QuoteAP sources: Dems reach deal to drop gov't-run plan
By DAVID ESPO, AP Special Correspondent
WASHINGTON – After days of secret talks, Senate Democrats tentatively agreed Tuesday night to drop a full-blown government-run insurance option from sweeping health care legislation, several officials said, a concession to party moderates whose votes are critical to passage of President Barack Obama's top domestic priority.
In its place, officials said Democrats had tentatively settled on a private insurance arrangement to be supervised by the federal agency that oversees the system through which lawmakers purchase coverage, with the possibility of greater government involvement if needed to ensure consumers of sufficient choices in coverage.
Additionally, the emerging agreement calls for Medicare to be opened to uninsured Americans beginning at age 55, a significant expansion of the large government health care program that currently serves the 65-and-over population.
At a hastily called evening news conference in the Capitol, Majority Leader Harry Reid, D-Nev., declined to provide details of what he described as a "broad agreement" between liberals and moderates on an issue that has plagued Democrats' efforts to pass health care legislation from the outset.
With it, he added with a smile, the end is in sight for passage of the legislation that Congress has labored over for months.
The officials who described the details of the closed-door negotiations did so on condition of anonymity, saying they were not authorized to discuss them publicly. Several officials stressed that so far, Democrats had technically agreed only on submitting proposals to the Congressional Budget Office for their impact on the bill's cost and other analysis.
At its core, the legislation would expand health care to millions who lack it, ban insurance companies from denying coverage on the basis of pre-existing medical conditions and rein in the rise of health care spending nationally.
The developments followed a vote on the Senate floor earlier in the day in which abortion opponents failed to inject tougher restrictions into sweeping health care bill, and Democratic leaders labored to make sure fallout from the issue didn't hamper the drive to enact legislation. The vote was 54-45.
Taken together, the day's developments underscored the complexity that confronts the administration and Reid as they seek the 60 votes needed to overcome Republican opposition and pass a bill by Christmas. Despite their reluctance, some senators had talked openly and in detail earlier in the day about the progress of the negotiations.
The provision in the legislation to be dropped under the emerging agreement provides for a government-run insurance option to be available to consumers, with individual states permitted to drop out. Liberals have long sought such as arrangement, as a means of forcing competition on insurance companies.
One participant in the talks, Sen. Tom Harkin, D-Iowa, referring to a deal among the negotiators, told reporters he didn't like it, but added, "I'm going to support it to the hilt" in hopes of securing passage of the health care bill.
Another senator involved, Sen. Russ Feingold, D-Wis., issued a statement saying, "I do not support proposals that would replace the public option in the bill with a purely private approach. We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars." But he did not rule out voting for the measure.
The White House quickly applauded the developments. "Senators are making great progress and we're pleased that they're working together to find common ground toward options that increase choice and competition," said a spokesman, Reid Cherlin.
In his comments to reporters, Reid said the emerging compromise "includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices."
It wasn't clear what he meant by a "public option," the Medicare expansion or a fallback in case private insurance companies declined to participate in the nationwide plan envisioned to be overseen by the Office of Personnel Management. One possibility was for the agency to set up a government-run plan, either national in scope or on a state-by-state basis.
Under the tentative agreement, liberals lost their bid to expand Medicaid, the federal-state program that provides health care for the poor, elderly and disabled. But they prevailed on the Medicare expansion, and the negotiators appeared ready to maintain a separate health care program for children until 2013, two years longer than the bill currently calls for, according to officials familiar with the details.
Additionally, there was consensus support for a requirement long backed by Sen. Jay Rockefeller, D-W.Va., and other liberals for insurance companies to spend at least 90 percent of their premium income providing benefits, a step that supporters argue effectively limits their spending on advertising, salaries, promotional efforts and profits.
Reid — the chief architect of the health care bill as well as an abortion opponent — played a prominent role in the debate over attempts by conservatives to toughen restrictions in the Senate measure. "No one should use the health care bill to expand or restrict abortion," he said, arguing that abortion foes were attempting to do just that. "And no one should use the issue of abortion to rob millions of the opportunity to get good health care."
The current legislation would ban the use of federal funds to pay for abortion services under insurance plans expected to be offered in a new health care system, except in cases of rape, incest or when the life of the mother is in jeopardy.
Individuals who receive federal subsidies to purchase insurance under the plans would be permitted to use personal funds to pay for abortion services — the point on which the two sides in the dispute part company.
"Segregation of funds is an accounting gimmick," said Sen. Ben Nelson, D-Neb., the chief Democratic supporter of tightened restrictions. "The reality is federal funds would help buy coverage that includes abortion."
