the medical insurance business, but they were invisible to the end user. The whole concept of employers providing medical insurance dates from WWII when wage and price controls prevented employers from stealing employees by paying higher wages. The idea really caught on and grew during the post war boom years. Back in the day, it wasn't uncommon for medical plans to cover virtually 100% of our medical care. Co-pays and deductibles were very low or non-existent. I remember conversations with my in-laws about their medical care being free because "we have insurance". They never understood that it was free for them but was costing his employer more every year.

When I started my professional career in the early 70's, I had access to a very good, cafeteria style, plan. We, younger employees focused on maternity and child care bennies and the older employees chose options more in tune with their needs. None of us paid more than token payments for co-pays, deductibles, or prescriptions.

A few years later, I was moving into management and questioned why my hourly billing rate was almost three times my salary. A couple of hours with our CFO explained the actual cost to have me the payroll and I was astonished to discover that the medical coverage was one of the costliest parts of that multiplier. The free market has always been a factor in medical plans, but the employees were shielded from seeing the real cost.


----------



## jmos (Nov 30, 2011)

Yup, that was pretty much my point, the pressure from employers to keep costs down have encouraged insurance companies to minimize coverage.

I don't see a real problem with single payer as you described; at least everyone would have some coverage. Those who are willing to pay more can get more. Sounds a lot more fair than our current system. Would also get the burden of health insurance costs off of businesses.

I guess I'm less 'scared' about the idea of single payer than many. I grew up as an Air Force dependent (19 years) with a single source for medical care. Not ideal, but it basically worked. After college I had insurance through Kaiser Permanente for a while, where you had to go to their hospital for your care; essentially a single payer system. Again, worked pretty well. Now on my Wife's plan it's not single payer, but they are strongly encouraging everyone to address all their medical needs through her hospital.

The high deductible plan has some up sides; you can put as much as $6250 per year in an account tax free, and keep it forever. As long as you spend it on health related expenses, you can withdraw tax free. Not a bad deal. Still the out of pocket cost can add up, and we're pretty healthy.


----------



## Sawkerf (Dec 31, 2009)

Yes, employers are trying to curtail costs and not just in the medical insurance area. They're looking at everything to find ways to control their costs. Like it or not, we're in a global economy and competition is fierce. Anyone who can't stay competitive is in big trouble.

Once upon a time, pretty much of all our products and services were provided domestically. Since the rules of the game were pretty consistant, the playing field was pretty level and our employers were only competing with other domestic employers. Those days are long gone and they ain't coming back. Today's employers have to compete on a global scale and if they can't get cost competitive, we're out of jobs - not just complaining about the cost of one of the benefits. We're smack in the middle of that Brave New World we've always heard about and we gotta play by today's rules. Our grandfathers world is gone.

I was listening to a talk show the other day and some lady called in complaining about our failure to manage and control global trade. Apparently, she just didn't grasp the idea that we ain't the big dog anymore. We don't have the ability to "manage and control" global trade, and would probably be invited to piss up a rope if we tried.


----------



## CharlieM1958 (Nov 7, 2006)

Just as a side note, I'm on the fringe benefits committee of the university where I work, and have been for quite a few years. So I have been one of those taking part in the decision process of balancing cost vs. benefits. (Since the university pays approximately 70% of the cost of coverage and the employees pick up the other 30%, it is a decision that both sides have a stake in.)

This year, our insurer is raising our rates by 13%, which translates to almost exactly an extra $1 million. That in itself isn't too terrible, but the university has decided it cannot afford the increase, so the entire $1 million will be passed on to the employees. That means our share of the cost will actually increase by 55%. Now the committee must decide what benefits, if any, to cut in order to limit the increase. Tough decisions.


----------



## DanYo (Jun 30, 2007)




----------



## DanYo (Jun 30, 2007)




----------



## Sawkerf (Dec 31, 2009)

That's more than just a "side note", Charlie. Much of the rancor in this kind of discussion is because most of the participants have no real understanding of how a business manages their costs.

Employers have the often contradictory goals of attracting and keeping good employees, growing (or at least maintaining) their market share, and managing their costs to stay in business. It's like building a house of cards - one false move and the whole thing collapses.

Like you, I've been in those meetings where there were no good choices - just some that were less bad than others.

A side note of my own:
This discussion has been going on for two days and 55 posts with almost no bickering, name calling, or "my guys are saints and your guys are jerks" comments. I really expected to hear from some of the more volatile LJ's by now but they've either stayed away or decided to keep their shouting to themselves. I'm impressed!! - lol


----------



## CharlieM1958 (Nov 7, 2006)

You know, I had the same thought about the civility of this discussion. I guess it proves that its not the topics that start arguments…. it's the attitude of the participants. This thread must have slipped under some folks' radar.


----------



## DanYo (Jun 30, 2007)

Two or three lumberjocks are blocked from this thread. 
..
I'm enjoying this piece myself. Many good ideas flowing.


----------



## DavidBethune (Feb 9, 2009)

You Americans are so blinded by the propoganda against socialized medicine it's amazing…
Almost EVERY country in the world has it…
I lived 25 years in the US… My daughters are both American.. One is in law enforcement.. They had their health care cancelled because it was to pricey..
WAKE UP AMERICA!!!!! Obamah is leading you in the RIGHT direction.. Someday you will all thank him


----------



## waho6o9 (May 6, 2011)

Obama's economy has been contracting for three years in a row. November can't 
come soon enough.
Vote out Obama and anyone who supported Obamacare.


----------



## CharlieM1958 (Nov 7, 2006)

LOL, Sawkerf…. we may have spoken too soon.


----------



## Sawkerf (Dec 31, 2009)

Then join in Dan. You started this, remember? - lol

David -
We Americans are a bundle of contradictions if you haven't noticed. Some of us support ideas that border on all out socialism and others are a few steps to the right of Attila the Hun. In spite of all the shouting, we usually manage to fall somewhere near the middle and it seems to have worked reasonably well for a couple of hundred years.

I'm not looking forward to it - and probably won't live to see it - but we will embrace even more socialism in the future. Many will resist, but sheer population pressure will force us there. We were once a nation of (mostly) rugged individualists, but there isn't enough open space anymore to support that lifestyle. Besides, I'm not so sure that we were ever as individualistic as our historical myths claim. John Wayne was never a real cowboy - and actually wasn't that comfortable on a horse. A really good rider seldom grabs the saddle horn. - lol

Is Obamacare the best solution to the problem? I haven't the faintest idea. There's much to like about it on a conceptual level, but the devil is always in the details. For all of it's potential pitfalls, it's better than what we have now - and that's a good start.


----------



## derosa (Aug 21, 2010)

I think obamacare as no where near the best solution but at the moment I see it as the best step we have in the right direction, and we need as a nation to be moving in a better direction. The one year I invited my wife to go and dig with me in Cyprus she developed a bladder infection from the constant heat. Here in the states that would have meant waiting till the night time clinics opened and hoping they would prescribe a medication we could afford and it usually meant at least 100.00 out of our pockets, rarely less. There we walked down to the druggist, explained the issue and 10.00 later left with the antibiotic that we needed, didn't even have to wait till dark.

