My View: Second Class Citizenship

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acaI have read a lot of deadpanning of the Affordable Care Act before the system has even been implemented.  Truth be told, it was not my favored approach.  I have no idea if it will work.  But I would like to see it fail before we scrap it.

I suspect that many of the people defending the current system, or at least lamenting the new system, have never been in a situation where they have had to deal with health care without medical insurance.

As regular readers know, my wife and I in the last three years have adopted one child and are raising our two nephews – 9 years old, and 21 months old.  It has been a wonderful experience and I would not trade it for the world.

However, at the same time, we have come to see the world through new eyes.  And since I have a voice, I feel compelled to speak up for those without a voice.

On other occasions, I have told stories of how people are treated by county social services.  It is appalling.  With the amount of time that people spend to get services, it is no wonder that people do not find work – even if there were jobs to be had.

The arrogant and condescending attitudes of some of the county employees continues to appall me.  Paperwork is routinely lost, misplaced, or misfiled.  We have had to come back numerous times with the same documents – each time wasting literally hours of time.

Remember – we are doing this to help two small boys and, in doing so, the community.  Unlike a foster care situation, we get no direct assistance to take care of the boys.  So instead, we have to rely on food stamps, WIC and MediCal.

Nowhere is it worse than having to go to the Davis Community Clinic.  When you are in the Foster Care system, when you are getting approved for adopting children, you have to get a huge amount of medical forms signed and approved.  With Kaiser, we take it to the office, they get the form to the doctor, and a couple of days later, we have it and can file it.

When we were trying to get our little guy enrolled at preschool for next year (still finding this hard to believe), it was a nightmare dealing with Davis Community Clinic.  They actually called up less than ten minutes before an appointment to cancel.  Remember, we have a number of small kids and getting anywhere is a hassle – gathering the kids, loading up the car, making sure they have gone to the bathroom or their diapers are changed.

The next time, my wife was a running a few minutes late having to get someone from school, and something came up and they cancelled the appointment on her.

The third time, they made them wait for hours and they never saw a doctor.

The fourth time, he was vaccinated but they refused to fill out the form, requiring a separate appointment.

That’s all just inconvenience.  And for us, less so than other people in the same position.  The other day, a friend of mine told me she went to the doctor and they cancelled on her, or tried to.  She is in a wheelchair and in order to get to the doctor’s office, she has to wait a certain amount of time to get on the bus and come down.  Then she has to go home.  So a typical trip to the doctor’s office takes her three or four hours.

You can imagine it is not so easy for her to simply turn around and come back next time.

Fortunately, my wife is not trying to pile three small kids onto a bus and take several hours at a time to get to a doctor’s appointment, but the time still adds up.  It was time when she could have been studying for the classes she is taking, or doing other things.

If anything occurs with the kids that needs attention within the next month, the state of Davis Community Clinic is such that we practically have to take the kids to ER.  One day we did that and the doctor there told my wife that she is taking the little one for a lot of very minor things.

That is a Sutter ER doctor, who apparently does not get a few things.  First, when it’s not your kid, you err on the side of caution.  Second, when a baby is throwing up continuously, you err on the side of caution.  And third, if we had private insurance for him, we would most likely make an appointment with his pediatrician.  But since we can’t be assured of getting him within a week, let alone that day, what’s the point?

Technically, these kids have medical insurance – MediCal.  Most private doctors either won’t take MediCal patients or only take a few limited spots.  That leaves the rest of the population who do not have private medical insurance to go to places like the Davis Community Clinic.

They do some good work there.  I am sure they are understaffed.  But at the end of the day, it is still second class citizenship.

So, at the end of the day, I am at least going to wait and see if things get better or worse under the Affordable Care Act.  And if that messes up your privileged health insurance, all I can say is welcome to my world.

—David M. Greenwald reporting

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About The Author

David Greenwald is the founder, editor, and executive director of the Davis Vanguard. He founded the Vanguard in 2006. David Greenwald moved to Davis in 1996 to attend Graduate School at UC Davis in Political Science. He lives in South Davis with his wife Cecilia Escamilla Greenwald and three children.

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108 thoughts on “My View: Second Class Citizenship”

  1. Growth Izzue

    [quote]So at the end of the day, I am at least going to wait and see if things get better or worse under the Affordable Care Act. And if that messes up your privileged health insurance, all I can say is welcome to my world.[/quote]

    Do you mean that privileged health insurance that I actually have to pay for?

  2. medwoman

    “Do you mean that privileged health insurance that I actually have to pay for?”

    Perhaps he means that privileged health insurance that you actually can afford to pay for.

  3. medwoman

    Exactly. A privilege which was largely provided by the government which supported me with Social Security when my father died when I was nine, provided for my free and then low cost education through college, and then supported me entirely for two years In medical school in return for two years service as a General Medical Officer for an under served population. Quite an investment I would say for a government that some claim is ruining the country by giving out free goodies !

  4. SODA

    David, I am sorry you have had your experiences with DCC.
    A close relative of mine works there part time and as a health care professional myself I have been very impressed with the organization.
    Two experiences come to mind. A number of years ago, we both were recruited for several Saturdays to provide volunteer professional services along with others, for pediatric physicals to migrant farm worker young kids so they could attend local schools during the growing season. We did it at the local farm housing along with UCD students providing translation, pediatricians, etc. One of the most rewarding experiences I have had.
    The other is when my relative was an evening clinic supervisor in the Salud clinic of Communicare and one of the evening tasks was to screen the patients with serious chronic conditions (such as diabetes) who had not showed up that day for an appointment. The cliinic then called them to follow up. I am a Kaiser member, pleased with their services, but I doubt that would happen in any private system, including Kaiser.
    So, again, I am sorry you have had these experiences and I hope there are Communicare members on the DV. I will certainly pass your comments along to my relative.