Abortion rights supporters, Senate Democratic women most prominently, countered heatedly.
Sen. Dianne Feinstein, D-Calif., said abortion opponents were driven by ideology, and Sen. Jeanne Shaheen, D-N.H., called the proposed changes "a very far-reaching intrusion into the lives of women."
The amendment that Nelson, Sen. Robert Casey, D-Pa, Sen. Orrin Hatch, R-Utah, and numerous Republicans proposed would also have barred insurance plans from covering abortions except in the three categories if any of their policyholders received federal subsidies. It also would have required insurance companies that offer no-abortion plans to make available a policy that offers such services.
In all, 50 Democrats, two Republicans and two independents voted to kill the abortion proposal. Thirty-eight Republicans and seven Democrats favored it.
Shock and Awe.
Well what the fuck is the point then? :mad:
Not surprised, this has looked like the inevitable end point for months. Indeed I would have been surprised if it had gone the other way.
Public option bad. More single payer good.
I don't understand conservative Democrats.
Well, looks like the US has failed at health care again. Maybe they'll try again in a generation.
Still, it's not that surprising. There was a lot of money to lose for the industries that have made health care their business.
Quote from: Neil on December 09, 2009, 07:37:49 AM
Well, looks like the US has failed at health care again. Maybe they'll try again in a generation.
Still, it's not that surprising. There was a lot of money to lose for the industries that have made health care their business.
It's quite pathetic really - but then again one can't go against one's own limitations.
G.
Quote from: Razgovory on December 09, 2009, 03:24:11 AM
Well what the fuck is the point then? :mad:
Covering those without coverage, subsidizing those with pre-existing conditions.
House version still has public option with state opt out. Interesting to see how it plays in conference.
You guys are still afraid of progress, eh.
Quote from: Grey Fox on December 09, 2009, 08:13:28 AM
You guys are still afraid of progress socialism, eh.
:yes:
It provides me no end of amusement how politicized such an essentially trivial aspect of health care has become. It's approaching Swiftian proportions of absurdity.
Quote from: Admiral Yi on December 09, 2009, 08:20:25 AM
It provides me no end of amusement how politicized such an essentially trivial aspect of health care has become. It's approaching Swiftian proportions of absurdity.
That's the way all political wedge issues work, though. It's nothing new. :mellow:
At least it gives us something to discuss. The thread at EUOT in particular is highly amusing. Libertarians. :bleeding:
Quote from: Caliga on December 09, 2009, 08:16:16 AM
Quote from: Grey Fox on December 09, 2009, 08:13:28 AM
You guys are still afraid of progress socialism, eh.
:yes:
BS. Your Federal government already pays more money per capita then the canadian government does.
Progress.
Also if you are afraid of socialism what about you stop regulation the Airline industry?
Quote from: Grey Fox on December 09, 2009, 08:29:33 AM
BS. Your Federal government already pays more money per capita then the canadian government does.
Progress.
Also if you are afraid of socialism what about you stop regulation the Airline industry?
Where did I say I didn't think that wasteful government spending per capita wasn't a huge problem as well? :yeahright:
I'm not sure that all regulation of the airline industry is socialist in nature, really. What sort of regulation are you referring to?
Yeah, I'm curious about the airline part as well.
I dunno about regulation, but their new practice of throwing fees everywhere instead of just simply adjusting rates...among many other airline business practices I could name...make me want to flog airline executives with a heavy-duty Samsonite case.
And the TSA needs to be purged with hellfire.
Quote from: Tonitrus on December 09, 2009, 08:49:18 AM
I dunno about regulation, but their new practice of throwing fees everywhere instead of just simply adjusting rates...among many other airline business practices I could name...make me want to flog airline executives with a heavy-duty Samsonite case.
And the TSA needs to be purged with hellfire.
Why? Why should the guys with no bags subsidize those with bags?
Quote from: Admiral Yi on December 09, 2009, 08:51:16 AM
Why? Why should the guys with no bags subsidize those with bags?
It's hardly that simple.
And heck, even I don't check luggage if I can help it. Though I have noticed that airplane boarding has become a practice of "swarm onto the plane and get your crap into the overhead space before it fills and you're forced to check your carry-on anyway".
Quote from: Caliga on December 09, 2009, 08:39:04 AM
Quote from: Grey Fox on December 09, 2009, 08:29:33 AM
BS. Your Federal government already pays more money per capita then the canadian government does.
Progress.
Also if you are afraid of socialism what about you stop regulation the Airline industry?