We eventually bought insurance through healthy NY when we got back to the states and started discussing children. Just over 500.00 a month for just her on the low income plan, we literally only made 24k between the two of us that year due to being in college and just her insurance was to be 1/4 our pay. Once our kid was born it rocketed up to 875.00 a month and nearly bankrupted us as it became a question of if our new jobs would start before we couldn't afford the bills anymore but we couldn't not have it just in case something went wrong. Since nothing did we ended up spending about 2k more then we would have but it was worth the risk.

Personally I'd rather we had a system where no one had to make those decisions because they needn't worry about medical costs. We'd already held off having a kid because of money issues and lack of insurance and had gambled when we decided to go ahead and that is just ridiculous. I'd gladly give up the insurance I have now, and it is amazing even if I don't use it, for everyone to be covered and live knowing that in 20+ years my daughter won't have to deal with the same worries.


----------



## Sawkerf (Dec 31, 2009)

Rev Russ -
I've also wondered why pharmacists aren't allowed to prescribe medications - especially some of the more obvious ones. I suspect that it's a liability issue and they just aren't in a position to assume the risk - even if they were legally able to do so.

Before going on Medicare and Kaiser (our Part B HMO), we used a grocery store pharmacy and the two pharmacists there provided a lot of information about the prescriptions - including suggestions that we talk to our Doctor about alternatives to a couple of his prescriptions. The doc once told me that a good pharmacist is the best possible source of info about drug interactions, siide effects, etc.

You may not be old enough to have seen it, but I remember the days of company paid, 100% coverage, cafeteria plan medical coverage. Many of my generation (I'm a few months ahead of the Baby boom) spent most of their working lives never thinking about the real cost of their medical care. Why should they? The company paid for it.

It was only when employers were no longer able to keep absorbing the cost that we realized just how costly it really is - and began screaming in outrage. We had become accustomed to excellent medical care at low cost (well our cost, anyway) and were totally unprepared to discover that it was never as cheap as we thought. All of a sudden, we were having to make the cost/benefit decsions that our employers had always made and it scared hell out of us.


----------



## americanwoodworker (Nov 26, 2011)

Dan here are my opinions on healthcare. 
1. You can't buy health ins. across state lines. Why? I have no choices, because I am not allowed too. 
2. Why am I paying for the illegals health care? They come here illegally, go to the E.R. and never pay. My tab goes up to pay for them.
3. Docs. and hospitals get sued for not doing more tests when someone has a medical issue. They get sued so bad that it ends up shutting down their business and Malpractice Ins. rates go up for them which raises our costs.
4. Tuition costs are so high today that future docs. are coming out of med school with literally a hundred thousand in debt or more.

You said keep it short so I won't continue on with the list. But why are we so quick to jump on the socialist bandwagon when we have not tried to fix the major problems to begin with? I just cannot start giving away my freedoms just willy nilly with out first exhausting all other options. What we are doing is applying a bandaid to an infection. We have to fight the infection first. Our taxes will just continue to go up and up under a socialist plan until we cannot afford it again, or only the "chosen ones" will get healthcare.

Personally I would like to see health ins. become like auto ins.. If you are a safe driver you get a discount in Auto ins.. If you are healthy and go to a gym you should get a discount, If you are over weight you pay more.

just my opinions.


----------



## BobM001 (Jan 8, 2012)

Perhaps the single largest cost for healthcare providers is malpractice insurance. There isn't ONE LINE in the ACA that addresses TORTE REFORM! Why? Because the majority of those in congress and the senate are LAWYERS! They can't cut the legs off their AMBULANCE CHASER BRETHREN now can they?

The degree of inefficiency/waste that the US government operates with at present and YOU WANT THEM TO RUN A HEALTHCARE SYSTEM? What are you CRAZY?


----------



## jmos (Nov 30, 2011)

AW, great points
1. I never understood that either.
2. Law says they have to treat anyone who walks in, regardless of ability to pay. Even if you made an exemption in the law allowing them to deny illegals, how would ER's manage it? Even if they could determine who was illegal, would they really turn away someone who needed care? That goes against everything health care professionals are trained to do. I agree it stinks, but I don't see any easy way around this.
3. This is a huge problem. Defensive medicine costs the system a fortune. Mt Wife sees this all the time; imaging studies ordered that are inappropriate or unnecessary. She pushes back, but she can't say no,, and the ordering Doc's usually insist. Huge waste of resources.
4. Amen. My Wife's loans are larger than most folks mortgage, and will take as long to pay back. It's barely worth going to med school for primary care docs. However, med schools are private and for profit; do we nationalize them? Should the government pay for med school? Or subsidize the tuition? Not an easy issue.

I agree with you that discounts should be given for being a healthy weight, not smoking, exercising.

Bob - tort reform is absolutely necessary, but your dead right about why it won't happen.


----------



## Sawkerf (Dec 31, 2009)

Actually, the ACA is about the cost of medical insurance rather than the cost of medical care in the U.S.. The two are certainly related, but they are different. Both need deep examination and change if we ever hope to get a reasonable system.

Tort reform is definitely a big part of the cost of medical care, but laying it off on politicians taking care of their own is a cop out. Fun perhaps, but intellectually dishonest.

We really have to get over the belief that medical practitioners are somehow infallible. No other profession is mistake free and it's insane to threaten medical practitioners with financial ruin if (no, when.) they make one. That threat is a significant contributor to the cost of medical care because doctors have to operate in full CYA mode and order tests that are almost certainly unecessary. It's harsh, but we have to accept some failures - even if grandma got worse, or died.

Bob's comment about efficiency and waste is true at most levels of government, but Medicare and Medicaid seem to be exceptions. Everything I've read and heard says that they're very cost effective. The real question is could they carry that effectivness into a nation-wide, single payer, system?


----------



## jmos (Nov 30, 2011)

Sawkerf,

I think we're saying very similar things about tort reform. I agree with your post, but I think the way out is to to change the laws around suing doctors for those mistakes. As the system is now, if you can prove anything resembling a mistake the jury tend to sympathize with the patient and award damages. Even if the error was perfectly reasonable, or even if 99 out of 100 doctors would have done the same thing. My Wife sweats getting sued every day; it's not unusual for her to see a study showing, say, lung cancer. Then she goes back and looks at prior films and, knowing where the cancer is now, can see something on the old film that was very very subtle and was not called. In many cases that would be a lawsuit and the radiologist that read the earlier film would loose, no question. I don't think it's intellectually dishonest at all to see the solution as revised laws that elevate the burden of proof in malpractice cases. Doctors do make mistakes that deserve compensation (amputating the wrong limb or leaving surgical gear in patients for example) but the bar is currently set way too low.

I hear what you're saying about medicare administrative costs, and it is true, but I do wonder how much of the additional efficiency is because medicare basically approves anything. My experience watching my parents and in-laws, who are all on medicare, is that they don't do much to try to verify service are really required, and to try to contain costs by disallowing unneeded, or ineffective, test/procedures/treatments.


----------



## jeepturner (Oct 3, 2010)

Continuing on the side conversation about Tort reform, I went to Wikipedia to do a little light reading, and came to the conclusion that the internet is a fantastic tool.
There are arguments on both sides weather tort cases are causing the medical costs to soar. There is no argument that they do contribute, but there is lots of room for debate on how much it contributes. If you take the time to read both the article and look at the sources you will find compelling arguments on both sides of the tort reform debate.
One of the things I found interesting is that the data from Ca. supports the argument that regulating insurance cost for practitioners does more for malpractice rates than does tort reform.