  5. Growth Izzue

    Oh pease, David’s last sentence “and if that messes up your privileged health insurance, all I can say is welcome to my world” was meant to be provocative. Being that I’m sure David only outlined their worst experiences and left out all of their better doctor visits I’m still sorry that they sometimes have the inconvenience of having to wait a while to get their “free” healthcare.

  6. JustSaying

    I’m not sure i want to jump in to comment on your personal problems, but….

    Let me rant for awhile about the hours of my life I’ve spent hanging around Kaiser to be seen for appointments for which I’ve shown up on time or driving back for drugs and the opportunity to make expensive co-payments or getting rescheduled a few days later when I’ve missed an appointment or catching a cold from the germ-laden folks sneezing next to me or being told “there are no appointments left for June and July scheduling hasn’t opened up yet, etc., etc. And, I pay a bundle for my health insurance as well as contribute to paying for less-fortunate folks health care.

    Expanding better health care access to more people is critical and worthwhile, even if those who benefit have to deal with inconveniences and frustrations. It will help the rest of us who get stuck with the expensive care for those who now head for the emergency ward to get routine treatment.

    If I were unable to pay for health care, I’d be most thankful for the Davis Community Clinic. While they might not be able to be fully responsive to my particular situation, at least they’re there. I’d probable be as irritated as anyone when things don’t go smoothly, but I’m pretty intolerant about the DMV too.

  7. Growth Izzue

    Thanks JustSaying for reminding me how many countless hours I’ve had to spend in Kaiser emergency waiting rooms while trying to get my sick wife and children seen by a doctor in order to use my paid for by me privileged healthcare.

  8. SouthofDavis

    David wrote:

    > And if that messes up your privileged health insurance,
    > all I can say is welcome to my world.

    > But don’t you know medwoman, it’s bad for the
    > government to help people, turns them into moochers.

    Then

    Growth Izzue wrote:

    > I’m still sorry that they sometimes have the
    > inconvenience of having to wait a while to get
    > their “free” healthcare.

    More and more it seems like people are saying I should feel bad about the fact that I worked 80+ hours a week saving and investing for years and now can pay (on average about $2K a month) for my families health insurance and the stuff not covered by insurance. It seems like many people that don’t pay for health care not only don’t feel bad that they are making myself and others pay for their “free” healthcare, but are bitter that guys that get up at 5:00am every day and work until after dark have “privileged” health care that is a little better than the care they get for “free”…

  9. DT Businessman

    I’m no slouch. I’ve been known to work a few hours now and again. I also take lots of business risk and only get paid upon transaction closure. Much of my work goes uncompensated. That all said, I’m a very strong believer in a social safety net including medical care. It is critical to the well being of our community in both the larger and smaller sense. I don’t loose sleep over those that don’t pull their weight and abuse the safety net. I wish they didn’t, but there’s a lot inequity in life. There are countless wealthy and upper middle class individuals that don’t pull their weight and sponge of the productivity of others. Abuse is not confined exclusively to social programs.

    -Michael Bisch

  10. Frankly

    [i]So when Obamacare takes over and all of us are getting the kind of service that you are getting, then you will be satisfied?[/i]

    Bingo!

    Thinking about this…

    Recently there was a study on mastery and it concluded a now popular principle that a human can master almost any skill by putting in 10,000 hours of practice. The point I am relating to this is our ability to leverage brain plasticity to re-wire ourselves to accepting, expecting and performing a new normal.

    The downside to this is forgetting our past, and losing perspective.

    This is the case with respect to healthcare. David laments the difficulty getting care through the free clinics. But, he only can lament it by comparison to the quality of service that is available elsewhere today. He sees the quality of service available to others that can afford to pay for it, and in his new normal, he feels entitled to the same.

    The perspective is lost on David that he received that clinic care for free or near free; while those that pay for greater quality service pay a great deal for it. David is ignoring that point and only focusing on half of the argument. The quality of care he sees and desires is available to him if he pays for it. He does not want to pay for it because there are other things he would prefer to do with his money. Instead he developed a new normal view that conveniently implicated healthcare access as a social right, and not a pay-for-service business.

    The problem with David’s new normal is that it won’t provide him access to that high-quality service he believes he is entitled to. Instead, it will drag down the quality of service to be more like his free clinic experience. But then maybe David will still be satisfied as it will appear to him that he is closer to the top by comparison. At that point we can also conveniently forget our past of being able to purchase access to the greatest healthcare system in the world.

  11. DT Businessman

    God have mercy on us if this is the greatest healthcare system in the world. Surely there is something significantly better we can look forward to than the current inefficient, ineffectual, overpriced, mess we currently have.

    -Michael Bisch

  12. Don Shor

    [quote]Surely there is something significantly better we can look forward to than the current inefficient, ineffectual, overpriced, mess we currently have. [/quote]

    There are lots of other ways to go about providing health care. Here are 36 others. Note the range of public/private combinations.
    [url]http://www.businessinsider.com/best-healthcare-systems-in-the-world-2012-6?op=1[/url]

  13. Frankly

    [i]God have mercy on us if this is the greatest healthcare system in the world[/i]

    Aside from the point of affordability, it is absolutely the greatest healthcare system in the world. Those that can afford it flock to the US for healthcare… especially for healthcare specialties.

