Hard to see how this will work, but looks like it's going to become a reality.
http://www.msnbc.msn.com/id/33748707/ns/politics-health_care_reform/
QuoteLandmark health insurance bill passes House
Tough fight still ahead in Senate, and two versions have wide differences
updated 12:18 a.m. ET Nov. 8, 2009
WASHINGTON - Triumphant Democrats passed landmark health care legislation in the House late Saturday night, spurred by a summons from President Barack Obama to "answer the call of history" and expand coverage to millions who lack it.
The final vote was a narrow 220-215. Only one Republican — Rep. Joseph Cao of Louisiana — voted for the measure; 39 Democrats voted against it.
Earlier, the House approved an abortion amendment and rejected a Republican substitute for the legislation, paving the way to final passage.
The passage of the bill was an exhilarating victory for House Speaker Nancy Pelosi and for President Barack Obama.
But the Senate has yet to begin floor debate on its own version of insurance reform. That debate may be weeks away, with Senate Democratic leaders still negotiating over the details of their legislation.
If the Senate enacts its bill, conferees from House and Senate would then meet to negotiate a final compromise measure.
That compromise would then need to be voted on by the House and Senate.
So Democratic members from Republican-leaning districts who cast a difficult vote Saturday night for the House bill will face yet another tough vote in several weeks.
"It provides coverage for 96 percent of Americans. It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it," said Rep. John Dingell, the 83-year-old Michigan lawmaker who has introduced national health insurance in every Congress since succeeding his father in 1955.
In the runup to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups. They prevailed on a roll call of 240-194.
The vote added to the Democratic bill an amendment sponsored by Rep. Bart Stupak, D-Mich., and others, that prohibits individuals who receive insurance subsidies from purchasing any plan that pays for elective abortions.
House Democratic leaders agreed Friday night to allow a floor vote on the Stupak amendment to the bill in order to win the support of about three dozen Democrats who feared that the original bill would have subsidized abortions.
Ironically, the abortion vote only solidified support for the legislation, clearing the way for the conservative Democrats to vote for it.
A cheer went up from the Democratic side of the House when the bill gained 218 votes, a majority. Moments later, Democrats counted down the final seconds of the voting period in unison, and and let loose an even louder roar when Pelosi grabbed the gavel and declared, "the bill is passed.'
From the Senate, Majority Leader Harry Reid of Nevada issued a statement saying, "We realize the strong will for reform that exists, and we are energized that we stand closer than ever to reforming our broken health insurance system."
Nearly united in opposition to the health care bill, minority Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.
"We are going to have a complete government takeover of our health care system faster than you can say, `this is making me sick,'" jabbed Rep. Candice Miller, R-Mich., adding that Democrats were intent on passing "a jobs-killing, tax-hiking, deficit-exploding" bill.
But with little or no doubt about the outcome, the rhetoric lacked the fire of last summer's town hall meetings, when some critics accused Democrats of plotting "death panels" to hasten the demise of senior citizens.
The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.
Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation.
At its core, the measure would create a federally regulated marketplace where consumers could shop for coverage. In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private firms.
The bill is projected to expand coverage to 36 million uninsured, resulting in 96 percent of the nation's eligible population having insurance.
To pay for the expansion of coverage, the bill cuts Medicare's projected spending by more than $400 billion over a decade. It also imposes a tax surcharge of 5.4 percent on income over $500,000 in the case of individuals and $1 million for families.
The bill was estimated to reduce federal deficits by about $104 billion over a decade, although it lacked two of the key cost-cutting provisions under consideration in the Senate, and its longer-term impact on government red ink was far from clear.
Democrats lined up a range of outside groups behind their legislation, none more important than the AARP, whose support promises political cover against the cuts to Medicare in next year's congressional elections.
The nation's drug companies generally support health care overhaul. And while the powerful insurance industry opposed the legislation, it did so quietly, and the result was that Republicans could not count on the type of advertising campaign that might have peeled away skittish Democrats in swing districts.
Overall, the bill envisioned the most sweeping set of changes to the health care system in more than a generation, and Democrats said it marked the culmination of a campaign that Harry Truman began when he sat in the White House 60 years ago.
Debate on the House floor had already begun when Obama strode into a closed-door meeting of the Democratic rank and file across the street from the Capitol to make a final personal appeal to them to pass his top domestic priority.
Later, in an appearance at the White House, he said he had told lawmakers, "to rise to this moment. Answer the call of history, and vote yes for health insurance reform for America."
Participants also said Obama had referred to this week's shooting rampage at Fort Hood, Texas, in which 13 people were killed. His remarks put in perspective that the hardships soldiers endure for the country are "what sacrifice really is," as opposed to "casting a vote that might lose an election for you," said Rep. Robert Andrews, D-N.J.
It appeared that the compromise brokered Friday night on the volatile issue of abortion had finally secured the votes needed to pass the legislation.
As drafted, the measure denied the use of federal subsidies to purchase abortion coverage in policies sold by private insurers in the new insurance exchange, except in cases of incest, rape or when the life of the mother was in danger.
But abortion foes won far stronger restrictions that would rule out abortion coverage except in those three categories in any government-sold plan. It would also ban abortion coverage in any private plan purchased by consumers receiving federal subsidies.
Disappointed Democratic abortion rights supporters grumbled about the turn of events, but appeared to pull back quickly from any thought of opposing the health care bill in protest.
One, Rep. Jan Schakowsky, D-Ill., detailed numerous other benefits for women in the bill, including free medical preventive services and better prescription drug coverage under Medicare. "Women need health care reform," she concluded in remarks on the House floor.
Republicans offered an alternative that relied heavily on loosening regulations on private insurers to reduce costs for those who currently have insurance, in some cases by as much as 10 percent. But congressional budget analysts said the plan would make no dent in the ranks of the uninsured, an assessment that highlighted the difference in priorities between the two political parties.
It fell by a near party line vote of 258-176.
Msnbc.com's Tom Curry contributed to this report from The Associated Press.
Pelosi seems intent on organizing a Democratic defeat in the mid terms. Obama, of course, couldn't agree more.
Meh...when it's all said and done, by the time it's watered down to virtually nothing, it'll be back to business as usual for everyone getting raped by doctors, insurance companies and the pharmaceutical industry in a big ol' Venn diagram of assfucking the public.
QuoteInsurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation.
However, that part does not break my heart.
Anyone know why 4% are left uncovered? Is that a forecast of the people that will opt out and pay the penalty?
Quote from: Admiral Yi on November 08, 2009, 12:45:23 AM
Anyone know why 4% are left uncovered? Is that a forecast of the people that will opt out and pay the penalty?
Illegal population?
This is going to incredibly hard on a lot of people, I think. The requirement to buy insurance will be what kills this for a whole lot of people.
It's not like car insurance. If you can't afford car insurance, you can just not drive and take public transportation. With this, you're smacked with a penalty, and no real options if you fall into the gap between what the government says you can afford and what you actually can afford.
Quote from: CountDeMoney on November 08, 2009, 12:44:37 AM
Meh...when it's all said and done, by the time it's watered down to virtually nothing, it'll be back to business as usual for everyone getting raped by doctors, insurance companies and the pharmaceutical industry in a big ol' Venn diagram of assfucking the public.
Are you implying there was or is something in the full strength, unwatered version that would have prevented or ameliorated said rape?
Quote from: Darth Wagtaros on November 08, 2009, 12:40:34 AM
Pelosi seems intent on organizing a Democratic defeat in the mid terms. Obama, of course, couldn't agree more.
By doing what they were elected to do? I don't get this. WTF are Democrats supposed to do to stay elected, act like Republicans?
In any case, even if it is true, it's better to be voted out for doing what you promised to do, rather than be voted out for not doing what you promised to do.
Quote from: merithyn on November 08, 2009, 12:56:37 AM
This is going to incredibly hard on a lot of people, I think. The requirement to buy insurance will be what kills this for a whole lot of people.
It's not like car insurance. If you can't afford car insurance, you can just not drive and take public transportation. With this, you're smacked with a penalty, and no real options if you fall into the gap between what the government says you can afford and what you actually can afford.
You won't be able to receive health care from emergency rooms without paying for it anymore. Crying shame, I tell ya. I swear, if we have to give up that plasma and XBox 360...
Quote from: Admiral Yi on November 08, 2009, 12:45:23 AM
Anyone know why 4% are left uncovered? Is that a forecast of the people that will opt out and pay the penalty?
Amish?
Quote from: Admiral Yi on November 08, 2009, 01:00:54 AM
Quote from: CountDeMoney on November 08, 2009, 12:44:37 AM
Meh...when it's all said and done, by the time it's watered down to virtually nothing, it'll be back to business as usual for everyone getting raped by doctors, insurance companies and the pharmaceutical industry in a big ol' Venn diagram of assfucking the public.
Are you implying there was or is something in the full strength, unwatered version that would have prevented or ameliorated said rape?
I'll use the Yi Strategy, and answer a question with a question, OK?
Quote from: Fate on November 08, 2009, 01:35:48 AM
Crying shame, I tell ya. I swear, if we have to give up that plasma and XBox 360...
That probably wouldn't even come close to covering the bill.
Quote from: DGuller on November 08, 2009, 01:02:07 AM
Quote from: Darth Wagtaros on November 08, 2009, 12:40:34 AM
Pelosi seems intent on organizing a Democratic defeat in the mid terms. Obama, of course, couldn't agree more.
By doing what they were elected to do? I don't get this. WTF are Democrats supposed to do to stay elected, act like Republicans?
In any case, even if it is true, it's better to be voted out for doing what you promised to do, rather than be voted out for not doing what you promised to do.
Obama has lost the votes of alot of people who already hate him in doing this.
Quote from: Admiral Yi on November 08, 2009, 12:45:23 AM
Anyone know why 4% are left uncovered? Is that a forecast of the people that will opt out and pay the penalty?
Penalty? How much is that? How is it enforced?