Where did I say I didn't think that wasteful government spending per capita wasn't a huge problem as well? :yeahright:
I'm not sure that all regulation of the airline industry is socialist in nature, really. What sort of regulation are you referring to?
We know how you think, always looking out for big business never for the common man.
Quote from: Admiral Yi on December 09, 2009, 08:20:25 AM
It provides me no end of amusement how politicized such an essentially trivial aspect of health care has become. It's approaching Swiftian proportions of absurdity.
For the left, it's a sign that we're going to actually "reform" health care, and not just pass out subsidies to insurance companies. For the right, it's a sign of the march of Socialism.
QuoteWith the Senate shifting sharply away from a "pure public option," an insurance industry insider who has been deeply involved in the health care fight emails to declare victory.
"We WIN," the insider writes. "Administered by private insurance companies. No government funding. No government insurance competitor."
http://www.politico.com/blogs/bensmith/1209/Insurance_industry_insider_We_win.html
Quote from: Caliga on December 09, 2009, 08:39:04 AM
I'm not sure that all regulation of the airline industry is socialist in nature, really. What sort of regulation are you referring to?
I am not aware of any particular socialist policies regarding American airline - except perhaps the way most of the big carriers dropped their legacy pension costs in a chapter 11 in the last decade or so. But the airline industry in America (and basically in all regions of the world except the EU) is quite protectionists. Foreigners can't buy a controlling stake in an US airline. To be fair, that's the case virtually everywhere (even in the EU) as the landing rights are usually negotiated between governments, not between airlines and airport operators. Foreign airlines may not offer domestic flights in the US - that's allowed in the EU now.
Quote from: Admiral Yi on December 09, 2009, 08:20:25 AM
It provides me no end of amusement how politicized such an essentially trivial aspect of health care has become. It's approaching Swiftian proportions of absurdity.
It is trivial to the extent that it is the only proven way to actually reduce the absurdly high costs of health care.
What approaches the Swiftian proportions of absurdity is the panic that can be induced among the herd by demagogues simply mischaracterizing the astonishing success of the government option in other countries. "They are more healthy than us and live longer for half the health care expenditures! That must be
death panels1111oneoneone"
If the US could reduce its per-capita health care costs to the levels that Germans and Brits pay, it could abolish personal income taxes and still come out ahead.
Seriously. And I'll tell you, at least some of us lefties are looking for some actual reform; at my highest-paid full-time job, I couldn't afford to get coverage worth a damn- the employer-provided coverage had so many limits and strings on it (one was a cheap PPO out of the midwest with no providers here) that I ended up just having to drop it to concentrate on paying other bills. Health insurance companies at present don't charge premiums; they commit usury.
As it stands, the insurance I have through the college is worthless. The caps would kick in before the end of the first day of treatment if something were to happen to me, yet that doesn't stop them from charging me $100 per semester for the privilege of "having insurance."
Quote from: Caliga on December 09, 2009, 08:16:16 AM
Quote from: Grey Fox on December 09, 2009, 08:13:28 AM
You guys are still afraid of progress socialism, eh.
:yes:
Exactly. Even when the socialist system is by far the best, all one needs to do is call it "socialist" and the herd will stampede and trample it.
Quote from: Grey Fox on December 09, 2009, 08:29:33 AM
BS. Your Federal government already pays more money per capita then the canadian government does.
Progress.
That is sorta where I have been coming from. If we are already bearing all the negative burdens of socialism, high taxes and deficits, we might as well try to get a few of those benefits as well :P but yes I know it simply is not feasible for spend as much as Canada and get Canadian results. We would have to pay far more for that...why I am not sure...but that is the case.
Hopefully whatever reforms they do pass will have an overall positive impact.
Quote from: Admiral Yi on December 09, 2009, 08:51:16 AM
Why? Why should the guys with no bags subsidize those with bags?
I fly Southwest and do that and somehow still pay less for my flight. Other Airlines = fail.
Quote from: Admiral Yi on December 09, 2009, 08:51:16 AM
Quote from: Tonitrus on December 09, 2009, 08:49:18 AM
I dunno about regulation, but their new practice of throwing fees everywhere instead of just simply adjusting rates...among many other airline business practices I could name...make me want to flog airline executives with a heavy-duty Samsonite case.
And the TSA needs to be purged with hellfire.
Why? Why should the guys with no bags subsidize those with bags?
Because increasing mobility around the country has a social benefit.