  14. Growth Izzue

    [quote]Aside from the point of affordability, it is absolutely the greatest healthcare system in the world.[/quote]

    Agreed, DT might look into changing his health provider if he’s so unsatisfied.

  15. Mr.Toad

    My brother had polio when he was 1. He is now 60 and has been a self supporting small businessman his entire life. One of his largest expenses has been his own health insurance since he has had to pay high premiums because of his polio history and his biggest fear has been that he wouldn’t be able to buy insurance because of his pre-existing condition. We looked at covered california to see what he will pay now under Obamacare. We put in his age, marital status and dependents. There were no questions about medical history. Not only will he be paying about half as much as he does now he doesn’t need to worry about being cut off. For him Obamacare is a big winner. For everyone who worried they would get cut off if they developed an expensive condition Obamacare will be a huge relief.

  16. DT Businessman

    I have worked in 2 of the countries cited on the list. My personal experience leads me to believe that those 2 healthcare systems are superior to the US system. However, those experiences are from more than 15 years ago and I do not know much about the current status.

    -Michael Bisch

  17. davehart

    Well said, Frankly. It’s the greatest health care system for those who can afford it. In fact, that’s exactly WHY it’s the greatest health care system for those who can afford it. The millions who can’t afford it are kept out of it or are put through the meat grinder to get some lower level of access. It is the greatest health care system for those who can afford it. God bless them every last wealth one.

  18. Growth Izzue

    David

    [quote]Or the privilege to be able to afford to provide it. [/quote]

    LOL, so it’s a privilege that I’ve worked hard all my life and can afford healthcare? Is it also a privilege that I worked two jobs in order to buy my nice house and cars? Since you feel that you’re entitled to free cadillac healthcare and being that housing and transportation are vital to ones existence should you also have a free house and cars as nice as mine?

  19. DT Businessman

    davehart is spot on. Frankly and GI, we are not talking about the healthcare system for the wealthy, we’re talking about the US healthcare system overall. Or do non-wealthy citizens not count? The caveat, “aside from the point of affordability”, undermines your entire case. What a strange notion to ignore cost when evaluating alternatives.

    -Michael Bisch

  20. Growth Izzue

    [quote]Frankly and GI, we are not talking about the healthcare system for the wealthy, we’re talking about the US healthcare system overall.[/quote]

    Neither am I, I have your basic Kaiser and am very satisfied with it. The US healthcare system overall is one of the best in the world.

  21. Frankly

    davehart, I get your sentiments here, and I don’t disagree with them. But you cannot just argue one side of that argument. There are consequences for attempting to solve the affordability problem by disrupting and dismantling the existing pay-for-service model.

    If you remove affordability from the assessment, the US healthcare system is the best in the world. So, lets not throw the baby out with the bathwater. But, that is what we are doing. We allow the social welfare, social justice, collectivists to misrepresent the data in ways that lie to the public that the US healthcare system is not high quality. The problem with this approach is that people don’t value what it really is because of their own displeasure about the cost.

    Cost and access for pre-existing conditions are the ONLY significant problems we have. So, why then are we going forward with Obamacare? Pre-existing conditions has always been supported from a bipartisan perspective.

    Now let’s get to costs. How do we lower costs?

    – Reduced government regulations that drive up the administrative costs for delivering healthcare.

    – Tort reform to eliminate the extreme high number of frivolous malpractice law suits that drive doctor insurance premiums to be the highest in the industrialized world.

    – Legislation to roll back the pay and benefits that goes to unionized nurses and other medical professionals. US non-doctor healthcare workers are by far the highest paid in the industrialized world, and they work fewer hours too.

    – Greater insurance company competition at a national level.

    – Tax incentives for individuals to purchase private health insurance.

    – Immigration reform.

    – Increased funding and incentives for clinics and GP care provide by more nurse practitioners.

    – Etc., etc., etc.

    The point here is that there are number of things we could do to leverage and maintain our existing high-quality pay-for-service system while lowering costs. However, since the left wants a single-payer collectivist system, we get this crappy Obamacare junk legislation that will create a bigger mess and knock down the quality so that those that can’t or won’t pay for health insurance can feel better about themselves by comparison.

  22. Mr.Toad

    Is access to healthcare a privilege or a right. I think that is the question. Obamacare seeks to change it to a right. Everyone dies, everyone needs healthcare. How do you reduce the cost to make access easier? I think one way to control costs is that we should train many more doctors so that they are more available and charge less.

  23. Frankly

    [i]The caveat, “aside from the point of affordability”, undermines your entire case. What a strange notion to ignore cost when evaluating alternatives. [/i]

    Michael, not at all. I am surprised that you can’t distinguish this difference.

    Davis is an expensive and high-quality place to live that many cannot afford. Are you willing to increases taxes on those that can afford to live here to subsidize those that can’t? Are you agreeable that Davis is down the list of quality places to live only because the cost is high?

    Where are your free-market principles here?

    If you want a top-down, central-control system that nets out fairness, then you must know that there will be a corresponding drop in access to the higher qualities that money buys? I mean it is not fair that Dave Rosenberg lives in that 6000 sq. ft. mansion in Davis Farms even though he earns enough to pay for it. We should dismantle it and use the land and materials to build 10 600 sq ft loft residences so that everyone gets the same.