In jan 1, 2010, all US monies must be exchanged for Obama Dollars
Quote from: Jaron on November 08, 2009, 03:55:33 AM
In jan 1, 2010, all US monies must be exchanged for Obama Dollars
These are different from Bush Dollars in what way?
Quote from: FunkMonk on November 08, 2009, 04:21:34 AM
Quote from: Jaron on November 08, 2009, 03:55:33 AM
In jan 1, 2010, all US monies must be exchanged for Obama Dollars
These are different from Bush Dollars in what way?
Not as much cocaine on them.
Quote from: citizen k on November 08, 2009, 02:54:30 AM
Quote from: Fate on November 08, 2009, 01:35:48 AM
Crying shame, I tell ya. I swear, if we have to give up that plasma and XBox 360...
That probably wouldn't even come close to covering the bill.
The bill? No. The premiums (or if you're crazy and choose the fine)? Yes.
The fine is $3,800 per year in the Senate version. I don't know the price tag of the public option premium in the House or Senate bills, but individual states such as Washington offer a public option on a sliding scale of your ability to pay between $90-250 a month.
Quote from: merithyn on November 08, 2009, 12:56:37 AM
With this, you're smacked with a penalty, and no real options if you fall into the gap between what the government says you can afford and what you actually can afford.
Wouldn't this have no effect at all if there wasn't some sort of penalty?
Quote from: Fate on November 08, 2009, 04:56:05 AM
The bill? No. The premiums (or if you're crazy and choose the fine)? Yes.
The fine is $3,800 per year in the Senate version. I don't know the price tag of the public option premium in the House or Senate bills, but individual states such as Washington offer a public option on a sliding scale of your ability to pay between $90-250 a month.
Which is why if I start getting fined, I'm taking that shit to court. I can't pay that. I can't even pay the bills I already have without family assistance. I'm really hoping the government's ready for the number of right to privacy suits that are going to be taken to court when the fines start forcing lower-income families even further behind on bills, but I'm pretty sure that's a false hope.
Quote from: merithyn on November 08, 2009, 12:56:37 AM
This is going to incredibly hard on a lot of people, I think. The requirement to buy insurance will be what kills this for a whole lot of people.
It's not like car insurance. If you can't afford car insurance, you can just not drive and take public transportation. With this, you're smacked with a penalty, and no real options if you fall into the gap between what the government says you can afford and what you actually can afford.
Isn't the point that if you can't afford it the government will subsidize it?
Quote from: Faeelin on November 08, 2009, 10:12:11 AM
Isn't the point that if you can't afford it the government will subsidize it?
In theory. As Meri subtly pointed out, there's often a disparity between what the government
thinks you can afford and what you can
actually afford.
Of course, there is generally a disparity between what citizens think they can afford and what they can actually afford.
Quote from: CountDeMoney on November 08, 2009, 02:54:14 AM
I'll use the Yi Strategy, and answer a question with a question, OK?
Depends. If you drop the "public option would have lowered costs" line then it's OK. If you bring it up again we can revisit it then. :)
Quote from: Admiral Yi on November 08, 2009, 02:47:12 PM
Depends. If you drop the "public option would have lowered costs" line then it's OK. If you bring it up again we can revisit it then. :)
It would lower my costs. <_<
Quote from: DontSayBanana on November 08, 2009, 09:13:26 AM
Quote from: Fate on November 08, 2009, 04:56:05 AM
The bill? No. The premiums (or if you're crazy and choose the fine)? Yes.
The fine is $3,800 per year in the Senate version. I don't know the price tag of the public option premium in the House or Senate bills, but individual states such as Washington offer a public option on a sliding scale of your ability to pay between $90-250 a month.
Which is why if I start getting fined, I'm taking that shit to court. I can't pay that. I can't even pay the bills I already have without family assistance. I'm really hoping the government's ready for the number of right to privacy suits that are going to be taken to court when the fines start forcing lower-income families even further behind on bills, but I'm pretty sure that's a false hope.
The country can no longer afford to pay for you and others like you who abuse health care services only when shit hits the fan in an emergency room. Time to pay up.
The public option does lower costs, because the public insurer has the advantage of being able to tell the hospitals what price they are allowed to charge.
Quote from: merithyn on November 08, 2009, 12:56:37 AM
This is going to incredibly hard on a lot of people, I think. The requirement to buy insurance will be what kills this for a whole lot of people.
It's not like car insurance. If you can't afford car insurance, you can just not drive and take public transportation. With this, you're smacked with a penalty, and no real options if you fall into the gap between what the government says you can afford and what you actually can afford.
If we are going to provide universal care, it is going to suck for whoever has to pay for it.
Quote from: Neil on November 08, 2009, 03:46:24 PM
The public option does lower costs, because the public insurer has the advantage of being able to tell the hospitals what price they are allowed to charge.
Well, the private insurers have the advantage of being able to tell the hospitals how much they will pay despite what the hospitals are allowed to charge.
Actually who cares about costs? Clearly the US government can just spend as much as it likes.
Quote from: Fate on November 08, 2009, 01:35:48 AM
You won't be able to receive health care from emergency rooms without paying for it anymore. Crying shame, I tell ya. I swear, if we have to give up that plasma and XBox 360...
You're obviously not someone in the "in between" if you think that they have a plasma TV or XBox 360. The working poor usually make enough to get by, and not a whole lot else. At the same time, they don't qualify for food stamps, subsidized insurance, etc., because they make too much. Unless the government is very careful about where that cut off is, there is going to be a large group out there with no options.
Quote from: garbon on November 08, 2009, 02:45:24 PM
Of course, there is generally a disparity between what citizens think they can afford and what they can actually afford.
That's true, as well, but a $3800 fine is too steep. Show me someone right passed the poverty line who can afford $300+ per month. Unless they offer some sort of sliding scale in all states, that's just not going to be possible for any of these people.
We're sitting at more than 10% unemployment. The bankruptcy rate is the highest it's been in decades. It won't take long before people decide that it's in their best interest to quit working and go on public aid and public health because it saves them money to do so. This new policy that requires health insurance or face a $300/month fine will push a whole lot of people over that line.
Surely that $3,800 is the max fine, not the minimum or a flat rate.
Quote from: merithyn on November 08, 2009, 04:55:41 PM
We're sitting at more than 10% unemployment. The bankruptcy rate is the highest it's been in decades. It won't take long before people decide that it's in their best interest to quit working and go on public aid and public health because it saves them money to do so. This new policy that requires health insurance or face a $300/month fine will push a whole lot of people over that line.
That's the true democrat paradise. :)
Quote from: Admiral Yi on November 08, 2009, 04:56:48 PM
Surely that $3,800 is the max fine, not the minimum or a flat rate.
Ask Fate. He dropped the numbers into the conversation.
Hey Fate, is that $3,800 a max fine, a minimum, or a flat rate?
Quote from: Admiral Yi on November 08, 2009, 04:59:09 PM
Hey Fate, is that $3,800 a max fine, a minimum, or a flat rate?
He was euthanized by the death panel. :( :(
Quote from: Darth Wagtaros on November 08, 2009, 05:14:51 PM
He was euthanized by the death panel. :( :(
Last time I listen to Meri. <_<
Sorry. :(
I thought that was scheduled for tomorrow.
Quote from: Darth Wagtaros on November 08, 2009, 05:14:51 PM
Quote from: Admiral Yi on November 08, 2009, 04:59:09 PM
Hey Fate, is that $3,800 a max fine, a minimum, or a flat rate?
He was euthanized by the death panel. :( :(
Sarah Palin saved me from the death panel.
Quote from: Admiral Yi on November 08, 2009, 04:59:09 PM
Hey Fate, is that $3,800 a max fine, a minimum, or a flat rate?
The language I read was "up to" but the $3,800 number is most frequently quoted by GOPtard blogs so who knows if it's still accurate with respect to the current iterations of health care reform.
Quote from: merithyn on November 08, 2009, 04:48:13 PM
Quote from: Fate on November 08, 2009, 01:35:48 AM
You won't be able to receive health care from emergency rooms without paying for it anymore. Crying shame, I tell ya. I swear, if we have to give up that plasma and XBox 360...
You're obviously not someone in the "in between" if you think that they have a plasma TV or XBox 360. The working poor usually make enough to get by, and not a whole lot else. At the same time, they don't qualify for food stamps, subsidized insurance, etc., because they make too much. Unless the government is very careful about where that cut off is, there is going to be a large group out there with no options.
You have an option. Buy insurance or pay a fine.
:nelson
http://news.yahoo.com/s/ap/20091108/ap_on_bi_ge/us_health_care_overhaul
QuoteThe glow from a health care triumph faded quickly for President Barack Obama on Sunday as Democrats realized the bill they fought so hard to pass in the House has nowhere to go in the Senate.
Speaking from the Rose Garden about 14 hours after the late Saturday vote, Obama urged senators to be like runners on a relay team and "take the baton and bring this effort to the finish line on behalf of the American people."
The problem is that the Senate won't run with it. The government health insurance plan included in the House bill is unacceptable to a few Democratic moderates who hold the balance of power in the Senate.
If a government plan is part of the deal, "as a matter of conscience, I will not allow this bill to come to a final vote," said Sen. Joe Lieberman, the Connecticut independent whose vote Democrats need to overcome GOP filibusters.
"The House bill is dead on arrival in the Senate," Sen. Lindsey Graham, R-S.C., said dismissively
68% of the Connecticut's citizens support the public option, but thank god Leiberman is on the front lines defending the health insurance lobby.
There's always reconciliation. :)
Quote from: Fate on November 08, 2009, 05:57:29 PM
Quote from: merithyn on November 08, 2009, 04:48:13 PM
You're obviously not someone in the "in between" if you think that they have a plasma TV or XBox 360. The working poor usually make enough to get by, and not a whole lot else. At the same time, they don't qualify for food stamps, subsidized insurance, etc., because they make too much. Unless the government is very careful about where that cut off is, there is going to be a large group out there with no options.