Dan, I like the re-peel cartoon.


----------



## americanwoodworker (Nov 26, 2011)

SawKerf you are correct but why do you think Medical ins. is so high? Because medical care costs so much. If everyone drove around $200,000 cars instead of $30,000 cars do you think the cost of Auto Ins. Would be the same?

Jmos you fix the illegal problem by shutting off the border to Illegal immigration. I would rather help pay for someone who comes here legally and wants to become an American and live the dream than those who want to milk us and think we must evolve into the country they left. Also, just because people can't pay financially doesn't mean they can't do community service of some sort. That is what we are doing in a sense. We work hard for our own benefit and are told by society that we must give money that we earn through working to the less fortunate. We have to give community service, why can't they?

By the way, I came from a single parent home and was homeless for the majority of my early teen years. I used to believe that the rich should pay more since they had more. Then I started working and found out the harder I worked and the more I made the more taxes were taken out. I had no life while what I considered were my friends at the time had a life but were on some sort of government assistance. I know what true poverty is.

Dan thanks for hosting this civil discussion. I enjoy these talks when they are productive.


----------



## DanYo (Jun 30, 2007)

I Like Charlie's idea ... wonder if the numbers would work?
..
..
..









..
..
..


----------



## Sawkerf (Dec 31, 2009)

Woodworker -
Of course medical insurance reflects the cost of the care it provides. Could it be any other way?

Another reason medical care costs have risen so much is the incredible advances in medicine over the past few years. Back in the day, an X-ray machine was about as good as it got for non-invasive examination. Doctors would listen to your heart, take your blood pressure, look down your throat, and have you turn your head and cough. That was about it for most diagnoses. If you needed more you were hospitalized for exploratory surgery. Medication was pretty much limited to antibiotics and pain pills.

Now, we have MRI's, CAT scans, and Sonograms which can look inside of us (non-invasively) and give very clear pictures of what's going on. Blocked arteries which were once a death sentence, or required major surgery are now treated on an outpatient basis. Many other surgical procedures which once required highly invasive operations and long hospital stays are now performed with minimally invasive procedures and very brief stays in the hospital. We have access to a plethora of medicines that weren't even imagined before. I take blood pressure meds which do a great job of controlling my BP. My grandfather died from heart disease because there were few (if any) ways to control his BP. We have access to medical care that wasn't available even a few years ago. The small town doctors I knew as a child probably wouldn't be allowed inside today's hospitals - except as a patient.

None of this comes cheap, however. Even if we could eliminate all the ineffeciency, waste, and general stupidity in the health care system it would still cost far more than it did a generation ago. Anyone who thinks that it wouldn't needs to back off on their consumption of wacky tabaccy - even if they have a prescription for it. - lol


----------



## DanYo (Jun 30, 2007)




----------



## pashley (Mar 22, 2008)

*Ok, here's one real-world example why Obamacare is bad for business and the economy.*

My wife is benefits and wages manager for a major employer in my area, with over *43,000 people*. Obviously, she and her team have to do the calculus on if Obamacare stays or not, and how they will work with it. I can also tell you that this company has been #1 on Fortune 500's Best Companies to work for, and has been in the top ten on that list for over 8 years. They provide health insurance for their employees (among many other benefits), and for their families. Co-pays are very small, once a reasonable deductible is passed. I can tell you, it's a great plan.

So what can Obamacare offer to these employees that this employer has not? Obviously, nothing.

As it stands now, each full time employee costs the company about $7500 per year for their insurance. That's a lot, and a great benefit. You've heard that Obamacare will be a benefit to companies because now they can dump their health insurance costs by handing over their employees to Obamacare, and pay the $2500 penalty per employee. For this company, that seems to be quite a savings…right?

Wrong. This company actively recruits the best people, and wants to offer the best benefits package to attract the best people - the reason for their incredible success. Perhaps the most attractive benefit is their health insurance, therefore, for them to drop it, ostensibly to save money, and dump them on Obamacare, takes away their major recruiting - and retaining - tool. So instead, at least for now, they are going to keep their health care the way it is now - PLUS pay another 33% because of the president's awesome health care bill. That means less money to expand, less money for employee benefits, and yes, less profits.

Thanks, Obama.


----------



## Sawkerf (Dec 31, 2009)

Pashley -
One of the weaknesses of Obamacare is that employers might just drop their plans so their employees have to sign up with someone else/ But, what makes you think that they will?

Your wife's employer probably wouldn't dream of that if their medical plan is such a big part of their ability to attract and retain top notch employyes. Obamacare is an option - not a mandate.

One scenario I can see is that employers drop the marginal plans, but still offer better plans. If an employee only wants the bare bones, he can go with the gov't plan. If he wants something better the employer has some options.


----------



## DanYo (Jun 30, 2007)




----------



## americanwoodworker (Nov 26, 2011)

*One scenario I can see is that employers drop the marginal plans, but still offer better plans. If an employee only wants the bare bones, he can go with the gov't plan. If he wants something better the employer has some options.*

Don't forget, you will be charged extra taxes for a having a "Cadillac" plan by the Government.


----------



## Gatorjim (May 12, 2012)

Entitlments? when did just beliving alive gives you the right for health care ? Oh and were already paying for these freeloaders rent and cell phones, and food . yes times are hard but there not hard for the ones on the ones on the free band wagon. They get more and more while i pay more for my insurance and taxes so that the freeloaders can keep getting more and more. Go on youtube there are people on there braging aobout how much there serewing the american taxpayers that were stupid we keep working and they get more. I'm talking about american citizens not the ileagles there another thorn in the american side. It dosn't matter what fool we have in the big house I want them all to know this. STOP GIVING MY MONEY TO PEOPLE WHO HAVE DONE NOTHING TO DESERIVE IT. Having a pulse dosn't count as deseriving.


----------



## Sawkerf (Dec 31, 2009)

What, exactly, is a "cadillac plan"? Anything more than the bare bones is a cadillac? I kinda doubt that.


----------



## oldnovice (Mar 7, 2009)

*" What, exactly, is a "cadillac plan"? Anything more than the bare bones is a cadillac?"*

The Cadillac plan is close to what the legislators have which is the Mercedes, or Roll Royce plan.

*The plan we should all have!*


----------



## pashley (Mar 22, 2008)

*Sawkerf,* I think you missed the point. Obamacare was sold as being, in part, a help to business, since they won't have to provide health care for their employees. Sure, you can opt to keep your plan, but dammit, you're going to pay for it. So, because this company is providing a great benefit for their employees - which we would like every employee to do, right? - they are getting hit hard for not dumping their people on the government plan. How is that a good thing? Our family might have to lose our great benefit and be dumped on the crappy government plan - yeah, that's great.

And just to throw this in, my brother-in-law works for a health insurance company; he deciedes, on case-by-case basis, if a patient can use a drug for "off label" use, that is, will they cover the cost of a drug for a condition that it was not meant for - yet the doctor thinks it might help.

He tells me the reason that drugs are so damn expensive is not because the drugs cost so much, coming from the actual manufacturer, but the incredible mark-up at the pharmacy. This is why you see even drive-up pharmacies now, because of the incredible profit margin. He told me he had to get a prescription for himself, and he had to pay $100 - for pills that cost that pharmacy $5. So, they have to cover the cost of proper use drugs, which is so incredibly high, and that's why you have insane premiums, at least in regards to drug costs.