Quote from: Valmy on December 09, 2009, 09:22:58 AM
yes I know it simply is not feasible for spend as much as Canada and get Canadian results. We would have to pay far more for that...why I am not sure...but that is the case.
Why not? Why would it be more expensive in the US? Usually it's Canada that is 7% more expensive then the US.
Quote from: Grey Fox on December 09, 2009, 09:28:03 AM
Why not? Why would it be more expensive in the US? Usually it's Canada that is 7% more expensive then the US.
A couple questions about the Canadian system. Are all health workers public employees? Does the patient get whatever tests and procedures he asks for, or is there an HMO style gatekeeper system (i.e. the primary care doctor says "no Grey Fox, you don't need a CAT scan, STFU.")
Quote from: Valmy on December 09, 2009, 09:26:09 AM
I fly Southwest and do that and somehow still pay less for my flight. Other Airlines = fail.
Southwest pays a bunch less for fuel, or at least they used to. I haven't looked to see if that's still going on or not recently.
Quote from: Valmy on December 09, 2009, 09:22:58 AM
Hopefully whatever reforms they do pass will have an overall positive impact.
Agree, and I agree that we are in dire need of reform. I don't think that nationalizing the health care industry is the solution though. Maybe we are just incompetent compared to Europeans, but we seem to suck horribly at nationalizing shit and still making it affordable and high quality.
In Spain there is staff overseeing expenditures. Basically watching if this or that physician been giving prescriptions for brand instead of generic when available, ordering tests out of protocol, etc. I have never had a test, procedure or hospital stay revoked - I have no idea if it is common or rarely happens.
Quote from: Admiral Yi on December 09, 2009, 09:32:07 AM
A couple questions about the Canadian system. Are all health workers public employees? Does the patient get whatever tests and procedures he asks for, or is there an HMO style gatekeeper system (i.e. the primary care doctor says "no Grey Fox, you don't need a CAT scan, STFU.")
In the UK, which I think is different, then doctors are employees of the NHS but consultants are allowed to divide their time between NHS commitments and private practice (which many do) and I believe GPs have financial autonomy so can set their own wages. There's an HMO style gatekeeper system I suppose, in that if you request a test and the doctor already thinks you've been diagnosed he'll probably say that you don't need it. Though you can always get a second opinion.
QuoteAgree, and I agree that we are in dire need of reform. I don't think that nationalizing the health care industry is the solution though. Maybe we are just incompetent compared to Europeans, but we seem to suck horribly at nationalizing shit and still making it affordable and high quality.
The UK is, to the best of my knowledge the only country that's nationalised healthcare. Absolutely no proposal that's been offered by anyone in the US has been to institute an American NHS. Nationalisation is a giant strawman.
Quote from: Admiral Yi on December 09, 2009, 09:32:07 AM
Quote from: Grey Fox on December 09, 2009, 09:28:03 AM
Why not? Why would it be more expensive in the US? Usually it's Canada that is 7% more expensive then the US.
A couple questions about the Canadian system. Are all health workers public employees? Does the patient get whatever tests and procedures he asks for, or is there an HMO style gatekeeper system (i.e. the primary care doctor says "no Grey Fox, you don't need a CAT scan, STFU.")
Surprisingly, and even tho there's Federal legislation about it, Health care is a provincial matter, so it will differ in each provinces.
In Québec, we have so called "private clinics". There staff are privately employed. Not sure about the physicians themselves tho.
Usually Specialized test have to be "prescribe" by the doctors. Takes forever to get one in the free parts, couple of days in the paying parts. Altho, that might have changed. I don't go to the doctors regularly.
Quote from: Caliga on December 09, 2009, 09:38:35 AM
Quote from: Valmy on December 09, 2009, 09:22:58 AM
Hopefully whatever reforms they do pass will have an overall positive impact.
Agree, and I agree that we are in dire need of reform. I don't think that nationalizing the health care industry is the solution though. Maybe we are just incompetent compared to Europeans, but we seem to suck horribly at nationalizing shit and still making it affordable and high quality.
You don't need to nationalize everything. In reality there isn't such a thing as a European model. It's a whole array of different systems.
Quote from: Caliga on December 09, 2009, 09:38:35 AM
Agree, and I agree that we are in dire need of reform. I don't think that nationalizing the health care industry is the solution though. Maybe we are just incompetent compared to Europeans, but we seem to suck horribly at nationalizing shit and still making it affordable and high quality.
Oh I agree I was just figuring if we are going to pay money as if we had nationalized it we might as well get the paltry benefits that go with it. That was mostly tongue in cheek though. I have no idea why we pay so much for health care and not only get mediocre results but look to be sitting on a health care public time bomb that is eventually supposedly to overwhelm our ability to fund it.