You have an option. Buy insurance or pay a fine.
And when you can't afford insurance or the fine?
Quote from: merithyn on November 08, 2009, 08:49:45 PM
Quote from: Fate on November 08, 2009, 05:57:29 PM
Quote from: merithyn on November 08, 2009, 04:48:13 PM
You're obviously not someone in the "in between" if you think that they have a plasma TV or XBox 360. The working poor usually make enough to get by, and not a whole lot else. At the same time, they don't qualify for food stamps, subsidized insurance, etc., because they make too much. Unless the government is very careful about where that cut off is, there is going to be a large group out there with no options.
You have an option. Buy insurance or pay a fine.
And when you can't afford insurance or the fine?
Pawn the plasma.
Quote from: merithyn on November 08, 2009, 08:49:45 PM
Quote from: Fate on November 08, 2009, 05:57:29 PM
Quote from: merithyn on November 08, 2009, 04:48:13 PM
You're obviously not someone in the "in between" if you think that they have a plasma TV or XBox 360. The working poor usually make enough to get by, and not a whole lot else. At the same time, they don't qualify for food stamps, subsidized insurance, etc., because they make too much. Unless the government is very careful about where that cut off is, there is going to be a large group out there with no options.
You have an option. Buy insurance or pay a fine.
And when you can't afford insurance or the fine?
Shoot your president.
Meri--first, people at the poverty level aren't (or at least shouldn't) be hit with penalties for not getting private insurance. Second, for people that are subject to the mandate, the fines would just be another part of the taxes the people must pay. I would assume people could plan for the payments just like the they do the rest of their taxes. And if they don't, they get to negotiate with the IRS.
Quote from: alfred russel on November 08, 2009, 08:59:41 PM
Meri--first, people at the poverty level aren't (or at least shouldn't) be hit with penalties for not getting private insurance. Second, for people that are subject to the mandate, the fines would just be another part of the taxes the people must pay. I would assume people could plan for the payments just like the they do the rest of their taxes. And if they don't, they get to negotiate with the IRS.
The problem isn't people below the poverty line. The problem is those slightly above it.
We have a requirement in our school district that requires health insurance in order for students to participate in sports. A good number of our athletes' parents came in to complain because they made too much to qualify for state-sponsored insurance, and yet too little to afford private healthcare, since their companies' policies were too expensive.
I had to quit my second job at Borders working 10-15 hours per week so that my kids would qualify for state-assisted insurance. I couldn't afford insurance through the school district because they charged $630/month for the family plan, and the private health insurance providers were worse. (The lowest you could possibly get regardless of number of kids, etc.) It wasn't worth the few extra hundred dollars a month (the money that went toward school activities for the kids, or the occasional night out for Max and me) and lose insurance, especially with two sick kids.
If you're not living on the edge, you don't know what it's like. I saw it every day at the school: the working poor struggling to feed their kids lunches because they didn't qualify for free or reduced lunches, but were struggling to pay their rent, utilities, car insurance, and put food on the table.
It's a nice idea... and if played out right, has potential. The reality, however, is rarely what people think it is. Those just over the poverty line are the most at risk in this.
Quote from: Fate on November 08, 2009, 06:50:33 PM
68% of the Connecticut's citizens support the public option, but thank god Leiberman is on the front lines defending the health insurance lobby.
There's always reconciliation. :)
And 74% of polls are made up.
You guys were so close.
Quote from: Grey Fox on November 09, 2009, 08:49:32 AM
You guys were so close.
Not really. Remember: Any bill that doesn't eviscerate their current system isn't really much of a step forward.
And any system that forces insurance companies to provide coverage to anyone without seriously mandating everyone to buy coverage will just makes things much worse. I cannot comprehend the stupidity of politicians who lower the fines for the mandate to "make it easier on the families", seemingly oblivious to the fact that the two things MUST go together. The families aren't going to be helped when the premiums skyrocket because insurance would become something you buy when you get sick.
Lieberman said the same thing about the Clinton plan in '93 and then still ended up voting for it.
IMO--Joe is stuck and it's our own fault. If we hadn't Lamonted him, his base would not have changed to not include the people who support the plan. By pushing him out of the party, his base of support changed to the moderates and even a lot of Republicans. That's who he's trying to keep happy. In the near future, we might be blaming the failure of universal health care on Ned Lamont.
Quote from: MadImmortalMan on November 09, 2009, 03:41:55 PM
Lieberman said the same thing about the Clinton plan in '93 and then still ended up voting for it.
IMO--Joe is stuck and it's our own fault. If we hadn't Lamonted him, his base would not have changed to not include the people who support the plan. By pushing him out of the party, his base of support changed to the moderates and even a lot of Republicans. That's who he's trying to keep happy. In the near future, we might be blaming the failure of universal health care on Ned Lamont.
I wish Count was still here so he could read this post.
How would I go about paying this for instance? Full time student, unemployed, no real income. I don't like it, I never go to the doctor, but if they were making me pay I'd be getting every little ailment checked out, may as well.
Quote from: Alcibiades on November 09, 2009, 04:19:21 PM
How would I go about paying this for instance? Full time student, unemployed, no real income. I don't like it, I never go to the doctor, but if they were making me pay I'd be getting every little ailment checked out, may as well.
One good thing I saw is that children can be on their parents' policy up until 27 (as opposed to until the end of college). That's a HUGE crack that's being patched up, and one that I was personally in for some time.
Quote from: Alcibiades on November 09, 2009, 04:19:21 PM
How would I go about paying this for instance? Full time student, unemployed, no real income. I don't like it, I never go to the doctor, but if they were making me pay I'd be getting every little ailment checked out, may as well.
That's how its worked out hre in Mass. Now that everyone has to have insurance everyone is running to the Doctor whenever something comes up.
Quote from: Darth Wagtaros on November 09, 2009, 04:51:54 PM
Quote from: Alcibiades on November 09, 2009, 04:19:21 PM
How would I go about paying this for instance? Full time student, unemployed, no real income. I don't like it, I never go to the doctor, but if they were making me pay I'd be getting every little ailment checked out, may as well.
That's how its worked out hre in Mass. Now that everyone has to have insurance everyone is running to the Doctor whenever something comes up.
Of course, why not? It doesn't cost you anything, or very little, so you might as well use it!
The joys of disconnecting the consumer of a service from the person paying for it - what could possibly go wrong???
Quote from: Hansmeister on November 09, 2009, 12:06:47 AM
Quote from: Fate on November 08, 2009, 06:50:33 PM
68% of the Connecticut's citizens support the public option, but thank god Leiberman is on the front lines defending the health insurance lobby.
There's always reconciliation. :)
And 74% of polls are made up.
The public option is overwhelmingly popular in Lieberman's state. :huh:
Quote from: Alcibiades on November 09, 2009, 04:19:21 PM
How would I go about paying this for instance? Full time student, unemployed, no real income.
This may not apply to your circumstances, but I know the House bill changed the rules so that you are able to stay on your parents' insurance until the age of 27.
Oops, DG beat me. I know my parents' current plan has always been set at 25, rather than 22 (which is when most people graduate).
Parents aren't an option. I'm flying completely solo these days.
Quote from: Berkut on November 09, 2009, 04:58:19 PM
Quote from: Darth Wagtaros on November 09, 2009, 04:51:54 PM
Quote from: Alcibiades on November 09, 2009, 04:19:21 PM
How would I go about paying this for instance? Full time student, unemployed, no real income. I don't like it, I never go to the doctor, but if they were making me pay I'd be getting every little ailment checked out, may as well.
That's how its worked out hre in Mass. Now that everyone has to have insurance everyone is running to the Doctor whenever something comes up.
Of course, why not? It doesn't cost you anything, or very little, so you might as well use it!
The joys of disconnecting the consumer of a service from the person paying for it - what could possibly go wrong???
Who could have imagined a 600+ million dollar budget deficit? Surely the thousands of people who will be layed off, and their slightly more fortunate peerrs who will be getting furloughs will be pleased that their sacrifice means that someone who paid nothing in will be getting necessary work done.
Isn't higher utilization kind of the point of health insurance reform? The goal is not to have people avoiding doctors with insurance, whereas previously they avoided doctors without insurance. Yeah, yeah, I know the point you guys are making, but I'm just throwing food for thought here.
Rachel Maddow is not too fond of Joe Lieberman right now. he he
Quote from: Fate on November 09, 2009, 05:27:29 PM
Quote from: Hansmeister on November 09, 2009, 12:06:47 AM
Quote from: Fate on November 08, 2009, 06:50:33 PM
68% of the Connecticut's citizens support the public option, but thank god Leiberman is on the front lines defending the health insurance lobby.
There's always reconciliation. :)
And 74% of polls are made up.
The public option is overwhelmingly popular in Lieberman's state. :huh:
Evidence?
http://www.myleftnutmeg.com/diary/11757/support-for-public-option-in-connecticut-by-district (http://www.myleftnutmeg.com/diary/11757/support-for-public-option-in-connecticut-by-district)
Quote from: Peter Wiggin on November 09, 2009, 11:58:41 PM
http://www.myleftnutmeg.com/diary/11757/support-for-public-option-in-connecticut-by-district (http://www.myleftnutmeg.com/diary/11757/support-for-public-option-in-connecticut-by-district)
That must be the only poll showing a majority supporting the "public option" because virtually every serious poll I've seen shows between a majority and a plurality against it. This particular poll shows not only a large majority in Connecticut, but also large majorities nationwides supporting it, which is a laughable. Of course you would have to look at the internals of the poll and the way the question was phrased by the left-wing group that did this poll to get to the bottom of it.
Quote from: Berkut on November 09, 2009, 04:58:19 PM
Quote from: Darth Wagtaros on November 09, 2009, 04:51:54 PM
Quote from: Alcibiades on November 09, 2009, 04:19:21 PM
How would I go about paying this for instance? Full time student, unemployed, no real income. I don't like it, I never go to the doctor, but if they were making me pay I'd be getting every little ailment checked out, may as well.