    In the US we can purchase Rolls Royce quality healthcare down to Volkswagen-quality healthcare. Those than can’t or won’t purchase healthcare insurance for financial reasons are a problem we should and can fix without reducing access to the highest quality that money can buy. And, those that cannot afford the highest quality that money can buy should not be entitled to it unless they figure out a way to pay for it. However, there is a level of basic healthcare coverage that should be affordable and accessible to all. I think we are well on the way to providing that by simply increasing the funding and incentives for more free or cheap clinics.

  24. Frankly

    [i]I think one way to control costs is that we should train many more doctors so that they are more available and charge less[/i]

    Doctors in France are identified early in their education in a competitive program and have their education almost 100% subsidized. They become doctors 3-5 years sooner than American doctors because of the credentialing requirements. The work on average 30-35 hours per week compared to American doctors average of 50 hours per week. They make about 60% of what American doctors make… but the start their earning career 3-5 years sooner and have no education debt to pay off.

    For us to pay US doctors less, we would need to change the education system and also the doctor credentialing system in the US.

    Frankly, this is a non-starter solution. We need to pay US doctors more to attract more people to the profession. It is drug costs, malpractice and non-doctor labor costs driving up the cost of healthcare. In addition, there are added costs from technological diagnosis and treatment advances that are justified and the reason US healthcare is great.

    Keep in mind too that the wait time for appointments to see a specialist are much higher in France and Canada and other places that US liberals like to claim have a higher quality system than the US.

  25. Don Shor

    [quote]There are consequences for attempting to solve the affordability problem by disrupting and dismantling the existing pay-for-service model. [/quote]

    [quote]our existing high-quality pay-for-service system[/quote]

    Correct me if I’m wrong, but I thought Kaiser was not fee-for-service.

    I don’t know why you (and Republicans) are still trying to debate and defeat the Affordable Care Act. Just implement it. It’s the law of the land now.

  26. Frankly

    [i]I don’t know why you (and Republicans) are still trying to debate and defeat the Affordable Care Act. Just implement it. It’s the law of the land now[/i]

    Sure Don, but as it screws up the healthcare system reducing quality and increasing costs, we will make sure to pin it on the Democrats and all that supported it. It is not looking good at this point.

  27. Mr.Toad

    There are different ways to skin the cat. We could increase the supply of doctors by creating or expanding training programs. In Northern CA we could reduce prices by adding competition among provider groups. We could lower costs by negotiating better drug prices. We could give greater responsibility to medical professionals that are not doctors. There are lots of ways to improve the system and lower costs but as long as people want to nullify Obamacare it will be difficult to improve the system.

  28. medwoman

    [quote]The problem with David’s new normal is that it won’t provide him access to that high-quality service he believes he is entitled to.[/quote]

    I don’t believe that this is the problem. I believe that this is huge oversimplification of David’s point. Making comparison’s between Cadillac care and VW care may sound good, but ignores one very important point.
    Each car will get you from point A to point B with the differences being those of comfort and style. This is simply not true for health care.

    With medical care, the difference between having the ability to see the same physician over time, or that provides regular preventative measures rather than just urgent care, or that covers for hospitalization instead of just stabilize and release may literally mean the difference between life and death. Or to be totally crass, for those who prefer to think in only economic terms, may be the difference between an illness being treated promptly and effectively so that an individual can return to full time productive employment, or their becoming disabled such that they are unable to support themselves and their families.

    Like any huge program Obamacare has some good aspects and some bad. In my personal life, and in the life of many of my patients ( especially since we are in a University town) allowing young adults to stay on their parents health plans has been a God send. Not allowing exclusions for pre existing conditions or allowing insurance to deny care based on minor clerical errors in filling out applications once a serious condition is diagnosed will be major improvements for many people. Obamacare would not have been my preferred approach but I see many of its provisions as steps in the right direction. For those who feel that health care should remain a private market driven service, I would point out that had the insurance companies and providers not stuck with such completely egregious practices and charges, this kind of reform would not have been necessary in the first place. It is specifically because doctors, pharmaceutical companies, hospitals, equipment manufacturers and insurers abused the ability of people to pay, that reform is necessary. I can say this as someone who has worked within our health care system for 30 years in the military, the university setting and with Kaiser.

  29. medwoman

    Frankly

    [quote]but as it screws up the healthcare system reducing quality and increasing costs, we will make sure to pin it on the Democrats and all that supported it. It is not looking good at this point.[/quote]

    I would like specifics on how it is going to “screw up the health care system”. When you say reduce quality,
    please specify for whom. For people who cannot get access to care now, it will likely be an improvement. For those who can afford “the best of the best” now, it will probably not affect them at all. So who exactly do you think will have their quality reduced ? The “middle class” whomever you perceive that to be, well it will take some time to see how they are impacted. We simply don’t know at this point in time. I realize that your ideologic world view does not allow you to see any way that this might be beneficial, but I have a very different perspective as someone who came close to renal failure because my mother could not afford hospitalization,
    and who over the course of my years of practice have seen many people delay needed medical care until they could get insurance, or do without it entirely because of their inability to acquire it because of “pre existing
    conditions” until they were near death. I fail to see how this is going to “screw up the health care system” for these less fortunate individuals.

  30. Don Shor

    [quote]Don: pay-for-service is not the same as fee-for-service.[/quote]

    Then you just mean ‘pay-for-service’ as in the opposite of free aka socialized medicine? The Affordable Care Act doesn’t change the fact that people pay for their health care.