But it is simply ignorant to think that all other Western health systems consist of a socialist nationalizing solution. They also balance private and public and so forth.
A combination of factors most likely. From higher medication prices to admin and regulatory costs, lack of leverage (it is not the same to buy 1 MRI machine than 50), higher doctor salaries, defensive medicine, higher ER costs if problems are left untreated long enough and so on.
Also, behavioral patters. I've never been to the US but if it is true that there's a higher percentage of obese that could also explain things. Not to mention long work hours.
Quote from: Valmy on December 09, 2009, 09:51:04 AM
Oh I agree I was just figuring if we are going to pay money as if we had nationalized it we might as well get the paltry benefits that go with it. That was mostly tongue in cheek though. I have no idea why we pay so much for health care and not only get mediocre results but look to be sitting on a health care public time bomb that is eventually supposedly to overwhelm our ability to fund it.
We get so little for so much because there is no one with the incentive and power to control costs. Drugs are so much cheaper in Canada, for instance, because the provinces negotiate prices, and if the drug companies want to much, the provinces just don't buy.
QuoteBut it is simply ignorant to think that all other Western health systems consist of a socialist nationalizing solution. They also balance private and public and so forth.
But it is simply ignorant to say that "socialized medicine does not work, and all we need to do is tweak the free market US system and miracles will occur" (not that
you are saying this, of course). A rational look at health care from the top down would reveal those areas where the market could help control costs and allocate resources efficiently, and where it won't (and we need to look at countries where health care is a success to do this). Where the invisible hand doesn't work, the visible hand must be employed. Germany, for instance, has a system in which 77% of the money is paid by the government-run system (and covers about 87% of the population), but self-employed people can go for the more expensive (23% of the total expenditures divided amongst only about 13% of the population) private system. The private system allows for the accumulation of benefits (and is thus an actual insurance system), so the additional costs are not all spent on immediate care. The government-run system is single-payer but service providers are not government employees.
This is just as valid a starting point as any other.
Does Spain have a single payer or multiple payer system?
Quote from: Caliga on December 09, 2009, 08:16:16 AM
Quote from: Grey Fox on December 09, 2009, 08:13:28 AM
You guys are still afraid of progress socialism, eh.
:yes:
That's a load of shit. We're fine with a socialist single payer system as long as we call it medicare. But call it a Public Option and all hell breaks lose.
Quote from: Admiral Yi on December 09, 2009, 10:33:35 AM
Does Spain have a single payer or multiple payer system?
Single payer.
Edit: Here's the wiki map. Single payer's pretty rare and I think most European insurance systems differ from country to country:
http://upload.wikimedia.org/wikipedia/en/e/e7/Universal_Health_Care_World_Map.svg
Quote from: DontSayBanana on December 09, 2009, 09:11:24 AM
Health insurance companies at present don't charge premiums; they commit usury.
Do you know what usury is?
Quote
As it stands, the insurance I have through the college is worthless. The caps would kick in before the end of the first day of treatment if something were to happen to me, yet that doesn't stop them from charging me $100 per semester for the privilege of "having insurance."
Well, $100 per semester is like 10% of the average US premium, and probably more like 5% of the average NJ premium. How much can you really expect from such a policy? I really don't get why some people expect insurance companies to operate at a loss.
Quote from: Admiral Yi on December 09, 2009, 09:32:07 AM
Quote from: Grey Fox on December 09, 2009, 09:28:03 AM
Why not? Why would it be more expensive in the US? Usually it's Canada that is 7% more expensive then the US.
A couple questions about the Canadian system. Are all health workers public employees? Does the patient get whatever tests and procedures he asks for, or is there an HMO style gatekeeper system (i.e. the primary care doctor says "no Grey Fox, you don't need a CAT scan, STFU.")
Not public employees, at least like I am (where I get a big "Government of Canada" check every payday). Health care workers work for a variety of clinics or hospitals, some of which are for-profit, some of which are run by non-profits or by arms length government agencies. That being said the principal source of revenue for all these clinics and hospitals is the government.
Any test r procedure needs to be approved by the primary care doctor. You can not just walk in and demand a blood test - you need a referral from a doctor. That being said there is essentially no incentive for a doctor to not recommend a test or procedure.
And of course you can always get a second opinion or switch doctors if you like. That's probably the one thing that aggravates me most about the system down here. Your insurance frequently dictates which doctor you can go to and still receive benefits. And god forbid you switch jobs.