Also, prescription glasses - you can pay $300-$500 for those. Again, incredible mark up. My other brother in law works as a manager that grinds the lenses and mounts them in frames for opticians. The cost of parts is about $15, and the labor about $25 - so $40, then his company does a markup to about $100, and then optician marks it up at least double, usually triple, to $300. This is how $15 turns into $300. Many people have insurance for glasses, so they don't care what the cost is, as "insurance will pay for it" - so there is no incentive to shop around. My insurance doesn't pay for it - though we do have a flexible medical account that I could use, but I'll be damned if I'll pay $300+ for glasses out of my own pocket, so I get them at 39dollarglasses.com. Yes, they are great glasses, not crap.

It seems insurance only serves to drive up health care costs, not lower them.


----------



## americanwoodworker (Nov 26, 2011)

Look at the cost. The finance committee defines high-cost or "Cadillac" as any plan with premiums higher than $8,000 for individuals or $21,000 for families. Keep in mind that these figures include everything you and your employer spend on health care except for the deductible: premiums for medical (the portions paid by you and by your employer), dental, and vision coverage, as well as any money you put into a flexible spending account, which allows you to set aside pretax money to cover medical costs. That is what a Cadillac plan is.

My overall point is, lets stop focusing on socialism and lets start focusing on fixing the problem. Since none of the actual problems which contribute to high HC costs are being fixed or even discussed one wonders if there is actually an ulterior motive.


----------



## CharlieM1958 (Nov 7, 2006)

Pashley, I agree with some of your points, but I don't think you have it quite right in how the law was meant to relate to employers offering insurance. The law was *intended* to keep businesses offering coverage, because it provides for fines to those companies that drop their coverage. However, the fines are less than the cost of providing coverage, so there is a fear that many companies will just drop employee coverage and force people into the government plan.

Also, the plans that most employers offer would not qualify as Cadillac plans.


----------



## Sawkerf (Dec 31, 2009)

Pashley -
I'm not going to try to make a point-by-point response to your post, but a couple of your statement hit the heart of the whole debate.

"...but dammit, you're going to pay for it."
You couldn't be more correct. Someone will have to pay for the insurance and we have to decide who it's gonna be. It's my belief that it will come down to each of us no matter what path it takes. It can come directly out of our pockets and reflect the choices we make regarding the levels of coverage we want or need; it will come out of our pockets indirectly in the form of higher prices (if employers have to absorb the cost); or higher taxes (if the gov't picks up the tab). I'm betting that it will be some of each.

"Our family might have to lose our great benefit …."
Yes, you might. Or, your wife's employer might continue the existing plan(s) and find ways to absorb the added cost so they can continue to realize the benefit of having happier employees. They will probably try to hammer out compromises which will hit some employees harder than others. Your wife will probably find herself in some "blood on the floor" meetings before it's over.

How does your brother in law make his decisions regarding "off label" use of a drug? Does he have the medical training to make these decisions, or is he just going with the doctors recommendation? Last week, the FDA announced a $3 billion settlement with some big pharma companies regarding "off label" use of some drugs. That money isn't huge (relatively speaking), but is another $3 billion added to the overall cost of the businesses and will have to come from somewhere. If your BIL's employer had to share in that settlement, would he make the same decisions?

"Many people have insurance for glasses, so they don't care what the cost is, as "insurance will pay for it""
Take out the part about glasses, and you've hit on one of the core problems of the whole debate - our total lack of understanding of the real cost of medical care. Now that we're being slapped in the face with the costs, we're screaming about being ripped off. As easy as it may be to yell about "greedy, unscrupulous, crooks", we really need to try to understand what the costs are. I suspect that they're much more justified than we want to admit.


----------



## jmos (Nov 30, 2011)

This is really one of the key issues with the whole system; no one knows what anything costs. The Doctors don't; they order tests, perform procedures, and write prescriptions without knowing any of the costs. With all the varying reimbursement levels, how could they know. Since they don't know, they can't tell the patients. So those buying the service and those providing the service are both in the dark. Normal market forces are horribly so distorted in the health insurance industry.

This is one reason why, like it or not, a single payer system simplifies things. Costs become flat and knowable. Doctors would have clear guidelines as to what services they need to provide under what circumstances; eliminated defensive medicine and over treating to pad billing. Drug and material costs are lowered by negotiating prices (which medicare is legally prohibited from doing now under Part D). Cuts out a lot of inefficiency.

Not perfect by any stretch, but doesn't really seem to be much worse than the patchwork system we have now.

Another philosophical issue raised in some of the above posts is the nature of healthcare; is it a right or a privileged. Both are valid viewpoints.

While I don't think a single payer system where everyone get everything (like medicare is now) is reasonable or affordable, a single payer system that provides basic health care to all is something the richest country in the world should be able to provide. We're the only first world country that doesn't. Personally, I think if we can't extend basic coverage to all, we should abolish medicare. As a society, why do the elderly deserve unlimited healthcare, but children do not?


----------



## Sawkerf (Dec 31, 2009)

John -
Excellent post. I agree with most of what you say, although I believe that doctors have a better idea of the costs than you might think. But, since they have to be so defensive in their practices they're reluctant to lay them out and have a patient decline something and then sue them later for their "mistake".

As for continuing Medicare, the "selfish" side of me strongly opposes that. The logical side agrees in principal, but the "selfish" side says that I get it because I met my side of a social contract that I had to accept almost 50 years ago. For most of my working life, I paid my Medicare (and Social Security) "dues" with the understanding that they would be available in my old age (and today, I'm feeling older than normal - lol). A great deal of my retirement planning counted on Medicare (and Social Security) to augment my other retirement strategies. At this point in my life, there is no way for me to substitute something else if they're taken away - or even significantly changed.


----------



## jmos (Nov 30, 2011)

Sawkerf, being married to a doctor I can attest she has no idea what the hospital charges. She has some idea what her department gets reimbursed for a particular study (she a Radiologist), but what they bill, and to whom, who knows. She's asked their business person, and he usually can't give her a straight answer. She also has a lot of Doc friends, and I think many are in the same boat; they have a general idea in some cases, but the contracts are so convoluted, they really don't know what something will actually cost a patient. Now, having said that, there are some Docs that know exactly what makes them the most money and exploit that to their personal gain, regardless of whether the patient needs the procedure/test of not.

As for medicare, if it were to be eliminated it would have to be phased out. I agree we are obligated to provide it to folks who are currently in, or are soon to be, in the system. My only beef with medicare, from my experience with family, is that they seem to pay for almost anything. It seems to me that it is the biggest Cadillac health plan out there; I know none of the insurance plan I've ever had were as generous. That's nice, but it's not really sustainable. If something isn't done to reign in the costs, their won't be anything left for anyone.


----------



## DrDirt (Feb 26, 2008)

At our company we see the same kind of increases for 2013 to our healcare ~16% again.

So what part of the Affordable Care Act is making insurance Affordable?
What part is actually addressing Cost of Care?
Where are the extra doctors for the 30Million uninsured going to come from?

As I see my premium going up - what exactly are these 30 Million people going to Buy that they couldn't buy last week?
The only thing that really happened is to create a fine for not having health insurance. And a few key reforms I support, like not dropping people for having a claim, and pre-existing condions.
However the AHA (or ACA) to me is misnamed - and in its enactments - has little to nothing to do with Affordable.