  31. Frankly

    Don, pay-for-service in this case includes the third party insurance company. I pay the insurance company that pays my healthcare bills minus my deductible and minus the excess any out of pocket maximum. Fee-for-service, as I refer to it, is paying directly to the service provider a fee for services provided. For example, the situation where the doctor does not take any insurance payments and bills the patient directly for each and every service. I think we need more of this. I think this makes great sense for lower income people for routine healthcare visits and non emergency care.

    This might be my own definition, but I think it is a common one.

    Medwoman, the quality of care will decline for several reasons, including a general increased rise in premiums that causes existing covered people to have to purchase lower quality plans. The added taxes on “Cadillac” plans (an inflammatory label) that causes those people to have to reduce coverage. However, the biggest reason we will see a general decline in healthcare quality is the shortage of doctors and specialists that Obamacare does nothing to address.

    Also, we have higher taxes being levied on pharmaceutical and medical equipment producers. This will lead to reduced innovation and higher costs.

    We will also see companies that currently provide insurance, opt out and the result will be a lower quality individual plan for many employees.

  32. Don Shor

    [quote]I pay the insurance company that pays my healthcare bills minus my deductible and minus the excess any out of pocket maximum.[/quote]

    The Affordable Care Act doesn’t change that.

  33. medwoman

    Frankly

    You may not be aware that there are a number of new medical schools opening and there has been a major move to maximizing the services of mid level care providers. These are steps that should have been taken many years ago.

    In my opinion, profits on pharmaceuticals and medical equipment have been egregiosously out of line for as long as I have been involved in medicine. A piece of plastic that would cost $5.00 at a hardware or novelty store goes for $120.00 once it called a”breast screening model”.
    This is not innovation and the costs could hardly be higher than they are now in the ” free market” where prices are jacked up astronomically because the word “medical” is used.

    To me, the insurance companies add absolutely nothing of value . I would have vastly preferred a single party payer system such as members of the military have. I would eliminate the insurance companies altogether, train enough doctors and mid level providers to provide care for all, enact torte reform, demand truly transparent medical and hospital billing so that the patient understands what their care actually costs and demand that pharmaceutical and equipment manufacturers either truly set their prices competitively or be subject to government regulation of prices ….their choice.

  34. jrberg

    I’ve been waiting for the military system to pop up in this discussion. Although I’ve never served in the military, I grew up with military medicine. They definitely follow the “socialist” single payer model. But they get the job done – including having saved my life when I was 11 years old, and doing a great complex broken arm repair when I was 12.

    I have been in the Kaiser system for most of the rest of my life, and I find them to be the next best thing to military medicine. I don’t deal with insurance claims at all, and most of the service has been excellent, especially their specialists.

    Some people have mentioned poor emergency room service at Kaiser. This is where the overall system fails – ER service must, by law, be available to all, not just Kaiser subscribers. ER’s do triage, which means that even if you are covered by Kaiser, someone else who is not gets higher priority for service because of the seriousness of their illness or injuries. I have had great service at Kaiser ER’s, but sometimes I have waited for a very long time to have myself or family members treated. If there’s a gunshot victim that comes in after you’ve been waiting for awhile, he or she is going to get priority service. An ER is not a clinic, and was never meant to be, which is one of the great failings of the US system of medicine, since some people think it should fill that role. No, that’s not what an ER is for.

    I would love to have the military/Kaiser model instituted nationwide.

  35. wesley506

    On Tort reform that many apparently believe is the holy grail for reigning in health care costs………..
    On average, 97 percent of medical negligence claims have merit. Researchers at the Harvard School of Public Health examined over 1,400 closed medical negligence claims and found that [b]97 percent were meritorious[/b]. Of those 1,400 claims, 80 percent involved death or serious injury. The study concluded that “portraits of a malpractice system that is stricken with frivolous litigation are overblown.”
    Medical negligence compensation accounts for only [b]0.3 percent of national healthcare costs.[/b] According to the National Association of Insurance Commissioners, the total amount spent defending medical malpractice claims and compensating victims is $7.1 billion – [b]just [u]0.3 [/u]percent of America’s $2.2 trillion in healthcare spending[/b]. Meanwhile, the real driver of healthcare costs are preventable medical errors, which are responsible for an additional – and unnecessary – cost of $29 billion annually.
    There is little correlation between medical malpractice claims and medical malpractice premiums. Instead, premiums rates are driven almost entirely by insurance trends. The National Bureau of Economic Research has found that “increases in malpractice payments made on behalf of physicians do not seem to be the driving force behind increases in premiums.” Meanwhile, American for Insurance Reform found that [b]“rate increases were rather driven by the economic cycle of the insurance industry, driven by declining interest rates and investments.”[/b] Finally, on average, doctors spend less on malpractice insurance – just 3.2 percent of their revenue – than they do on rent.
    [b]The average liability premium is higher in states with damage caps than those without.[/b] With damages capped, insurance companies pay out less money towards awards, but they don’t pass those savings along to doctors in the form of lower premiums. The strongest example of this is Texas, which passed a restrictive damages cap in 2003. Following the cap, the nation’s largest medical malpractice insurer – GE Medical Protective – told the Texas Insurance Commissioner that caps had a negligible impact on rates and announced a 19 percent increase in doctors’ premiums. In its filing, GE Medical Protective acknowledged that “non-economic damages are a small percentage of losses paid. Capping non-economic damages will show loss savings of 1.0 percent.” Even the president of the American Insurance Association has said that [b]“We have not promised price reductions with tort reform.”[/b]
    Defensive medicine is less prevalent than suggested and there are little savings to be gained from targeting it. The vast majority of academic and government research has found that targeting indirect costs, such as defensive medicine, offer little savings. Also, [b]much of what is considered defensive medicine is motivated by the desire to generate more income rather than a fear of litigation.[/b]
    No more than one-half of one percent of malpractice payments resulted in an award of $1 million or more, and judge or jury awards account for only 5 percent of all medical malpractice dollars. In 2005, the average award for a [b]significant permanent injury was $215,000[/b], while the average award for a [b]major permanent injury was $315,000[/b]. The median award for cases where the patient was rendered a [b]quadriplegic, brain damaged, or in need of lifelong care was $635,000[/b], and the award average for a patient’s [b]death was only $195,000[/b].From 1991 to 2003, the average size of trial awards grew only 3.4 percent. A RAND study looked at the growth in malpractice awards between 1960 and 1999 and found that real average awards have grown by less than real income.[b][b][/b][/b]