That's how its worked out hre in Mass. Now that everyone has to have insurance everyone is running to the Doctor whenever something comes up.
Of course, why not? It doesn't cost you anything, or very little, so you might as well use it!
The joys of disconnecting the consumer of a service from the person paying for it - what could possibly go wrong???
Trouble with that idea is, going to the doctor is no great fun... actually, it's more like a pain in the ass, you do it only because you have to. Yes, with 'socialized health care' you go to the doctor 'whenever something comes up', he sees you and you don't pay a cent... in money. But you spend at least two hours making the appointment, going to the health center, waiting, seeing the doctor and afterwards you have to buy medicines if necessary (at a discount, but they aren't 100% free). Not my idea of a well spent afternoon unless I'm ill, and not totally free... besides, that 'whenever something comes up' part avoids persons going to the doctor only when their little ailments have developed into something really serious.
And you really really
want people to use doctors, if only because so many ailments are infectious illnesses.
You really should spend all of five minutes examining how this kind of thing works in Europe. Not that the system is perfect, far from it, but some things you fear simply don't happen. Fearing consumers will visit the doctors every day without any valid reason is a bit like fearing mandatory car insurances will make the number of car crashes skyrocket right trough the roof.
Quote from: Alatriste on November 10, 2009, 03:59:51 AM
You really should spend all of five minutes examining how this kind of thing works in Europe. Not that the system is perfect, far from it, but some things you fear simply don't happen. Fearing consumers will visit the doctors every day without any valid reason is a bit like fearing mandatory car insurances will make the number of car crashes skyrocket right trough the roof.
He's probably going by personal anecdotal experience here... I can tell you anecdotally that Princesca's former boss in Massachusetts was going to the doctor nonstop for both her and her two kids, and all three were on an absurd amount of medication. Seriously, she was at doctors' appointments like 3-5 times a week on average. She had her eight year old son on Prozac, Xanax, some acid reflux shit, etc. and had him going to a psychiatrist. The thinking is that this kind of behavior is what killed HMOs.
I don't know for sure, of course, but I wouldn't be surprised if Berkut has seen this kind of nonsense himself.
Based on the research that I've been doing here in Europe, I'd venture that Americans tend to care a lot less about the state and its money that Europeans. Patients talk here about not wanting to be on very expensive medications as they understand that it costs the government a lot of money. I think, us Americans, are more likely to be give what you got, I want the best and I don't care how much it costs the state.
Quote from: garbon on November 10, 2009, 08:39:17 AM
Based on the research that I've been doing here in Europe, I'd venture that Americans tend to care a lot less about the state and its money that Europeans. Patients talk here about not wanting to be on very expensive medications as they understand that it costs the government a lot of money. I think, us Americans, are more likely to be give what you got, I want the best and I don't care how much it costs the state.
:yes: That's very interesting, and I agree... I've never heard anyone even consider what's best for the state (libertarian or not).
Quote from: Caliga on November 10, 2009, 08:41:21 AM
Quote from: garbon on November 10, 2009, 08:39:17 AM
Based on the research that I've been doing here in Europe, I'd venture that Americans tend to care a lot less about the state and its money that Europeans. Patients talk here about not wanting to be on very expensive medications as they understand that it costs the government a lot of money. I think, us Americans, are more likely to be give what you got, I want the best and I don't care how much it costs the state.
:yes: That's very interesting, and I agree... I've never heard anyone even consider what's best for the state (libertarian or not).
Truth. The closest we come is pundits screaming about how much this program is going to add overall to the national deficit.
Quote from: Alatriste on November 10, 2009, 03:59:51 AM
Quote from: Berkut on November 09, 2009, 04:58:19 PM
Quote from: Darth Wagtaros on November 09, 2009, 04:51:54 PM
Quote from: Alcibiades on November 09, 2009, 04:19:21 PM
How would I go about paying this for instance? Full time student, unemployed, no real income. I don't like it, I never go to the doctor, but if they were making me pay I'd be getting every little ailment checked out, may as well.
That's how its worked out hre in Mass. Now that everyone has to have insurance everyone is running to the Doctor whenever something comes up.
Of course, why not? It doesn't cost you anything, or very little, so you might as well use it!
The joys of disconnecting the consumer of a service from the person paying for it - what could possibly go wrong???
Trouble with that idea is, going to the doctor is no great fun... actually, it's more like a pain in the ass, you do it only because you have to. Yes, with 'socialized health care' you go to the doctor 'whenever something comes up', he sees you and you don't pay a cent... in money. But you spend at least two hours making the appointment, going to the health center, waiting, seeing the doctor and afterwards you have to buy medicines if necessary (at a discount, but they aren't 100% free). Not my idea of a well spent afternoon unless I'm ill, and not totally free... besides, that 'whenever something comes up' part avoids persons going to the doctor only when their little ailments have developed into something really serious.
You are basically arguing that there is enough dis-incentive to visit the docotr that the cost of the visist somehow doesn't matter?
That is just silly - not everyone is as terrified of visiting a physician as perhaps you or the people you know are - I certainly see all the time people going to the doctors for all kinds of stupid crap. My sister is an ER nurse in NYC - and she sees this all the time - people coming to the ER (who of course have no insurance of any kind) for the most minor of ailments.
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And you really really want people to use doctors, if only because so many ailments are infectious illnesses.
Very few infectious illnessnes that are commonly seen are going to be less infectuous because someone goes to the doctor AFTER they are already sick. We aren't talkng about ebola, we are talking about the common cold.
Quote
You really should spend all of five minutes examining how this kind of thing works in Europe. Not that the system is perfect, far from it, but some things you fear simply don't happen.
I don't need to go to Europe, this is already happening right here in the good old United States. It is, IMO, the primary reason that health care costs in the US have skyrocketed in the last decade or two.
You bumped your head? Hey, order up an MRI! Why not, it is FREE!!!!
Quote
Fearing consumers will visit the doctors every day without any valid reason is a bit like fearing mandatory car insurances will make the number of car crashes skyrocket right trough the roof.
I don't think I said I was afraid consumers would visit doctors every day, I said I think consumers will consume a lot more services if they do not have to pay for those services themselves. You can argue that if you want, I guess, but I don't think you will have much luck, since that is a pretty basic assumption of human nature.
And really, comparing consuming health services with getting in a car accident? You are making Marty analogies look good.
To the extent the analogy works, it works for my point - you don't think people don't insist when they get in an accident that their car be fixed with only brand new parts, and go to the best shop for body work, and they want a nice rental car while the repair is being done, etc. etc., etc. - all because someone else will be paying for it?
Quote from: Caliga on November 10, 2009, 08:27:21 AM
Quote from: Alatriste on November 10, 2009, 03:59:51 AM
You really should spend all of five minutes examining how this kind of thing works in Europe. Not that the system is perfect, far from it, but some things you fear simply don't happen. Fearing consumers will visit the doctors every day without any valid reason is a bit like fearing mandatory car insurances will make the number of car crashes skyrocket right trough the roof.
He's probably going by personal anecdotal experience here... I can tell you anecdotally that Princesca's former boss in Massachusetts was going to the doctor nonstop for both her and her two kids, and all three were on an absurd amount of medication. Seriously, she was at doctors' appointments like 3-5 times a week on average. She had her eight year old son on Prozac, Xanax, some acid reflux shit, etc. and had him going to a psychiatrist. The thinking is that this kind of behavior is what killed HMOs.
I don't know for sure, of course, but I wouldn't be surprised if Berkut has seen this kind of nonsense himself.
Indeed. I don't even need to look at other people, I see it myself. Why not go to the doctor if the cost is very little? It takes me 5 minutes to make an appointment, and maybe an hour for the appointment itself. The cost to me is $20, and that is the cost no matter what the doctor decides I might need, "just in case".
I most *certainly* go to the doctor more often than I would if I had to bear the real cost myself - and by real cost I mean the actual fair market value if we had a fair market - it is pretty much impossible to know what that actually is though. A lot more than my co-pay, almost certainly a lot less than what the doctors bills my HMO.
Alatriste is right. Unless you are one of the first for the day, going to the doctor basically kills an entire morning (I have to do it often, sadly). And getting an MRI or similar in a non-emergency situation will take you another morning, and so on ... I don't know of anybody who does that for "fun". In fact most of my roommates at the hospital took too long in going to the doctor (just as I did).
What really clogs our system is simply the amount of old people out there.
Also, I suspect most of those who flood the doctors with silly stuff do it already, just like addicts get their fix by whatever means possible. The rest of you are indeed supposed to go to get checked if you have a problem.
Quote from: Iormlund on November 10, 2009, 09:33:35 AM
What really clogs our system is simply the amount of old people out there.
:yes:
I've said it before and I'm sure I'll say it again, but we need a mandatory execution age. :)
Quote from: Hansmeister on November 10, 2009, 12:11:19 AM
Quote from: Peter Wiggin on November 09, 2009, 11:58:41 PM
http://www.myleftnutmeg.com/diary/11757/support-for-public-option-in-connecticut-by-district (http://www.myleftnutmeg.com/diary/11757/support-for-public-option-in-connecticut-by-district)
That must be the only poll showing a majority supporting the "public option" because virtually every serious poll I've seen shows between a majority and a plurality against it. This particular poll shows not only a large majority in Connecticut, but also large majorities nationwides supporting it, which is a laughable. Of course you would have to look at the internals of the poll and the way the question was phrased by the left-wing group that did this poll to get to the bottom of it.
I have seen other polls that show that large majorities nationwide are supporting. In fact the polls I know that are showing that people don't support it are done by the same types who showed that John McCain would actually win in November.
Incidentally, I've seen a couple of people claiming the Stupak Amendment is unconstitional. Am I missing something, or is that a pile of horse shit?