Insurance costs are driven by HEALTHCARE COSTS - - -yet we are only advised by our leadership to kick and scream about the evil insurance companies supposedly raking in the cash by denying claims, when it really is the cost of care that needs to be addressed. Our BC/BS plan even covers getting procedures done overseas because it is so much cheaper. Asia and India are building health centers just for medical tourism. Already our doctors send out the Imaging analysis to India - so the tech here takes the x-ray or MRI, and sombody in India does the diagnosis. Anyone else think this is a problem - - and one NOT addressed by ACA?

Obamacare does hire more than 10 thousand IRS employees to assess fines. But somehow that doesn't make me feel better….pun intended.


----------



## Sawkerf (Dec 31, 2009)

John -
Yes Medicare seems to cover everything (or almost everything), but my understanding is that they actually pay very little for many of those coverages - a major reason why many doctors are limiting the number of Medicare patients they'll accept. Since other insurers follow the Medicare lead, some doctors are leaving the profession because they can't recover the cost of the care they provide.

DrDirt -
To respond to your questions;
- Define "affordable". If your definition includes the costs from 10-20 years ago, you need to study today's economic world.

- The ACA addresses the cost of medical insurance. That's certainly intertwined with the cost of health care, but if the ACA had tried to deal with that as well, it would have been even more complicated. It's just a start (and an imperfect one, at that) - not the final solution.

- Helluva good question! My guess is that the new docs will materialize much as they did as the population surged during the baby boom. For sure we'll see an upsurge in foreign born (or trained) doctors. When my wife was hospitalized in 2010, only a handful of her doctors and nurses were born and raised Americans. Two of her best doctors were Russian and Afghan. Excellent doctors, but communication was sometimes difficult. All but 2-3 of her nurses were Filipina. Great caregivers, but sometimes difficult to communicate with.

I would also ask if there is a shortage of doctors. Are medical schools begging for students? AFAIK, medical schools turn away far more applicants than they accept so there must be somthing attracting people to the profession. Those docs-to-be may need to find new business models, but most of them will probably find ways to practice their profession and make a decent living doing it.


----------



## DanYo (Jun 30, 2007)




----------



## DrDirt (Feb 26, 2008)

Sawkerf -
The doctor shortage is a keen use of Supply and demand by the AMA.

If there were more doctors - there would be more competition because there no longer is scarcity to drive up wages.

As far as the "Affordable" discussion - I am paying ~300/month for family coverage (employer is paying ~65%).
Costs are going UP….I am not talking about 20 years ago - I am talking about 2009 when this thing passed and its enactment…. What is it doing to LOWER the COST of care to the average joe?

IF the problem really is the EVIL INSURANCE COMPANY - policies are too expensive, but all you really have is a new MANDATE?

What did obama really accomplish with his legislation?
I propose that Insurance is Just as expensive (and climbing) under obamacare as it was before. He didn't accomplish anything regarding care, but did put in a huge bureaucracy of government control/penalty assessors and panels with oversight….

But NOTHING in there that makes healtcare AFFORDABLE - as the legislations name would imply. It is all about POWER and CONTROL. Barry could give a rats behind if you die in the street.


----------



## americanwoodworker (Nov 26, 2011)

Drdirt you made my point exactly. This does not fix the problems that currently contribute to rising healthcare costs. We jumped completely over the problems and decided to make it political and go after big Ins.. Now we have Big banks, Big Oil, and Big Ins. to attack. Each one of those have underlying problems contributing or even causing the crisis. This is why I say health Ins. Should be more like auto ins.. If you are out of shape you will pay more. That would help solve the obesity problem.

But we do not have the political will to fix the problems because they are politically unpopular. You can't shut the border down to illegal immigration which has people come over and milk the system. You can't tell people no you cannot buy a house if you can't afford it and you can't tell people we will continue drilling for oil at home. Because our leaders are so focused on power they will not attack the problems outright. They put temporary bandaids on issues and leave it for the next generation. Then we continue to solve problems with problems.

One thing that very little people are talking about that this obamacare has brought forth is the taxing power. Because we fail to fix the problems we have now created yet another problem. We now have a Government that can Literally tell us what to do by using the taxing power. This is why I believe there are ulterior motives.

*Only when you focus on the contributing problems and get them solved, will I then be open to debate further Government involvement.*


----------



## Sawkerf (Dec 31, 2009)

DrDirt -
Turn off the caps. You're shouting and my hearing works just fine without it.

Woodworker saved me from having to respond to your post since he also recognizes that the problem goes far beyond sloganeering and political huffing and puffing.

Quit taking the easy road by blaming "big this" and "big that". Look more closely and you'll find that the problems are far more complex.


----------



## DanYo (Jun 30, 2007)

*Interesting read to share with my ole LumberBUDS!*

*NEW YORK TIMES

Op-Ed Columnist
Five Obamacare Myths
By BILL KELLER
Published: July 15, 2012 450 Comments

ON the subject of the Affordable Care Act - Obamacare, to reclaim the name critics have made into a slur - a number of fallacies seem to be congealing into accepted wisdom. Much of this is the result of unrelenting Republican propaganda and right-wing punditry, but it has gone largely unchallenged by gun-shy Democrats. The result is that voters are confronted with slogans and side issues - "It's a tax!" "No, it's a penalty!" - rather than a reality-based discussion. Let's unpack a few of the most persistent myths.
Enlarge This Image
Nicholas Blechman

OBAMACARE IS A JOB-KILLER. The House Republican majority was at it again last week, staging the 33rd theatrical vote to roll back the Affordable Care Act. And once again the cliché of the day was "job-killer." After years of trying out various alarmist falsehoods the Republicans have found one that seems, judging from the polls, to have connected with the fears of voters.

Some of the job-killer scare stories are based on a deliberate misreading of a Congressional Budget Office report that estimated the law would "reduce the amount of labor used in the economy" by about 800,000 jobs. Sounds like a job-killer, right? Not if you read what the C.B.O. actually wrote. While some low-wage jobs might be lost, the C.B.O. number mainly refers to workers who - being no longer so dependent on employers for their health-care safety net - may choose to retire earlier or work part time. Those jobs would then be open for others who need them.

The impartial truth squad FactCheck.org has debunked the job-killer claim so many times that in its latest update you can hear a groan of weary frustration: words like "whopper" and "bogus" and "hooey." The job-killer claim is also discredited by the experience under the Massachusetts law on which Obamacare was modeled.

Ultimately the Affordable Care Act could be a tonic for the economy. It aims to slow the raging growth of health care costs by, among other things, using the government's Medicare leverage to move doctors away from exorbitant fee-for-service medicine, with its incentive to pile on unnecessary procedures. Two veteran health economists, David Cutler of Harvard and Karen Davis, president of the Commonwealth Fund, have calculated that over the first decade of Obamacare total spending on health care, in part by employers, will be half a trillion dollars lower than under the status quo.

OBAMACARE IS A FEDERAL TAKEOVER OF HEALTH INSURANCE. Let's be blunt. The word for that is "lie." The main thing the law does is deliver 30 million new customers to the private insurance industry. Indeed, a significant portion of the unhappiness with Obamacare comes from liberals who believe it is not nearly federal enough: that the menu of insurance choices should have included a robust public option, or that Medicare should have been expanded into a form of universal coverage.