  36. JustSaying

    [quote]“I’ve been waiting for the military system to pop up in this discussion.”[/quote]I second your emotion about the socialized medicine my family and I received while I was in the military. It’s difficult to sort out the true costs just as it is to analyze the subsidization of the commissaries and the officers’ clubs. But, the level of care certainly would be a satisfactory standard our country to seek for our citizens. Those who can afford more and want to spend more certainly could seek out something better either for general practice or for specialist care.

    Doctors are the best thing about our health care program. There are many problems with free market medicine, not the least of which is the unchecked, massive profits of drug and equipment companies. Medical insurance companies have assured high profits more than quality care. I was surprised to learn that even non-profits have used their tax status to assure high management salaries and unnecessary buildings and equipment that further drive up costs.

    The “affordable care” Obama Care hardly can be a much worse experiment than Bush’s wasteful Medicare Part D drug company giveaway for which we’re borrowing from China to finance.

  37. wesley506

    N[quote]ow let’s get to costs. How do we lower costs?

    – Legislation to roll back the pay and benefits that goes to unionized nurses and other medical professionals. US non-doctor healthcare workers are by far the highest paid in the industrialized world, and they work fewer hours too.[/quote]
    The median expected salary for a typical experienced Staff Nurse – RN in the United States is $67,273. That is about $33.46/hr. The RN is typically the one who will triage your phone call and determine whether your problem is emergent, urgent or routine and what you should do about it. They are typically the ones who will be the first ones to see you when you come in the ER, and will monitor you while being diagnosed and treated, will make sure the surgeon does not forget a foreign object in a body cavity in the OR, will monitor you post-op to make sure you come out of anesthesia uneventfully, will double-check all inpatient physician orders to make sure you are not administered anything contraindicated, will provide most if not all patient education, will evaluate your ability to understand provider recommendations, will keep track of records and make sure the MD is aware of critical test results, and a multitude of other things that ensure your medical problems are managed appropriately. Do you think this level of responsibility which requires considerable knowledge, skills, and ability only merits minimum wage?

  38. jrberg

    Wesley, both of your posts are a refreshing antidote to the hysterical posts by the uninformed and ignorant posters. Note that by using the terms “uninformed” and “ignorant,” I am not accusing those posters of being willfully so. I’m sure they actually believe their worldview.

    JustSaying: My father was enlisted; we never saw the inside of an Officer’s Club, but we sure heard a lot about what went on inside them. Lots of alcohol…..

  39. Don Shor

    [quote]as it screws up the healthcare system reducing quality and increasing costs,[/quote]
    By any measure, quality had been declining and costs had been increasing prior to the passage of the ACA. And it doesn’t take effect until 2014. So by what metric will you measure the success or failure of the ACA?

  40. Frankly

    Here is a link to a list of nurse salaries and hours worked by country…

    [url]http://www.worldsalaries.org/professionalnurse.shtml[/url]

    We are number one! In highest pay and fewest hours worked.

    Other non-doctor healthcare employees (like lab techs and radiologists) are also paid the top wages in the world, and work fewer hours.

    It is a pretty good gig. Too bad we are all paying for it.

  41. jrberg

    Classic cognitive dissonance:

    [quote]

    06/08/13 – 08:36 PM

    Here is a link to a list of nurse salaries and hours worked by country…

    http://www.worldsalaries.org/p…urse.shtml

    We are number one! In highest pay and fewest hours worked.

    Other non-doctor healthcare employees (like lab techs and radiologists) are also paid the top wages in the world, and work fewer hours.

    It is a pretty good gig. Too bad we are all paying for it.
    1 2[/quote]

    So, do you want much lower paid and trained medical personnel assisting at your next surgery? Or interpreting your lab or xray results? Please tell us exactly how the people who keep you healthy should be compensated. We’d appreciate the insight.

  42. medwoman

    Wesley506

    [quote]much of what is considered defensive medicine is motivated by the desire to generate more income rather than a fear of litigation. [/quote]

    While I do not dispute or confirm your actual statistics, I think that you also are over simplifying this issue. “Defensive medicine is about much more than just malpractice costs. I do not doubt that generation of income may be one motivator in ordering unnecessary or redundant tests in fee for service medicine, I know for a fact that “defensive medicine ” is also a motive. In a system such as Kaiser where we do not pay for our own medical malpractice, nor benefit personally for ordering unnecessary tests, there is still wide variability in ordering of tests. Some of this is of course variations in individual judgement as is fully warranted. Some is also practitioners ordering studies and procedures because they are afraid not of malpractice payouts but of the harm done to their reputation should a settlement exceed the reporting limits and their name be listed as having been associated with a malpractice settlement. And, we have not even begun to address the feeling of personal responsibility that goes along with the thought of making the oversight that will result in serious harm to a patient and the inclination especially of younger doctors to rely more and more on the security provided by increasingly expensive and elaborate tests to ensure that “nothing has been missed” even when an extremely low probability is acknowledged.