Quote from: Faeelin on November 10, 2009, 10:06:32 AM
Incidentally, I've seen a couple of people claiming the Stupak Amendment is unconstitional. Am I missing something, or is that a pile of horse shit?
Not sure about blatantly unconstitutional, but here's the text of the amendment itself:
http://documents.nytimes.com/the-stupak-amendment#p=1
I think I see where the issue is- the amendment claims that it in no way prohibits the purchase of supplemental coverage to include nonessential abortions, but it's unreasonable to assume that those using the subsidy to purchase insurance would be able to afford supplemental insurance; even though it says it doesn't prohibit coverage for abortions, it attacks the indigents' right to select their coverage through their pockets.
Quote from: garbon on November 10, 2009, 08:39:17 AM
Based on the research that I've been doing here in Europe, I'd venture that Americans tend to care a lot less about the state and its money that Europeans. Patients talk here about not wanting to be on very expensive medications as they understand that it costs the government a lot of money. I think, us Americans, are more likely to be give what you got, I want the best and I don't care how much it costs the state.
I don't know if that's the biggest divide between us. For me the idea of deserving or not medical treatment because you can or cannot pay for it is much more alien. It just doesn't sound right. That everyone should have access to decent health care is for me a basic requirement of a working society, just like education or security.
Quote from: Alatriste on November 10, 2009, 03:59:51 AM
Trouble with that idea is, going to the doctor is no great fun... actually, it's more like a pain in the ass, you do it only because you have to. Yes, with 'socialized health care' you go to the doctor 'whenever something comes up', he sees you and you don't pay a cent... in money. But you spend at least two hours making the appointment, going to the health center, waiting, seeing the doctor and afterwards you have to buy medicines if necessary (at a discount, but they aren't 100% free). Not my idea of a well spent afternoon unless I'm ill, and not totally free... besides, that 'whenever something comes up' part avoids persons going to the doctor only when their little ailments have developed into something really serious.
And you really really want people to use doctors, if only because so many ailments are infectious illnesses.
You really should spend all of five minutes examining how this kind of thing works in Europe. Not that the system is perfect, far from it, but some things you fear simply don't happen. Fearing consumers will visit the doctors every day without any valid reason is a bit like fearing mandatory car insurances will make the number of car crashes skyrocket right trough the roof.
I was going to make the same point, but you said it better. Everyone in my family has insurance, but no one sees doctors themselves (although my sister does see them regularly for her three children, of course). Why? Just foolish stubborness, and the fact that it's not a fun experience.
I would make an exception for the old folk. I think a lot of them do like seeing doctors, for them it seems like a social event, and unfortunately the doctors frequently oblige. However, that falls under Medicare, not the new coverage we're talking about.
Quote from: Iormlund on November 10, 2009, 10:32:49 AM
Quote from: garbon on November 10, 2009, 08:39:17 AM
Based on the research that I've been doing here in Europe, I'd venture that Americans tend to care a lot less about the state and its money that Europeans. Patients talk here about not wanting to be on very expensive medications as they understand that it costs the government a lot of money. I think, us Americans, are more likely to be give what you got, I want the best and I don't care how much it costs the state.
I don't know if that's the biggest divide between us. For me the idea of deserving or not medical treatment because you can or cannot pay for it is much more alien. It just doesn't sound right. That everyone should have access to decent health care is for me a basic requirement of a working society, just like education or security.
But you don't need socialized health care to provide that, and in fact, the US already fulfills that "basic requirement" of a working society.
The debate is not whether or not everyone should have access to health care - that debate was settled decades ago - it is whether or not everyone should have the SAME access to health care, convenience, and who should pay for it all.
Quote from: Berkut on November 10, 2009, 11:03:27 AM
But you don't need socialized health care to provide that, and in fact, the US already fulfills that "basic requirement" of a working society.
It doesn't always. It does when you get into a car accident, it doesn't when you get cancer.
Quote from: DGuller on November 10, 2009, 10:40:09 AM
I was going to make the same point, but you said it better. Everyone in my family has insurance, but no one sees doctors themselves (although my sister does see them regularly for her three children, of course). Why? Just foolish stubborness, and the fact that it's not a fun experience.
So we should base the entire countries health care plan on the assumption that everyone is like your family?
I can assure you that there are lots of people out there who do not think like that.
And what is more, no matter how reluctant your family is to go see a doctor, obviously they would be MORE reluctant if they had to pay for it themselves - or rather, if their payment to go see a doctor was more clearly tied to their decision to go see one.
Quote
I would make an exception for the old folk. I think a lot of them do like seeing doctors, for them it seems like a social event, and unfortunately the doctors frequently oblige. However, that falls under Medicare, not the new coverage we're talking about.
How is the new coverage different such that it will prevent people from seeing the doctor whenever they have a tummy ache, if in fact they are inclined to do so?
What is different about this 'new coverage' that solves the fundamental problem I am talking about? And remember, this problem is not health care specific - it is a basic tenet of economic theory, that people will consume a service base din large extent on the cost of that service.
Is the plan to make the service so unpleasant and difficult to obtain that people won't want to get it, even if they really do need it?
BTW - I am not arguing that this would actually be any worse than what we have now, which seems to combine the worst aspects of private healthcare with the worst aspects of public servicing, so we get this current reality of ever increasing costs for the same levels of service, with the lions share of the increased money simply making the health care industry consume more and more and more of our actual income.
Quote from: Berkut on November 10, 2009, 11:03:27 AM
The debate is not whether or not everyone should have access to health care - that debate was settled decades ago - it is whether or not everyone should have the SAME access to health care, convenience, and who should pay for it all.
Don't confuse the debate with reality like that Berkut. It makes the GOP look much worse if people are allowed to scaremonger by suggesting that poor people are being denied medical care.
Quote from: Berkut on November 10, 2009, 11:09:06 AM
What is different about this 'new coverage' that solves the fundamental problem I am talking about? And remember, this problem is not health care specific - it is a basic tenet of economic theory, that people will consume a service base din large extent on the cost of that service.
The difference is that it affects people who don't actually like seeing doctors, and/or have something better to do with their time. The old folks don't see doctors frequently because they have Medicare, it's because they're old folks. In Soviet Union, where everyone had coverage, it was the same. They just don't have much to do with their time.
The problem you describe most certainly is there, but I think you're focusing on the wrong part. It's severity, not frequency, that takes a hit. It's not that people choose to go to the doctors willy-nilly, but rather that they go along with very expensive treatmennt that no cost-benefit analysis would come close to justifying, when a treatment 50 times cheaper would work almost as well.
Quote from: Berkut on November 10, 2009, 11:03:27 AM
But you don't need socialized health care to provide that, and in fact, the US already fulfills that "basic requirement" of a working society.
I think you and I have different ideas of what access entails. Having to go into bankruptcy to try to save someone close from cancer (to follow DGuller's example) doesn't sound to me like access at all. That that is an actual possibility at all is simply incomprehensible to me.
Quote from: Iormlund on November 10, 2009, 11:24:57 AM
Quote from: Berkut on November 10, 2009, 11:03:27 AM
But you don't need socialized health care to provide that, and in fact, the US already fulfills that "basic requirement" of a working society.
I think you and I have different ideas of what access entails. Having to go into bankruptcy to try to save someone close from cancer (to follow DGuller's example) doesn't sound to me like access at all. That that is an actual possibility at all is simply incomprehensible to me.
Oh, bankrutpcy may even apply in a car accident. The example with cancer has to do with not getting the treatment at all. Hospitals can't reject people who need emergency treatment, but they're not going to administer chemotherapy in the ER.
EDIT: Actually, car accident specifically is a bad example, because usually car insurance would cover something. So, to be perfectly exact, substitute some other catastrophe in place of car accident.
Now that you mention it, I don't think national health plan covers traffic accidents. AFAIK those fall under either work (when in itinere) or mandatory car insurance.
Quote from: Iormlund on November 10, 2009, 11:32:51 AM
Now that you mention it, I don't think national health plan covers traffic accidents. AFAIK those fall under either work (when in itinere) or mandatory car insurance.
Made an edit to that effect split second before you posted it.
Quote from: garbon on November 10, 2009, 08:39:17 AM
Based on the research that I've been doing here in Europe, I'd venture that Americans tend to care a lot less about the state and its money that Europeans. Patients talk here about not wanting to be on very expensive medications as they understand that it costs the government a lot of money. I think, us Americans, are more likely to be give what you got, I want the best and I don't care how much it costs the state.
I don't think Europeans are that self-less. However they've been talked out of overconsuming medical care (if indeed they have) it's not because of some sort of care for the state's resources. If I were to guess, and it's a pure guess, I'd imagine any lowering in consumption has to do with targetted education effort including by the doctors (no, no anti-biotics for this shit etc) and more direct controls (no, you can't have 27 appointments this months, fuck off).
Quote from: Iormlund on November 10, 2009, 11:32:51 AM
Now that you mention it, I don't think national health plan covers traffic accidents. AFAIK those fall under either work (when in itinere) or mandatory car insurance.
It actually becomes a major pain. My wife got into a car accident recently. Our health insurance provider and the car insurance company are fighting over who needs to cover the medical bills. The crux of the matter is that she either fell a sleep or blacked out while driving on her way to work. The car insurance is arguing that if she didn't fall a sleep than it's a pre-existing condition, so they won't pay for any doctors visits to help determine if it was a pre-existing condition.
Quote from: Jacob on November 10, 2009, 11:35:07 AM
(no, no anti-biotics for this shit etc) and more direct controls (no, you can't have 27 appointments this months, fuck off).
It would be great if Americans could be convinced of the fact that you don't in fact need antibiotics for everything. The same woman I earlier mentioned who was at the doctor nonstop for herself and her kids also used to demand she and her kids be prescribed things like Erythromycin whenever they had the flu. :frusty:
I think doctors hit a point where they just get tired of arguing and prescribe away.