Under the law, to be sure, insurance will be governed by new regulations, and supported by new subsidies. This is not the law Ayn Rand would have written. But the share of health care spending that comes from the federal government is expected to rise only modestly, to nearly 50 percent in 2021, and much of that is due not to Obamacare but to baby boomers joining Medicare.

This is a "federal takeover" only in the crazy world where Barack Obama is a "socialist."

THE UNFETTERED MARKETPLACE IS A BETTER SOLUTION. To the extent there is a profound difference of principle anywhere in this debate, it lies here. Conservatives contend that if you give consumers a voucher or a tax credit and set them loose in the marketplace they will do a better job than government at finding the services - schools, retirement portfolios, or in this case health insurance policies - that fit their needs.

I'm a pretty devout capitalist, and I see that in some cases individual responsibility helps contain wasteful spending on health care. If you have to share the cost of that extra M.R.I. or elective surgery, you'll think hard about whether you really need it. But I'm deeply suspicious of the claim that a health care system dominated by powerful vested interests and mystifying in its complexity can be tamed by consumers who are strapped for time, often poor, sometimes uneducated, confused and afraid.

"Ten percent of the population accounts for 60 percent of the health outlays," said Davis. "They are the very sick, and they are not really in a position to make cost-conscious choices."

LEAVE IT TO THE STATES. THEY'LL FIX IT. The Republican alternative to Obamacare consists in large part of letting each state do its own thing. Presumably the best ideas will go viral.

States do have a long history of pioneering new ideas, sometimes enlightened (Oregon's vote-by-mail comes to mind) and sometimes less benign (see Florida's loopy gun laws). Obamacare actually underwrites pilot programs to reduce costs, and gives states freedom - some would argue too much freedom - in designing insurance-buying exchanges. But the best ideas don't spread spontaneously. Some states are too poor to adopt worthwhile reforms. Some are intransigent, or held captive by lobbies.

You've heard a lot about the Massachusetts law. You may not have heard about the seven other states that passed laws requiring insurers to offer coverage to all. They were dismal failures because they failed to mandate that everyone, including the young and healthy, buy in. Massachusetts - fairly progressive, relatively affluent, with an abundance of health providers - included a mandate and became the successful exception. To expand that program beyond Massachusetts required … Barack Obama.

When Mitt Romney signed that Massachusetts law in 2006, the coverage kicked in almost immediately. Robert Blendon, a Harvard expert on health and public opinion, recalls the profusion of heartwarming stories about people who had depended on emergency rooms and charity but now, at last, had a regular relationship with a doctor. Romneycare was instantly popular in the state, and remains so, though it seems to have been disowned by its creator.

Unfortunately, the benefits of Obamacare do not go wide until 2014, so there are not yet testimonials from enthusiastic, family-next-door beneficiaries. This helps explain why the bill has not won more popular affection. (It also explains why the Republicans are so desperate to kill it now, before Americans feel the abundant rewards.)

Blendon believes that because of the delayed benefits and the general economic anxiety, "It will be very hard for the Democrats to move the needle" on the issue this election year.

He may be right, but shame on the Democrats if they don't try. There's no reason except cowardice for failing to mount a full-throated defense of the law. It is not perfect, but it is humane, it is (thanks to the Supreme Court) fiscally viable, and it comes with some reasonable hopes of reforming the cockeyed way we pay health care providers.

Even before the law takes full effect, it has a natural constituency, starting with every cancer victim, every H.I.V. sufferer, everyone with a condition that now would keep them from getting affordable coverage. Any family that has passed through the purgatory of cancer - as mine did this year, with decent insurance - can imagine the hell of doing it without insurance.

Against this, Mitt Romney offers some vague free-market principles and one unambiguous promise: to dash the hopes of 30 million uninsured, and add a few million to their ranks by slashing Medicaid.

If the Obama campaign needs a snappy one-liner, it could borrow this one from David Cutler: "Never before in history has a candidate run for president with the idea that too many people have insurance coverage." 
*


----------



## Dinger (Mar 16, 2012)

Anyone who believes this plan will work to solve the problem are being misled. Want to see our healthcare system in action? Go spend a day/night in the ER where my wife works. 90% of people she sees have no need to be there. A small fraction of those people are those who "can't afford" primary care. While I understand young families with young kids spend thousands of dollars a year in those costs, there are many who simply abuse the Medicare/Medicaid system to no end. As a former inner city EMT myself, 95% of the calls I went on weren't emergencies - AT ALL. a certain percentage of those non-emergencies were people who weren't sure, which is fine, but the VAST majority were just abusing the system. I went on calls for trouble sleeping, stubbed toes, scraped knees, a headache that started 15 minutes ago, people who have bi-polar disorders or depression ALL of which could have sought medical care on their own outside of the emergency system. I picked up the same drunk SIX times in one night. Why? Because he'd pass out in a public area where someone would see him, call 911 for a "man down" we'd pick him up, take him in, ER docs would discharge him after doing the required work-up, discharge him, then he'd go drink some more, pass out…you get the picture. I couldn't NOT take him or I'd lose my license, he had an "altered mental status" (No kidding) and therefore the docs had to run the same tests over and OVER again in order to not lose their licenses. I can't deny "care" and neither can the hospital. At what point does personal responsibility kick in? My wife had a mother ask my wife to write her a scrip for her kid for antibiotics that cost $5 out of pocket so her insurance would pay as she packed cigarettes in her hand. She had some kid who was "disabled" ask for a medical marijuana prescription. Why? Because he was disabled. What was the nature of his disability? He didn't know. All he knew was that his disabled friends all had medical marijuana. He didn't even TRY to be deceptive. And what about the people who come in and ask for Oxy or Vicodin when they've had 100 filled already for the month? They don't have to pay if it comes from the ER. So, free visit, free meds, sell on the street, get cash, go buy cigarettes and booze. Wash, rinse, repeat. This isn't politics, this is real world experience. How does charging $750 per year even begin to address that level of abuse? I don't know how else to stress this - these behaviors are the RULE not the EXCEPTION. We wouldn't even be having this discussion if everyone in America (including the politicians) spent a day on an ambulance or in the ER. I wish someone would do a documentary on this.


----------



## pashley (Mar 22, 2008)

To be sure, this is a complex problem.

*Lawyers:* Drive up the cost of malpractice insurance for doctors and hospitals, force stupid rules (see Dinger's post), and are constantly looking for a lawsuit ("Injured by a doctor that didn't see you on time?! Call us now! You may be entitled to compensation!")

*Medical supply vendors* like these diabetic supplies, eyeglass vendors and motorized chairs companies on TV that can work Medicare and other insurances to make sure you get their over-priced product;

*Pharmacys* that have incredible mark-ups in drugs;

*Doctors* that schedule unneeded tests and follow up visits (No, I'm not scheduling a "well-visit" for my kids so you can tell me they are absolutely fine, and pocket $150 for 5 minutes).

*Insurance companies* that pay, without a fight, for outrageous costs, and don't find alternative solutions for their clients.

*Private citizens* that don't shop around for best prices, and just say, "I don't care, insurance will pay for it."

Just a couple other anecdotes….