  43. jrberg

    Now that I think of it, I think Frankly just made the argument that the US should have the same single payer system found in most industrial, advanced countries. I agree.

  44. Frankly

    [i]To me, the insurance companies add absolutely nothing of value.[/i]

    You must be forgetting that healthcare costs were a political hot potato before HMOs came on the scene after the Health Maintenance Act of 1973. HMOs did exactly what they were supposed to do and reduced overall healthcare costs. They have done so despite a few biased, left-leaning, single-payer-dreaming, studies claiming that they have increased costs.

    I laugh at all the animus against health insurance providers by those in the medical profession, since those in the medical profession have failed to show any level of cost restraint and it has been exactly this that opened the door for greater insurance company control of healthcare.

    Responding to wesley506’s rant on malpractice costs in the US.

    [quote] Sixty percent of physicians age fifty-five years and older have been the subject of a medical lawsuit[1] Physicians can expect to spend $25,000 for every claim that is filed against them and up to $140,000 for cases that go to trial.[1] But the majority of malpractice claims (sixty-four percent) are either withdrawn, dropped or dismissed without any payment to the plaintiff (in most cases because the doctor was not negligent). [/quote]
    It is here that provides the evidence of all the Obamacare-biased fake academic studies on the Internet that claim US malpractice costs don’t add to much. The costs in higher premiums PLUS the legal and administrative costs that doctors have to spend to defend themselves from a constant barrage of frivolous law suits need to be considered.

    Also contributing to costs is the practice of defensive medicine… ordering ALL the procedures to make sure the patient does not turnaround and sue for missing something.

    One more bit of data related to higher US healthcare costs compared to other countries. The other countries have service supply constraints that present waiting queues, particularly for elective services. These service supply constraints result in people dropping off the queue and/or dying before they get service. This too helps to keep costs lower and tends to prevent law suits.

  45. Don Shor

    Are you seriously making the claim that nurses’ compensation are a significant factor in the increased cost of health care? That we should reduce nurses’ pay to reduce health care costs?

  46. Growth Izzue

    [quote]The “affordable care” Obama Care hardly can be a much worse experiment than Bush’s wasteful Medicare Part D drug company giveaway for which we’re borrowing from China to finance. [/quote]

    LOL, ard who do you think we’re going to borrow from to pay for Obamacare?

  47. medwoman

    [quote]I laugh at all the animus against health insurance providers by those in the medical profession, since those in the medical profession have failed to show any level of cost restraint and it has been exactly this that opened the door for greater insurance company control of healthcare.
    [/quote]

    I believe that I attributed fault to the medical profession with regard to artificially restricting the number of doctors, limiting the practices of mid level providers unnecessarily, defending fee for service medicine and to a debatable degree practicing defensive medicine. None of this exonerates the insurance companies for their misdeeds.

  48. Growth Izzue

    [quote]Your physician spends 10 cents on malpractice insurance from every dollar you pay for health care, according to Diana Furchtgott-Roth, a senior fellow at the Manhattan Institute. Furchgott-Roth notes that premiums vary from $20,000 annually in low-cost states to $200,000 annually in high-cost states.[/quote]

  49. medwoman

    [quote]who do you think we’re going to borrow from to pay for Obamacare?[/quote]

    I have a few suggestions for fundraising:
    How about stopping subsidies to corporate farms to not plant certain crops ?
    Maybe closing loopholes on US companies and individuals that choose to hide assets outside the US?
    Maybe not engage in non defensive military operations.
    How about assessing real fees on banks that launder money for illegal enterprises ?
    End the completely ineffective “war on drugs”. Allow legalization and tax proceeds.
    Maybe we could tax organizations that claim to be doing charitable work, but are actually political fronts.
    Stop spending extravagantly on government “training sessions” ?
    Close Guantanamo ?

    Those combined wouldn’t come close to footing the bills, but I am sure you all can come up with your favorites.
    Some of you would prefer I am sure to cut back on food stamps and school lunch programs, or do away with publicly funded education. Those steps, just like not providing adequate health care to our citizens are bound to improve our country and lead to a more productive populace.

  50. wesley506

    [quote]Here is a link to a list of nurse salaries and hours worked by country…

    http://www.worldsalaries.org/p…urse.shtml

    [/quote]
    This data also shows that USA car mechanics, teachers, dentists, engineers, professors, fire fighters, and computer programmers are also the highest paid of all countries in the study. Maybe these professions could also participate in a race to the bottom so our economy can become more competitive.

  51. Frankly

    [i]Here is a link to a list of nurse salaries and hours worked by country…

    http://www.worldsalaries.org/p…urse.shtml

    This data also shows that USA car mechanics, teachers, dentists, engineers, professors, fire fighters, and computer programmers are also the highest paid of all countries in the study. Maybe these professions could also participate in a race to the bottom so our economy can become more competitive.[/i]

    We are talking about healthcare are we not?