It's comforting to see that, despite all our differences, insurance companies - like chatty old people - are the same everywhere. :P
Quote from: Caliga on November 10, 2009, 11:38:37 AM
I think doctors hit a point where they just get tired of arguing and prescribe away.
I think doctors get a lot of cash to prescribe away from the big drug makers.
Quote from: DGuller on November 10, 2009, 11:06:32 AM
Quote from: Berkut on November 10, 2009, 11:03:27 AM
But you don't need socialized health care to provide that, and in fact, the US already fulfills that "basic requirement" of a working society.
It doesn't always. It does when you get into a car accident, it doesn't when you get cancer.
Of course it does. If you get cancer, you go to the hospital and get health care. The level of care you will get will vary based on what state you are in (for example, in New York you will get as good of care being dirt poor as I can get being solidly middle class), but you cannot claim that everyone in the US (barring some extreme exceptions) does not get a basic level of health care. That is simply not true.
But no matter what system you use, *some* people will certianly get more care than others - so what do you define as the "basic minimum" that the state should provide? Even in a completely socialized system the super rich get better care - so you cannot claim that the system must provide perfectly even care - that is simply not possible.
And there lies the basic problem of all of this. Nobody is willing to actually talk about costs in a sane manner. It is all about what we "must" do, with the implication that it doesn't matter what the cost is, because everyone has some inalienable right to as much health care as they want.
Quote from: Iormlund on November 10, 2009, 11:24:57 AM
Quote from: Berkut on November 10, 2009, 11:03:27 AM
But you don't need socialized health care to provide that, and in fact, the US already fulfills that "basic requirement" of a working society.
I think you and I have different ideas of what access entails. Having to go into bankruptcy to try to save someone close from cancer (to follow DGuller's example) doesn't sound to me like access at all. That that is an actual possibility at all is simply incomprehensible to me.
So how often does that happen, where does it happen that someone will be refused treatment outright?
And what level of care should everyone get - should everyone get the very latest, most expensive treatments for cancer, no matter their ability to pay for it?
Like I said, this isn't about "basic healthcare", it is about what amounts of healthcare everyone should get, well beyond "basic healthcare". This becomes obvious in discussions like this when it immediately becomes clear that the actual definition of "basic healthcare" is "any and all treatments available to anyone".
Quote from: DGuller on November 10, 2009, 11:17:24 AM
The problem you describe most certainly is there, but I think you're focusing on the wrong part. It's severity, not frequency, that takes a hit. It's not that people choose to go to the doctors willy-nilly, but rather that they go along with very expensive treatmennt that no cost-benefit analysis would come close to justifying, when a treatment 50 times cheaper would work almost as well.
I don't think that fairly characterizes my point - it is not at all exclusive to frequency, it includes exactly what you are talking about. They are not at all exclusive.
And it manifests itself in other ways, even beyond people consuming too much health care. It manifests itself in costs as well - why does an MRI, a technology that has been around for decades, still cost $1500? Because there is no incentive for it to cost less, since nobody can get a competitive advantage by ruthlessly driving down the cost, since the basic cost/benefit market mechanism is non-existant.
Nobody care what their MRI costs, and nobody shops around for a cheaper MRI, since they are not paying for it anyway.
How do you solve this problem with socialized medicine? The obvious answer is that the state must demand it to be cheaper, but how is the state competent to decide what *ought to be* cheaper, and what is actually reasonably worth its high price?
I don't know what the answer is - what I do think though is that we are looking at the health care debate from the wrong side. We talk about how much the public option would cost, but it is all bullshit, since we have no real idea what the fair market value of health care actually is, since the market is so grossly distorted right now.
I suspect that we could all afford a lot more health care if the market actually priced the costs in some kind of sane manner. Right now the costs of routine coverage is grossly out of whack though, because the market has so many influences that create fucked up pricing mechanisms, and the net effect is that we keep paying more and more and more and more for the same amount of service, with the increases going to a growing health care market that isn't growing in services or quality, but simply growing in bureaucracy.
There are a number of fields where a market approach simply doesn't make sense. Energy, education, food, security, safety, infrastructure ... health care is just one of them.
Where the market works wonders is in anything you don't actually need.
Quote from: Berkut on November 10, 2009, 11:59:53 AM
Quote from: DGuller on November 10, 2009, 11:17:24 AM
The problem you describe most certainly is there, but I think you're focusing on the wrong part. It's severity, not frequency, that takes a hit. It's not that people choose to go to the doctors willy-nilly, but rather that they go along with very expensive treatmennt that no cost-benefit analysis would come close to justifying, when a treatment 50 times cheaper would work almost as well.
I don't think that fairly characterizes my point - it is not at all exclusive to frequency, it includes exactly what you are talking about. They are not at all exclusive.
And it manifests itself in other ways, even beyond people consuming too much health care. It manifests itself in costs as well - why does an MRI, a technology that has been around for decades, still cost $1500? Because there is no incentive for it to cost less, since nobody can get a competitive advantage by ruthlessly driving down the cost, since the basic cost/benefit market mechanism is non-existant.
Nobody care what their MRI costs, and nobody shops around for a cheaper MRI, since they are not paying for it anyway.
How do you solve this problem with socialized medicine? The obvious answer is that the state must demand it to be cheaper, but how is the state competent to decide what *ought to be* cheaper, and what is actually reasonably worth its high price?
I don't know what the answer is - what I do think though is that we are looking at the health care debate from the wrong side. We talk about how much the public option would cost, but it is all bullshit, since we have no real idea what the fair market value of health care actually is, since the market is so grossly distorted right now.
I suspect that we could all afford a lot more health care if the market actually priced the costs in some kind of sane manner. Right now the costs of routine coverage is grossly out of whack though, because the market has so many influences that create fucked up pricing mechanisms, and the net effect is that we keep paying more and more and more and more for the same amount of service, with the increases going to a growing health care market that isn't growing in services or quality, but simply growing in bureaucracy.
You do make a good point about costs. Like no-underwriting/no-mandate combination, we've got another highly perverse system with socialized demand and free-market supply.
You can't control it with a free market without getting rid of insurance, and that's just an intolerably bad thing in itself.
What you can have is some kind of health score for each patient, as well as a real primary care physician who's in charge of all referals for his patients. Then you reward primary care physicians for improvements in the health score of his patients, while deducting for use of resources.
Ideally that would ensure that everything primary care physician does or gives referral to is cost-effective. It would also ensure that the person with the real economic incentives is also the person with the actual skills and knowledge to make good trade-off decisions (the patient is certainly in no way qualified to decide whether the $1500 MRI is worth it).
Quote from: Caliga on November 10, 2009, 11:38:37 AM
Quote from: Jacob on November 10, 2009, 11:35:07 AM
(no, no anti-biotics for this shit etc) and more direct controls (no, you can't have 27 appointments this months, fuck off).
It would be great if Americans could be convinced of the fact that you don't in fact need antibiotics for everything. The same woman I earlier mentioned who was at the doctor nonstop for herself and her kids also used to demand she and her kids be prescribed things like Erythromycin whenever they had the flu. :frusty:
I think doctors hit a point where they just get tired of arguing and prescribe away.
Look, if I'm going to drag myself to the doctor, I'm getting some drugs.
Quote from: DGuller on November 10, 2009, 12:15:42 PM
What you can have is some kind of health score for each patient, as well as a real primary care physician who's in charge of all referals for his patients. Then you reward primary care physicians for improvements in the health score of his patients, while deducting for use of resources.
Why would physicians put up with historically "low H score yielders"? (whoever they may be, but likely the poor and minorities)
Quote from: Fate on November 10, 2009, 03:47:42 PM
Why would physicians put up with historically "low H score yielders"? (whoever they may be, but likely the poor and minorities)
There could be a benchmark in expected costs for each patient for each year, adjusted by their H score. If you have a bunch of crappy patients, you'll be expected to spend more on them each year. The point of the score is to adjust for the different levels of health or potentially problematic conditions when the patient is first assigned to the primary care physician.
Quote from: DGuller on November 10, 2009, 04:13:04 PM
Quote from: Fate on November 10, 2009, 03:47:42 PM
Why would physicians put up with historically "low H score yielders"? (whoever they may be, but likely the poor and minorities)
There could be a benchmark in expected costs for each patient for each year, adjusted by their H score. If you have a bunch of crappy patients, you'll be expected to spend more on them each year. The point of the score is to adjust for the different levels of health or potentially problematic conditions when the patient is first assigned to the primary care physician.
Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?
Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?
Quote from: Berkut on November 10, 2009, 04:52:32 PM
Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?
Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?
Any incentive system can be gamed or abused, and the higher the incentives, the higher the potential for abuse. Unfortunately, we kind of need incentives to avoid situations where there are no incentives. A well-designed score would be hard to manipulate down, however, short of inflicting permanent disabilities upon yourself (and you'll get no direct benefit from it anyway). I don't think people want to see doctors that badly.
Quote from: Berkut on November 10, 2009, 04:52:32 PM
Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?
Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?
:yes: People will be transplanting cancer into their bodies just to get all that sweet sweet chemotherapy.
Seriously, do you listen to yourself?
Quote from: Maximus on November 10, 2009, 05:07:32 PM
Quote from: Berkut on November 10, 2009, 04:52:32 PM
Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?
Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?
:yes: People will be transplanting cancer into their bodies just to get all that sweet sweet chemotherapy.
Seriously, do you listen to yourself?
I love it when people are outraged at the comments they make for others.
Explain, if you will, what incentive there could be to get "as low a score as possible".
Quote from: Berkut on November 10, 2009, 05:08:51 PM
I love it when people are outraged at the comments they make for others.
I love it when people make up outrage in order to get defensive.
The incentive would be for the doctors to massage the numbers in whichever direction gave them the best payout.
Unless I do not understand it, DGs plan involves a patient having some kind of health score, and the lower it is, the more care the doctor should lavish on them, and the more care the doctor is "allowed" in some fashion, to give them. This, btw, is absolutely health care rationing.