• I went to an ENT doctor for a throat issue; he used a special camera that snaked up my nose and down my throat. On my bill, he charged me $200 for use of that machine - one he uses several times a day, I'm sure. How do they get away with this? Does a plumber charge me for use of his motorized drain snake? It's your tools, you pay for the upkeep.

• I am out currently looking for new glasses. My insurance doesn't pay for them; However, we have a medical savings account thru my wife's employer. We pay for the glasses, they reimburse us. It was our money we put into that account, untaxed, by the way. Whereas I might have just picked out whatever I wanted at one these one-hour eyeglass stores because insurance pays for it, and blew $400, I'm now shopping around for best prices, including online (check out 39dollarglasses) because I'll be damned if I'm paying $300 for a little piece of stylish plastic, made in China (the frames).

Now that we apparently will have government insurance, watch the costs of medical care going even higher.


----------



## americanwoodworker (Nov 26, 2011)

*Private citizens that don't shop around for best prices, and just say, "I don't care, insurance will pay for it."*

Pashley you may or may not believe me. But I am a guy that believes in negotiating to get the best price. After my wife had a major surgery done, I did some calling around to different doctors and specialists that had billed us. What I do is call them up and offer them payment in full if they will give me a percentage discount. Every single one of them told me that the insurance company negotiates the price that they can charge. If they were to give me a discount it would be considered a violation of the agreement and the Ins. Company would not allow it.

Believe me, the billing personnel that would explain this to me thought it was idiotic as well. I have since only found a few medical bills that I could get to do this with. Mostly, I have noticed, its the bills from the actual hospital that will allow me to do this.


----------



## Sawkerf (Dec 31, 2009)

Pashley -
Dinger's post was difficult to follow because he didn't break things down into paragraphs, but if you're blaming lawyers for those "stupid" rules (and many of them are), you need to look again. Most of them are generated by politicians responding to the bleeding hearts who think that "it's a small price to pay" to make sure that everyone gets medical care. Their fervor to cover every base has led to abuses on a grand scale. The system needs some revision, but most ER personnel are pretty good at recognizing the abusers and sending them on their way after doing just enough to meet the legal requirements.

Those medical equipment suppliers you mention are definitely experts at "gaming" Medicare. One of the reasons they can do it is the requirement that Medicare pay providers "on demand" with little, or no, review to determine the validity of the charges. Many "providers" set up shop, run up millions in Medicare billings, collect the payments and shut down before Medicare recognizes that they've been scammed. Medicare reform needs to include the time and resources to perform a timely review of claims, and the legal cover to deny highly questionable or unnecessary charges.

Tort reform is absolutely necessary, but it isn't simple or easy. A great many medical malpractice claims are legitimate and must be heard. The needed changes must allow those while eliminating (or reducing) the absurd money grabs.

Do you have any hard data about those "incredible" drug markups, and what part of them might be unjustifiable? All businesses have markups reflecting their total cost (beyond materials and labor) to get their product to the customer. Most employees are astounded to discover that their employer has to spend 2-3 times their salary to even keep them on the payroll. I'm certainly no expert on pharmaceutical company cost accounting, but suspect that those "incredible" markups may be much more justified than we think.

As has been said before, many of those doctors tests are CYA's providing more protection from a lawsuit than any real diagnostic benefit. Other tests are performed to eliminate some conditions from a diagnosis. Sometimes, eliminating what it isn't there helps determine what is. Ok, so don't schedule any "well visits". Who said that you had to? FWIW, the ACA wants to provide those for free which should really add to the fun since they can't really be "free". If you're really paying your doctor $150 for a five minute office visit, you need to find another doctor. IME, most office visits run around 20 minutes and the charge is under $100. And, the doctor doesn't get to "pocket" the money. He/She has to pay for the staff, facilities, etc and only gets to keep what's left - if anything.

Which insurance companies just pay whatever the bill shows? IME, they're almost obsessive in their screening processes and only paying what they truly owe. If anything, they often err on the wrong side and have to be beaten about the head to pay for something they initially denied.

Yes, people are going to start shopping and it's long overdue. These debates are forcing us to actually look at things we've ignored for years and we don't like what we're seeing. The current situation is the result of years of inattention and poor decisions by everyone involved. Some of those decisions, however, were made because they were the best compromise available - not because they were perfect. Pretty much the whole system needs to be overhauled and it won't be easy. Doing it right, however, will require all of us to understand as much as possible and be willing to make compromises. Shouting a slogan and calling it a day won't be enough.


----------



## DS (Oct 10, 2011)

If the plan only allows me to buy insurance on my own, even with pre-existing conditions, as long as I've had continous credidble coverage; then I'd be happy.

The rest is regulatory hoo-hah as far as I'm concerned.


----------



## DrDirt (Feb 26, 2008)

Just wait - the Obama camp will refocus the angst from banks and insurance companies to Doctors.

He will ask the people how it could possibly be FAIR that doctors earn so much money…. they are profiteering on the backs of the sick, who are not in a position to defend themselves - yet the Doctors have the big houses and nice cars - and vacation homes.

Then he will descibe how medical schools are solely Rich good ol boys clubs, that exclude minorities and people that only have C+ grades.

The FIX for medical costs is coming - Obama will have Doctors on a GS payscale as members of SEIU and earning the same as the typical postal worker.

Just my foggy crystal ball view….but maybe not that foggy?


----------



## Sawkerf (Dec 31, 2009)

DS251 -

IMO, much of our current dilemma is the result of 60-odd years of tying medical insurance into our compensation. If it had never become so ingrained into part of our job compensation, we would probably have much more affordable health care today. People would be much more aware of the cost, and as informed consumers would probably forced more competition offering better services.

I've never had an employer express any interest in who provived my auto or himeowners insurance, but they've been in total control of my medical insurance. Why?

If we could somehow get medical insurance out of the pay package, the employers could put the premium money in our paychecks and save a bundle by dropping all of the admin overhead they spend to provide medical insurance in the first place.

DrDirt -
I envy you, man. My life would be so simple if I could just follow your lead and blame everything on someone else. - lol


----------



## oldnovice (Mar 7, 2009)

*Dinger,*

You are correct in your assessment of ER and the comment *"At what point does personal responsibility kick in?"*

You have mayors like Bloomberg who are legislating things like salt in food, size of soft drinks, air conditioning in cars, and more minutia laws taking away personal responsibility. California is banning Foie gras, cities banning plastic bags, and now a tax on soft drinks to stop the obesity outbreak (does the government have the right to reduce the profits of soft drink companies?).

*Unfortuately, people are willing to not assume any personal responsibility as long as the government can do it for them?*


----------



## DanYo (Jun 30, 2007)

*America needs to take care of its poor, its weak and innocents. 
*


----------



## americanwoodworker (Nov 26, 2011)

Agreed, however…

*"I am for doing good to the poor, but…I think the best way of doing good to the poor, is not making them easy in poverty, but leading or driving them out of it. I observed…that the more public provisions were made for the poor, the less they provided for themselves, and of course became poorer. And, on the contrary, the less was done for them, the more they did for themselves, and became richer." -Benjamin Franklin
*


----------



## cabs4less (Nov 2, 2010)

Old Ben he loved the poor and minorities so much he bought a few.