Quote from: Maximus on December 09, 2009, 12:38:57 PM
That's probably the one thing that aggravates me most about the system down here. Your insurance frequently dictates which doctor you can go to and still receive benefits. And god forbid you switch jobs.
Agree, this is one of the worst (if not *the* worst) problems.
How about medical school educations? How much of that is typically born privately in your country?
Quote from: Admiral Yi on December 09, 2009, 12:47:09 PM
How about medical school educations? How much of that is typically born privately in your country?
Like all other post-secondary education, the university is an arms-length non-profit that receives mostof it's funding from the government. Students pay, I dunno, 10-20% of the cost of their education?
Quote from: Barrister on December 09, 2009, 12:50:46 PM
Like all other post-secondary education, the university is an arms-length non-profit that receives mostof it's funding from the government. Students pay, I dunno, 10-20% of the cost of their education?
Do you know if that cost gets included in the total health care spending numbers that get thrown around?
Quote from: Admiral Yi on December 09, 2009, 12:59:10 PM
Do you know if that cost gets included in the total health care spending numbers that get thrown around?
I would imagine that it would be very hard to tell. It is like asking if the estimates of total volume of gold in the world includes the gold contained in human blood.
Quote from: Admiral Yi on December 09, 2009, 12:47:09 PM
How about medical school educations? How much of that is typically born privately in your country?
I don't know why, but Medicare/Medicaid pay the lion's share of resident (5th year+) salaries. I guess they're taking advantage of cheap(er) labor.
Quote from: Admiral Yi on December 09, 2009, 12:59:10 PM
Quote from: Barrister on December 09, 2009, 12:50:46 PM
Like all other post-secondary education, the university is an arms-length non-profit that receives mostof it's funding from the government. Students pay, I dunno, 10-20% of the cost of their education?
Do you know if that cost gets included in the total health care spending numbers that get thrown around?
Probably not. At least the straight education part. Residency probably is however.
That seems like a pity.
Anything that leaves the insurance industry thinking "it won" seems like it will fail to achieve too much. I mean, isn't a huge part of the increased cost due to the fact that the American health system has to support HMO and insurance administration, staffing and profits on top of the actual expenses of running the system?
Quote from: Jacob on December 09, 2009, 01:15:22 PM
That seems like a pity.
Anything that leaves the insurance industry thinking "it won" seems like it will fail to achieve too much. I mean, isn't a huge part of the increased cost due to the fact that the American health system has to support HMO and insurance administration, staffing and profits on top of the actual expenses of running the system?
I think 12% overhead vs. 3% for Medicare.
Quote from: Jacob on December 09, 2009, 01:15:22 PM
Anything that leaves the insurance industry thinking "it won" seems like it will fail to achieve too much. I mean, isn't a huge part of the increased cost due to the fact that the American health system has to support HMO and insurance administration, staffing and profits on top of the actual expenses of running the system?
Given the extreme degree of public interest in their business now, I don't think any outcome will leave the insurance industry thinking that. This is one industry where you definitely want people "on the street" to not be thinking about you and what you do in order to make money.
Quote from: Fate on December 09, 2009, 01:11:17 PM
I don't know why, but Medicare/Medicaid pay the lion's share of resident (5th year+) salaries. I guess they're taking advantage of cheap(er) labor.
Very interesting, didn't know that.
Quote from: Jacob on December 09, 2009, 01:15:22 PM
That seems like a pity.
Anything that leaves the insurance industry thinking "it won" seems like it will fail to achieve too much. I mean, isn't a huge part of the increased cost due to the fact that the American health system has to support HMO and insurance administration, staffing and profits on top of the actual expenses of running the system?
No, it's not a huge part. There are more significant reasons for the disparity.
Quote from: Admiral Yi on December 09, 2009, 01:24:10 PM
I think 12% overhead vs. 3% for Medicare.
To be devil's advocate, this comparison is misleading for two reasons. One is that Medicare claims are much larger in size, due to older population being insured. That shrinks the fixed costs as a percentage down. Another reason is that it is probably true that Medicare is more tolerant of fraud or over-utilization than private insurers, for pretty obvious reasons. Sniffing out the fraud takes resources and goes into the expense column (although if loss adjustment expenses are not included in that 12% figure, then it's not a valid point).
DGuller, question for you. How costly is actuarial work? Would it contribute significantly to the difference in overhead?
Reason I ask is Medicare doesn't do any.
Quote from: Admiral Yi on December 09, 2009, 12:59:10 PM
Do you know if that cost gets included in the total health care spending numbers that get thrown around?