That means that both the patient and the doctor will be incented to give the patient as low a score as possible, so there will be less difficulty in obtaining care in the future, should it be necessary. And if care is not necessary, great, the doc gets a higher efficiency rating. I can easily imagine a lot of chronic illnesses of the mild sort being diagnosed for example. More generally, the point is that any kind of rating system like this is going to be a mess. There is no way the government is going to come up with any kind of sophisticated system that will not have incredible unintended adverse incentives.
Notice nowhere in there is anyone injecting any cancer, but I am sure that is what I really mean.
Quote from: Peter Wiggin on November 10, 2009, 05:13:57 PM
The incentive would be for the doctors to massage the numbers in whichever direction gave them the best payout.
WHY DO YOU WANT PEOPLE TO INJECT THEMSELVES WITH AIDS YOU BASTARD!!!!
Quote from: Peter Wiggin on November 10, 2009, 05:13:57 PM
The incentive would be for the doctors to massage the numbers in whichever direction gave them the best payout.
Possibly. Making sure that the score would be completely independent of the assessment of the interested parties is impractical. However, compare the incentive to massage the scores to the incentive to order a bunch of expensive meaningless tests, to get a cut directly into your pocket.
Quote from: Maximus on November 10, 2009, 05:11:28 PM
Explain, if you will, what incentive there could be to get "as low a score as possible".
Easy. Let's say I have rheumatoid arthritis and I think it is quite severe, however, my physician thinks it is a mild case and thus will only put me on simple palliative drugs (like anti-inflammatories). I know that there are big expensive medications out there that I think would completely get rid of my pain but I don't have access to them as I can't afford them on my own and my physician isn't willing to prescribe them. If I could somehow manage to get myself a lower score (perhaps reassessed by someone else with less scruples), I might get those expensive drugs as the doctor would be motivated to spend what was necessary to get my failing health score up.
Quote from: Maximus on November 10, 2009, 05:13:04 PM
Quote from: Berkut on November 10, 2009, 05:08:51 PM
I love it when people are outraged at the comments they make for others.
I love it when people make up outrage in order to get defensive.
:lmfao: Mocking your rather sad strawman is not being defensive. It is just mocking.
Quote from: DGuller on November 10, 2009, 05:17:17 PM
Quote from: Peter Wiggin on November 10, 2009, 05:13:57 PM
The incentive would be for the doctors to massage the numbers in whichever direction gave them the best payout.
Possibly. Making sure that the score would be completely independent of the assessment of the interested parties is impractical. However, compare the incentive to massage the scores to the incentive to order a bunch of expensive meaningless tests, to get a cut directly into your pocket.
True enough - no doubt that there are currently plenty of crappy incentives in the current system.
But much of that is because the person paying for the expensive tests is totally removed from the people actually getting and ordering the tests.
Quote from: Berkut on November 10, 2009, 05:17:32 PM
:lmfao: Mocking your rather sad strawman is not being defensive. It is just mocking.
Beginning a rebuttal with a :lmfao: smiley is a particularly pathetic form of defensiveness.
Quote from: garbon on November 10, 2009, 05:17:28 PM
Easy. Let's say I have rheumatoid arthritis and I think it is quite severe, however, my physician thinks it is a mild case and thus will only put me on simple palliative drugs (like anti-inflammatories). I know that there are big expensive medications out there that I think would completely get rid of my pain but I don't have access to them as I can't afford them on my own and my physician isn't willing to prescribe them. If I could somehow manage to get myself a lower score (perhaps reassessed by someone else with less scruples), I might get those expensive drugs as the doctor would be motivated to spend what was necessary to get my failing health score up.
Fair enough. I guess I see "getting" a low score as completely different from "giving yourself" a low score. There are dishonest people in any system.
Quote from: Berkut on November 10, 2009, 05:16:27 PM
Unless I do not understand it, DGs plan involves a patient having some kind of health score, and the lower it is, the more care the doctor should lavish on them, and the more care the doctor is "allowed" in some fashion, to give them. This, btw, is absolutely health care rationing.
That means that both the patient and the doctor will be incented to give the patient as low a score as possible, so there will be less difficulty in obtaining care in the future, should it be necessary. And if care is not necessary, great, the doc gets a higher efficiency rating. I can easily imagine a lot of chronic illnesses of the mild sort being diagnosed for example. More generally, the point is that any kind of rating system like this is going to be a mess. There is no way the government is going to come up with any kind of sophisticated system that will not have incredible unintended adverse incentives.
Notice nowhere in there is anyone injecting any cancer, but I am sure that is what I really mean.
Any system is going to be very complicated. While our political system is retarded, it's not retarded to the point of suppressing some silver bullet that optimally solves all our problems.
One last point is that this system doesn't have to be administered by the government, it can be administered by HMOs. In fact, what I'm doing is basically describing a variant of an HMO system, with greater emphasis on statistical modeling, and greater discretion provided to the primary care physician.
Quote from: Maximus on November 10, 2009, 05:23:23 PM
Fair enough. I guess I see "getting" a low score as completely different from "giving yourself" a low score. There are dishonest people in any system.
Well you can't really just give yourself one...but the point is that you are incentivized to have a low score as you know you'll always get the best treatment that way. If you have to shop around to get that low score, no big deal.
Quote from: Berkut on November 10, 2009, 05:18:38 PM
True enough - no doubt that there are currently plenty of crappy incentives in the current system.
But much of that is because the person paying for the expensive tests is totally removed from the people actually getting and ordering the tests.
Not totally removed, but actually even farther than that. When you get a cut for ordering tests, directly or indirectly, you're worse than totally removed. You're connected in a perverse way.
Quote from: Berkut on November 10, 2009, 05:18:38 PM
But much of that is because the person paying for the expensive tests is totally removed from the people actually getting and ordering the tests.
:huh: What's the alternative?
Quote from: Iormlund on November 10, 2009, 05:30:02 PM
:huh: What's the alternative?
Out of pocket/medical savings accounts is an alternative, not necessarily a superior alternative.
Quote from: garbon on November 10, 2009, 05:25:54 PM
Well you can't really just give yourself one...but the point is that you are incentivized to have a low score as you know you'll always get the best treatment that way. If you have to shop around to get that low score, no big deal.
Not exactly, or at least not directly. No matter how low your score is, the doctor has incentives to spend his budget as efficiently as possible.
Quote from: Admiral Yi on November 10, 2009, 05:32:40 PM
Quote from: Iormlund on November 10, 2009, 05:30:02 PM
:huh: What's the alternative?
Out of pocket/medical savings accounts is an alternative, not necessarily a superior alternative.
That means you decide and pay for your tests, right?
Quote from: Iormlund on November 10, 2009, 05:35:11 PM
That means you decide and pay for your tests, right?
Yup.
Sounds to me like that would encourage people to forgo necessary treatment. Not really what you'd want if your objective is a healthier population and less ER costs.
Quote from: Maximus on November 10, 2009, 05:07:32 PM
Quote from: Berkut on November 10, 2009, 04:52:32 PM
Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?
Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?
:yes: People will be transplanting cancer into their bodies just to get all that sweet sweet chemotherapy.
Seriously, do you listen to yourself?
I'm sorry Berkut. This shit was uncalled for. I read it wrong.
Quote from: Iormlund on November 10, 2009, 05:45:55 PM
Sounds to me like that would encourage people to forgo necessary treatment. Not really what you'd want if your objective is a healthier population and less ER costs.
People have a right to be unhealthy if they so choose.
Quote from: Maximus on November 10, 2009, 05:53:09 PM
Quote from: Maximus on November 10, 2009, 05:07:32 PM
Quote from: Berkut on November 10, 2009, 04:52:32 PM
Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?
Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?
:yes: People will be transplanting cancer into their bodies just to get all that sweet sweet chemotherapy.
Seriously, do you listen to yourself?
I'm sorry Berkut. This shit was uncalled for. I read it wrong.
I read it the same way, until Berkut clarified himself.
Quote from: Iormlund on November 10, 2009, 05:45:55 PM
Sounds to me like that would encourage people to forgo necessary treatment. Not really what you'd want if your objective is a healthier population and less ER costs.
If the objective were a healthier population full stop we would spend 100% of income on health care. The true objective is an optimal allocation of resources to health care.
Quote from: MadImmortalMan on November 10, 2009, 05:53:35 PM
Quote from: Iormlund on November 10, 2009, 05:45:55 PM
Sounds to me like that would encourage people to forgo necessary treatment. Not really what you'd want if your objective is a healthier population and less ER costs.
People have a right to be unhealthy if they so choose.
You are missing the point. You think they carried me to the OR at the point of a gun? I could have gone for drugs or no treatment at all if I so wished.
The point is, what that system does is to
promote unhealthy behaviour, not just allow it. It's completely irresponsible.
Quote from: Berkut on November 10, 2009, 11:59:53 AM
I don't think that fairly characterizes my point - it is not at all exclusive to frequency, it includes exactly what you are talking about. They are not at all exclusive.
And it manifests itself in other ways, even beyond people consuming too much health care. It manifests itself in costs as well - why does an MRI, a technology that has been around for decades, still cost $1500? Because there is no incentive for it to cost less, since nobody can get a competitive advantage by ruthlessly driving down the cost, since the basic cost/benefit market mechanism is non-existant.
Nobody care what their MRI costs, and nobody shops around for a cheaper MRI, since they are not paying for it anyway.
How do you solve this problem with socialized medicine? The obvious answer is that the state must demand it to be cheaper, but how is the state competent to decide what *ought to be* cheaper, and what is actually reasonably worth its high price?
I don't know what the answer is - what I do think though is that we are looking at the health care debate from the wrong side. We talk about how much the public option would cost, but it is all bullshit, since we have no real idea what the fair market value of health care actually is, since the market is so grossly distorted right now.