----------



## americanwoodworker (Nov 26, 2011)

*"Old Ben he loved the poor and minorities so much he bought a few."*

Ahhh, I love it! It's unfortunate that remarks like these are thrown about without a real understanding of history. True, During the early part of his life he was a slave owner and even advertised rewards for runaway slaves in his newspaper, the Pennsylvania Gazette. But slave ownership was normal. Blacks owned blacks, Whites owned blacks , whites owned whites and on and on. It was a normal practice by everyone. *Not just the evil rich white man. 
*

It was not until his later years that he became an abolitionist and founded an anti-slavery society. You see, he was one of the first that started to see the error of common thought. That is what made him so great. He broke away from the crowed. In 1789 he wrote and published several essays supporting the abolition of slavery and his last public act was to send to Congress a petition on behalf of the Society asking for the abolition of slavery and an end to the slave trade. The petition, signed on February 3, 1790, asked the first Congress, then meeting in New York City, to "devise means for removing the Inconsistency from the Character of the American People," and to "promote mercy and justice toward this distressed Race."

Start looking at history with a mindset of what it was like back then. That is when you start understanding reality and not looking so foolish…no offense.

I find it comical that we can berate the founders for what was normal during their lifetimes and the things they did when they were younger, but we ignore that Obama did cocaine when he was young and it was against the law!


----------



## oldnovice (Mar 7, 2009)

As our Lady Liberty says:

*Give me your tired, your poor,
Your huddled masses, yearning to breath free,
The wretched refuse of your teeming shore,
Send these, the homeless, tempest tost to me,
I lift my lamp beside the golden door.*

That's what brought my parents and, so many others, here!

Yes, there are there people that abuse this, and there will always be, but there are also those on the other end of the spectrum who live by this!


----------



## cabs4less (Nov 2, 2010)

AMERICAN WOODWORKER are u comparing cocaine usage to owning people? And fact is Ben was a slave owner. he did see the light later in life. And just because something is considered common practise does NOT make it okay. And I would like to see your info on African Americans owning slaves when legaly they couldnt own land vote or even be counted as a whole person during a census so i doubt they were allowed to own slaves and if they were I highly doubt they would particpate in such evil. And no offense but to say owning another human being is normal is foolish and harsh.


----------



## DS (Oct 10, 2011)

Please correct me if I'm wrong, but, if I remember the history of slavery correctly, it sprang out of indentured persons who fled their creditors and were punished by adding time onto thier indenture. In a landmark case a court ruled that a man could theoretically be indentured for life as a punishment. This effectively made slavery "legal". The first slave owner of record-a black man.

BTW, that whole discussion is a little off topic-but who's keeping track.


----------



## GreatStuffGuy (Jul 19, 2012)

The core premise of your life is to create and use your God given freewill. Any sort of crutch or help or prop inhibits your freewill, plain and simple, so anything that helps you and keeps you imprisoned under the thumb of the government just keeps you from living the life you were born to live. Think very hard about that statement. I'm not religious but after a near death experience I know that to struggle brings about the best in the human experience. Ask most billionaires how they started and a large portion will tell you they had nothing and from nothing created everything.


----------



## americanwoodworker (Nov 26, 2011)

Cabs you missed the whole point. Today, okay, TODAY you know that slavery is not okay and is against man. Back then, okay, back then as in 200 years ago Slavery was normal. People did not think of it as abnormal because it was normal throughout history. Just like people thought witches that flew around on brooms were real. Stop using your mindset of today when you judge people from back then. To put it another way stop laughing at them for sending snail mail because you can send an email today. *They did not know any better. * We on the other hand do know better.

*are u comparing cocaine usage to owning people?* No, I was pointing out that Obama is not judged for what he did. You guys always seem to gloss over his faults and the "illegal" activities he did in his pass. However you judge the founders and their faults when what they were doing was actually a legal practice. They were not breaking the law. Obama on the other hand knowingly broke the law and did so more than once. Even admitting to vandalizing private property by "putting out his cigarettes in the carpet". But that's okay right?

If you fail to understand this then your are blinded by your partisanship and I will no longer explain facts. It would be a waste of my time.

*And I would like to see your info on African Americans owning slaves when legaly they couldnt own land vote or even be counted as a whole person during a census so i doubt they were allowed to own slaves and if they were I highly doubt they would particpate in such evil.* Please read about Anthony Johnson. The first slave owner in America. In the US Census of 1830 there were 3,775 free blacks who owned 12,740 black slaves.The census of 1830 lists 965 free black slave owners in Louisiana, owning 4,206 slaves. The state of South Carolina, lists 464 free blacks owning 2,715 slaves. The reason they could not be counted as a whole person in the census, not half but 3/5ths clause, not half as you have stated is because this was the founders first move towards freeing slaves. It's too long to go into here but if you wish please do your research from historians "without" an agenda.

Please read the following…
Free ************************* Owners of Slaves in the United States in 1830 (published in 1924), by Carter G. Woodson…A Black Historian.
The Known World, by Black author Edward P. Jones
Black Slaveowners: Free Black Slave Masters in South Carolina, 1790-1860 By Larry Koger


----------



## cabs4less (Nov 2, 2010)

American woodworker I never said my political views or that i was pro Obama You assume that and I never stated half I know of the 3/5 clause and i understand your view of what was okay then is not ok now but since the start of slavery there have been people who were agaisnt it and evil is evil no matter when it took place or what was political correct at that time. I do find it curious that You assume I am a democrat because i made a joke about ben and asked if you were comparing cocain to slavery. And please dont waste your time on me. And i find the tone of your post somewhat hostile. If i offended you I do apologize it was just a joke and then a follow up post with a honest question


----------



## americanwoodworker (Nov 26, 2011)

Cabs, I get hostile only when you try to put a bug near me, not when discussing Politics.  I am just not one who tries to be politically correct. I am blunt and say what I say. Call me old fashioned but I just refuse to play along with the continual path of creating a society where Dr. Phil can heal peoples hurt feelings. I guess I believe my way doesn't continually erode peoples skin, it adds to it.

I do apologize, I miss read your statement about the half part. I also never assumed you were a democrat, I did however assume you were an Obama supporter. Not saying thats right or wrong just that everyone deserves the same honest scrutiny. White or black. Democrat or republican.

Yes some people back then did think slavery was not okay. But some also thought the British were good to them. You will always find people through out history with different thoughts about common issues. Just like I assume you thought there was never such a thing of a Black man owning another black man. I don't think most of them ever really thought of it as a right or wrong issue at the time. It's what they grew up witnessing as children and assumed it was normal. Just like children who grow up in drug infested homes. They don't see anything wrong with what they are doing. It's normal too them and some grow up realizing it is wrong and change their ways and others don't. A good example would be the gay marriage movement today. Is gay marriage right or wrong?

You are correct in that evil is evil. The only reason we know right from wrong, is because someone told us it was. Or we observed it ourselves, and silently asked ourselves "how would I feel?". Now I am becoming philosophical and should probably stop here. I think You get my point.

By the way I do hope you do some reading up on the history of slavery. You will be surprised to know that slavery as we know it today only came about after a Black Man (Anthony Johnson) convinced a court that his servant (also a black man), John Casor, was his for life. That's when the tides turned and Indentured servitude became slavery from hell.

Cabs we still friends, no hard feelings brother.


----------



## DanYo (Jun 30, 2007)




----------



## DanYo (Jun 30, 2007)




----------