I think that's generally included in the cost of higher education spending :)
Looks like you guys are having a more efficient debate on health care than our highly esteemed Congress!! Hmmm....Must be that the Senate bill needs another thousand pages of fine print that no one can read, understand or decipher, in order to come to the same conclusions and ideas that some of you all have! ;)
Quote from: Admiral Yi on December 09, 2009, 01:43:22 PM
DGuller, question for you. How costly is actuarial work? Would it contribute significantly to the difference in overhead?
Reason I ask is Medicare doesn't do any.
It's pretty costly on a per-person basis, but I have no idea how much it adds up to on a total basis. I doubt it's more than a trivial amount, though, because there just aren't that many actuaries.
I'll try to make a very basic, conservative estimate, however. The SOA directory shows that there are 139 credentialed actuaries working at CIGNA. Let's around it up to 400, to account for uncredentialed actuaries and actuarial analysts. Let's also say that the average cost of employing those 400 people is $200,000 per year.
The total comes out to $80 million a year. I'll round it up to $150 mil just to be uber-conservative, maybe all the support services that actuaries need to work cost a fortune as well. Looking at CIGNA's income statement at Yahoo, their total revenue totaled $19 billion. So by a very conservative estimate actuaries cost CIGNA about 0.5-1% of their total revenue.
Quote from: Sheilbh on December 09, 2009, 01:56:01 PM
I think that's generally included in the cost of higher education spending :)
If we're comparing apples to apples it should be included in health care.
(Thanks DGuller)
Quote from: Admiral Yi on December 29, 1973, 01:42:44 PM
If we're comparing apples to apples it should be included in health care.
Why, is the cost of public higher education in the US counted as health spending for doctors?
Quote from: Sheilbh on December 09, 2009, 02:08:47 PM
Why, is the cost of public higher education in the US counted as health spending for doctors?
No, and neither is it anywhere else.
Newly minted MDs with zero education debt to amortize are going to affect the supply side.
Quote from: Admiral Yi on December 09, 2009, 02:10:56 PM
No, and neither is it anywhere else.
Newly minted MDs with zero education debt to amortize are going to affect the supply side.
Remember I'm thick and then try this again please :(
Sheilbh, Yi is saying that the consumer pays US dcotors' education through higher salaries after they start working, so they are in the books as a healthcare cost, while in here they are counted toward higher education, distorting the figures.
Quote from: Iormlund on December 09, 2009, 02:15:14 PM
Sheilbh, Yi is saying that the consumer pays US dcotors' education through higher salaries after they start working, so they are in the books as a healthcare cost, while in here they are counted toward higher education, distorting the figures.
Didn't I just say that?
:P
Interesting question, then, Yi: does the amount of money the US government pays medical schools NOT to fill all of their places come out of healthcare costs, or education costs?
And is this amount (and the amount that would be spent on medical education or is spent now to repay loans) even significant when compared to the $2.5+ trillion spent in the US on health care?
The average debt is $154,067 and there's roughly 20,000 medical students graduating every year. Three billion dollars? Perhaps it contributes, but I doubt it's a huge factor.
Quote from: Fate on December 09, 2009, 05:38:55 PM
The average debt is $154,067 and there's roughly 20,000 medical students graduating every year. Three billion dollars? Perhaps it contributes, but I doubt it's a huge factor.
Danke.
Quote from: grumbler on December 09, 2009, 03:40:37 PM
Interesting question, then, Yi: does the amount of money the US government pays medical schools NOT to fill all of their places come out of healthcare costs, or education costs?
Why would it pay schools not to fill all their places? :huh:
Quote from: Admiral Yi on December 09, 2009, 02:10:56 PM
Newly minted MDs with zero education debt to amortize are going to affect the supply side.
Oh. British doctors have about $60 000 education debt, maybe more. Though I think they get extra support from the NHS if they sign a contract to work for them for x number of years with no private practice (dentists have to work for the NHS for 2 years if they get public support) in a similar way to the military giving an engineer funding in exchange to enlisting for a number of years.
Quote from: jimmy olsen on December 09, 2009, 08:20:57 PM
Why would it pay schools not to fill all their places? :huh:
Good question. Ask the AMA.
AMA is a guild. Like all guilds, they really like reducing the supply of their members under the guise of "ensuring quality of services provided by their members". Lawyers, doctors, and yes, even actuaries, all have their salaries inflated because they're somewhat protected from competition.