I suspect that we could all afford a lot more health care if the market actually priced the costs in some kind of sane manner. Right now the costs of routine coverage is grossly out of whack though, because the market has so many influences that create fucked up pricing mechanisms, and the net effect is that we keep paying more and more and more and more for the same amount of service, with the increases going to a growing health care market that isn't growing in services or quality, but simply growing in bureaucracy.
This is the most sane post I've ever seen you make, Berkut. It is 100% true, and the absolute issue that needs to be addressed before all else.
I think my employer pays about $12,000/year for my familys medical coverage. I kick in a like amount between the portion of my health "insurance" that I pay for and co-pays and such.
I wonder how much routine health care I could afford if I just paid out of pocket for my health care, the costs were based on everyone paying for their own (and hence health care providers being driven to provide the best care for the lowerst price) and they let me keep that $24,000/year, after I use some amount of it to pay for true medical insurance to cover catastrophic costs?
I bet we could save enough to cover the out of pocket expenses AND catastrophic coverage for the poor (on some sliding scale based on income) if we had a system where the costs were understood and reacted to market realities.
I don't think that $24k sounds right for a family of 4, even in New York that sounds way too much for an employer's policy. It has to be about half that.
The problem with the market in health care, is that often the highest medical costs come from situations where the alternative to "doing without", as one can in many cases involving a normal purchase(a car, appliances, etc), is death. And even short of death, one may not be in a condition to "shop around".
Of course, one could say the same about food...but I doubt that would make a good analogy.
Quote from: Tonitrus on November 11, 2009, 12:52:03 AM
The problem with the market in health care, is that often the highest medical costs come from situations where the alternative to "doing without", as one can in many cases involving a normal purchase(a car, appliances, etc), is death. And even short of death, one may not be in a condition to "shop around".
Of course, one could say the same about food...but I doubt that would make a good analogy.
Yes. And even if you're not near death, a lay person just doesn't have the knowledge or experience to make the right decision. If we could, then we're wasting a whole bunch of money educating future doctors for a decade.
Quote from: Berkut on November 10, 2009, 11:59:53 AM
How do you solve this problem with socialized medicine? The obvious answer is that the state must demand it to be cheaper, but how is the state competent to decide what *ought to be* cheaper, and what is actually reasonably worth its high price?
:huh: Reason has nothing to do with pricing. The state will pay as much as it has to and no more.
Quote from: Tonitrus on November 11, 2009, 12:52:03 AM
The problem with the market in health care, is that often the highest medical costs come from situations where the alternative to "doing without", as one can in many cases involving a normal purchase(a car, appliances, etc), is death. And even short of death, one may not be in a condition to "shop around".
Of course, one could say the same about food...but I doubt that would make a good analogy.
That is precisely the argument behind agricultural subsidies in both the EU and the US. True as well, at least back in the day.
Quote from: Iormlund on November 11, 2009, 09:33:34 AM
Quote from: Berkut on November 10, 2009, 11:59:53 AM
How do you solve this problem with socialized medicine? The obvious answer is that the state must demand it to be cheaper, but how is the state competent to decide what *ought to be* cheaper, and what is actually reasonably worth its high price?
:huh: Reason has nothing to do with pricing.
When the state pays for it, this is often the case.
Quote from: DGuller on November 11, 2009, 12:32:31 AM
I don't think that $24k sounds right for a family of 4, even in New York that sounds way too much for an employer's policy. It has to be about half that.
If one of your kids has something like cerebral palsy, I guess it could be possible.
Quote from: DGuller on November 11, 2009, 01:01:36 AM
If we could, then we're wasting a whole bunch of money educating future doctors for a decade.
I read an article in some British newspaper the other day that said a sizable amount of the recent graduating medical students in Britain were unable to perform even basic tasks like injections.
Also, contrary to the feeling of some, I don't think that many doctors are even qualified to make the right decision.
Quote from: Fate on November 11, 2009, 09:54:39 AM
Quote from: DGuller on November 11, 2009, 12:32:31 AM
I don't think that $24k sounds right for a family of 4, even in New York that sounds way too much for an employer's policy. It has to be about half that.
If one of your kids has something like cerebral palsy, I guess it could be possible.
I don't think so, employer's policies have no underwriting by law. Maybe everyone at Berkut's workplace is just very sick, so his company gets charged a hefty premium.
Quote from: DGuller on November 11, 2009, 12:32:31 AM
I don't think that $24k sounds right for a family of 4, even in New York that sounds way too much for an employer's policy. It has to be about half that.
Yep, you are right - I had the numbers mixed in my head - it is actually about $13,000/year. Same principle applies though.
Quote from: Berkut on November 11, 2009, 10:30:15 AM
Yep, you are right - I had the numbers mixed in my head - it is actually about $13,000/year. Same principle applies though.
Really? An uninsured office visit is approximately $100. If you have one office visit per month per person, then for a family of four, you're shelling out $4,800 before you get any testing or procedures done- $13,000/year sounds like a bargain in comparison.
Quote from: DontSayBanana on November 11, 2009, 03:38:09 PM
Really? An uninsured office visit is approximately $100. If you have one office visit per month per person, then for a family of four, you're shelling out $4,800 before you get any testing or procedures done- $13,000/year sounds like a bargain in comparison.
Who goes to the doctor once a month?
I think someone without insurance would spend a lot of time haggling with medical providers to first get a price out of them, and then to negotiate that utterly absurd price down.
Quote from: Admiral Yi on November 11, 2009, 03:40:17 PM
Who goes to the doctor once a month?
My grandma, if "to the doctor" means "to each of her doctors".
Running numbers differently, four times a year. One sickness each season that goes through the entire household. $400 for office visits (one cost-saving issue could be that doctors could see family members at the same time for related problems, BTW), about $1,000 to $1,200 for the household's labwork... assuming all four need medication for a mild illness during the season, expect about $800. You're still looking at around $5,000 for mild illnesses like the flu or strep throat.
Quote from: DontSayBanana on November 11, 2009, 03:38:09 PM
Quote from: Berkut on November 11, 2009, 10:30:15 AM
Yep, you are right - I had the numbers mixed in my head - it is actually about $13,000/year. Same principle applies though.
Really? An uninsured office visit is approximately $100. If you have one office visit per month per person, then for a family of four, you're shelling out $4,800 before you get any testing or procedures done- $13,000/year sounds like a bargain in comparison.
Holy crap, once a month per person???
And what is the fair market price for an office visit, if in fact the market was determining the price?
Quote from: DontSayBanana on November 11, 2009, 03:46:21 PM
Running numbers differently, four times a year. One sickness each season that goes through the entire household. $400 for office visits (one cost-saving issue could be that doctors could see family members at the same time for related problems, BTW), about $1,000 to $1,200 for the household's labwork... assuming all four need medication for a mild illness during the season, expect about $800. You're still looking at around $5,000 for mild illnesses like the flu or strep throat.
Why would it cost $1000 for lab work, for a minor illness? And $800 per person for medication? Huh? Generic drugs don't cost anywhere near that amount of money, and would likely cost even less if there was more competition in the market for them.
Quote from: Berkut on November 11, 2009, 03:47:56 PM
Holy crap, once a month per person???
And what is the fair market price for an office visit, if in fact the market was determining the price?
It wouldn't change much for office visits. Billable time is expensive; consider that lawyers are bound to UCRs.
Quote from: Berkut on November 11, 2009, 03:47:56 PM
And what is the fair market price for an office visit, if in fact the market was determining the price?
I don't know how you'd even start to estimate that.
All those prices of medical procedures remind me of the sticker on the door of my hotel room in Vegas. It said that the maximum rate for the room I stayed in is $875 per night. I stayed for $30 a night. Maybe all those labs start with $875, and then agree on $30 with insurance companies.
Quote from: Admiral Yi on November 11, 2009, 03:55:41 PM
I don't know how you'd even start to estimate that.
Usual and customary rates.
Quote from: Admiral Yi on November 11, 2009, 03:55:41 PM
Quote from: Berkut on November 11, 2009, 03:47:56 PM
And what is the fair market price for an office visit, if in fact the market was determining the price?
I don't know how you'd even start to estimate that.
Neither do I, really.
Quote from: garbon on November 10, 2009, 08:39:17 AM
Based on the research that I've been doing here in Europe, I'd venture that Americans tend to care a lot less about the state and its money that Europeans. Patients talk here about not wanting to be on very expensive medications as they understand that it costs the government a lot of money. I think, us Americans, are more likely to be give what you got, I want the best and I don't care how much it costs the state.
That's interesting. I've never heard that view. In the UK, in my experience, it's slightly different. I think older people especially still have immense respect for their doctors, so they're not terribly likely to ask for a second opinion or demand an extra test. Which is bad but they view the doctor as their superior really (I think it's a class/deference thing in the older generation) and they don't want to make a fuss.
When my aunty was dying she refused to go into the hospital and stay there because she didn't want to cause a fuss. What that meant was that they had to move a hospital bed into her small semi, get a twice-weekly visit from a nurse and a carer come in to help my uncle. It is, of course, a lot more trouble than just going into hospital but she didn't want to cause a fuss. I think it's perhaps different in the US.
Quote from: Sheilbh on November 17, 2009, 01:04:29 PM
That's interesting. I've never heard that view. In the UK, in my experience, it's slightly different. I think older people especially still have immense respect for their doctors, so they're not terribly likely to ask for a second opinion or demand an extra test. Which is bad but they view the doctor as their superior really (I think it's a class/deference thing in the older generation) and they don't want to make a fuss.
When my aunty was dying she refused to go into the hospital and stay there because she didn't want to cause a fuss. What that meant was that they had to move a hospital bed into her small semi, get a twice-weekly visit from a nurse and a carer come in to help my uncle. It is, of course, a lot more trouble than just going into hospital but she didn't want to cause a fuss. I think it's perhaps different in the US.
Oh we heard that in all the countries we did as well and then especially in the UK. Not so much in Germany.