Hmm, I'd always assumed that the Health care industry gave more money to Republicans.
http://www.realclearpolitics.com/articles/2009/12/09/big_business_democrats_99453.html
Quote'Big Business' Democrats
By Jonah Goldberg
One of the great frustrations of the libertarian-minded right is how Republicans got stuck being "the party of big business."
The quotation marks around the term are at least somewhat necessary because, in many respects, it's not true.
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Jonah Goldberg RealClearPolitics
economy Democratic Party
The notion that big business is "right wing" has always been more sloppy agitprop than serious analysis. It's true that historically, big business is against socialism and communism -- and understandably so. Socialism and communism were once close to synonymous with expropriation of wealth and the nationalization of industry. What businessman or industrialist wouldn't be against that? But many of those same industrialists saw nothing wrong with cutting deals with statist regimes. For example, the Swope Plan, put forward by Gerard Swope, president of General Electric, laid out the infrastructure for much of the early New Deal.
Yet the debate is always framed as if the choice is between "government intervention" on the one hand and free-market capitalism on the other. From 30,000 feet, that division is fine with me. My objection is the glib and easy association of big business with the free-market guys (Milton Friedman was no champion of public-private partnerships and industrial policy).
This identification allows self-described progressive Democrats to run against big business when they are in fact in bed with the fat cats.
For instance, the standard line from the Democrats is that the plutocrats and corporate mustache-twirlers oppose healthcare reform because, in President Obama's words, they "profit financially or politically from the status quo." That sounds reasonable, and in some cases it is reasonable. But it makes it sound as if Obama is bravely battling "malefactors of great wealth."
But that's not really how it works, as Timothy Carney documents in his powerful new book, "Obamanomics." In 2008, Obama raked in more donations from the health sector than John McCain and the rest of the Republican field combined. Drug makers gave Obama $3.58 for every dollar they gave McCain. Pfizer gave to Obama at a 4-1 rate, as did the hospital and nursing home industries. In 2008, the insurance industry gave more money to House Democrats than House Republicans. HMOs give to Democrats over Republicans by a margin of 60 to 40.
So far, the healthcare industry has mostly been trying to cut insider deals with the government, not fighting to defend the status quo. Discussions between Big Pharma and the White House have been more like pillow talk than a shouting match.
This pattern is hardly unique to healthcare. The U.S. Climate Action Partnership, led by GE, includes many other Fortune 500 companies, including Goldman Sachs -- the company that has profited mightily from Obama's brand of hope and change. CAP is an aggressive supporter of the Democrats' climate change scheme. Why? Because GE and company stand to make billions from carbon pricing, thanks largely to investments in technologies that cannot survive in a free market without massive subsidies from Uncle Sam. GE chief Jeffrey Immelt cheerleads big government as "an industry policy champion, a financier and a key partner."
Going back to U.S. Steel and the railroads, the story of big business in America is often as not the story of fat cats rigging the system. And the story of progressivism is the same story. The New Deal codes were mostly written by big business to squeeze out smaller competitors. The progressives fought for these reforms on the grounds that it's easier to steer a few giant oxen than a thousand cats.
But healthcare is the most troubling example of the trend. Washington Post columnist Robert Samuelson notes that while everyone has been debating the government takeover of healthcare, what's really transpired is healthcare's takeover of government -- thanks to what he calls the "medical industrial complex." Already 1 in 4 federal outlays are for healthcare; government pays, directly or indirectly, for half of all healthcare costs; and the entire industry is heavily regulated. Obama's answer to this state of affairs is more -- much more -- of the same, on the phantasmagorial grounds that it will cut costs.
My biggest objection is not to what isn't true about the claim that the right is the handmaiden to big business, it's to what is true. Too many Republicans think being pro-business is the same as being pro-market. They defend the status quo against bad reforms and think they've defended economic freedom. The status quo stinks. And the sooner Republicans learn that, the sooner they'll deserve to win again.
Copyright 2009 Tribune Media Services, Inc.
It makes sense in a way. If you view campaign contribution as bribes, then it pays to bribe the guy who can hurt you.
I'd do a bit of digging before taking anything Jonah Goldberg writes at face value.
Quote from: Sheilbh on December 10, 2009, 07:16:52 AM
I'd do a bit of digging before taking anything Jonah Goldberg writes at face value.
Go ahead, then.
Makes sense to cozy up to the dude threatening to reform health care. Nothing new about this. Everybody in DC is largely out for their own interests.
Makes even more sense to cozy up the dude promising to expand demand for health care by another 30 million people or whatever and pick up the tab for all the Iormlunds in America. That's why I always tittered when people brought up the AMA's support for reform as proof of how fantastic it was.