    Except for firefighters which is another over-paid unionized profession, these other professions are working in competitive industries where consumer choice prevents hyper inflation like we see for healthcare.

    Since we are talking about the high cost of US healthcare, are you and Don making a case that the cost of healthcare labor in the the US is not a factor? That is what is sounds like to me. Why would you defend that practice of having the highest paid and fewest hours working nurses in the world if you really cared about that poor family getting access to quality healthcare services? Is it because the nurses union benefits your political party?

  52. Frankly

    [i]Your physician spends 10 cents on malpractice insurance from every dollar you pay for health care, according to Diana Furchtgott-Roth, a senior fellow at the Manhattan Institute. Furchgott-Roth notes that premiums vary from $20,000 annually in low-cost states to $200,000 annually in high-cost states.[/i]

    GI, correct!

    But this doesn’t include the other two costs that I listed:

    1. The cost of defending all the frivolous law suits ($25,000 per and $140,000 if it goes to trial)
    2. The cost of the practice of defensive medicine.

    Tort reform and national caps on malpractice awards would reduce premiums and also reduce the other two cost factors listed.

    However, the trial lawyer lobby keeps stuffing cash into the pockets of Democrat campaign bosses, so we won’t expect any liberal or Democrat agreement here.

    Again, it is okay for a good lefty to complain about the high cost of healthcare while blocking any solution that impacts Democrat political money.

  53. wesley506

    Texas enacted tort reform which included a cap on damages in 2003.
    Since the liability laws took effect:
    • The cost of health care in Texas (measured by per patient Medicare reimbursements) has
    increased at nearly double the national average;
    • spending increases for diagnostic testing (measured by per patient Medicare
    reimbursements) have far exceeded the national average;
    • the state’s uninsured rate has increased, remaining the highest in the country;
    • the cost of health insurance in the state has more than doubled;
    • growth in the number of doctors per capita has slowed; and
    • the number of doctors per capita in underserved rural areas has declined.
    The only improvement in Texas since 2003 has been a decline in doctors’ liability insurance
    premiums. But payments by liability insurers on behalf of doctors have dropped far more than
    doctors’ premiums. This suggests that insurers are pocketing more of the savings than they are
    passing to doctors.
    Health care costs are rising in Texas, and much faster than elsewhere. Per patient
    Medicare spending in Texas has risen at nearly twice the national average – 15.1 percent vs. 8.7
    percent – in the four years since the liability law was instituted. In contrast, in the four years
    before the law’s enactment, per patient Medicare care spending in Texas actually declined,4
    adjusted for medical services inflation.
    Liability opponents argue that steep increases in diagnostic testing are caused by fear of
    litigation, a phenomenon they call “defensive medicine.” But since 2004, the increase in testing
    expenditures in Texas has outpaced the national average by more than 50 percent, adjusted for
    medical services inflation. Medicare reimbursements for diagnostic, lab, and X-ray services in
    Texas grew by 16 percent from 2003 to 2007 compared to a national average of 10 percent over
    the same time period.
    In contrast to claims that health insurance has become “more affordable” in Texas since 2003,10
    premiums in Texas have increased by 114 percent for individuals and 144 percent for families.
    Health insurance premiums in Texas grew at about the same rate as the national average from
    2003 to 2008 (120 percent for individuals and 148 percent for families), and Texas occupied the
    same rank – 33rd highest premiums – at the beginning and end of the period.
    Doctors have seen a 27 percent reduction in liability insurance rates since the
    Texas law was instituted. But medical malpractice payments on behalf of Texas doctors are
    down 67 percent. This suggests that insurance companies have reaped most of the benefit from
    limited liability, doling out a smaller portion of their winnings to doctors. In contrast, patients
    and taxpayers appear to have been left out entirely.

  54. Frankly

    wesly506, you are cherry picking your example. In other states and other counties where there are limits to awards and clamps on frivolous law suits, healthcare costs are lower.

  55. medwoman

    [quote]In other states and other counties where there are limits to awards and clamps on frivolous law suits, healthcare costs are lower.[/quote]

    Please site your data.

  56. Don Shor

    [quote]the quality of care will decline for several reasons, including a general increased rise in premiums that causes existing covered people to have to purchase lower quality plans. [/quote]
    Premiums were going up before. So the decline in quality was already happening. Whether the Affordable Care Act will reduce that cost increase, reduce costs, or exacerbate it is a good question. Most likely is that the rate of increase will decline.

    [quote]Also, we have higher taxes being levied on pharmaceutical and medical equipment producers. This will lead to reduced innovation and higher costs.[/quote]
    The purpose of that tax was to reduce some of the other cost increases. So on the admittedly complicated balance sheet of the overall impact, it should be mitigated elsewhere.

    [quote]We will also see companies that currently provide insurance, opt out and the result will be a lower quality individual plan for many employees.[/quote]
    Which is their choice, but it should be noted that companies were already dropping health insurance at an increasing rate as they cut costs during the recession. So again, this was an existing problem. It will make them less competitive in seeking workers as the economy recovers.
    Insurance companies and health care providers are getting a huge boon as the mandate takes effect. They will get millions of new enrollees. Theoretically that should enable them to reduce costs as healthy uninsured individuals sign up. What we don’t know, and won’t know, is how many will simply choose to pay the penalty rather than get insurance.

    A big part of reducing overall costs was the expansion of Medicaid via federal subsidy of the state’s costs. But with Republican governors refusing to accept that, even at 100% reimbursement, the cost of the Affordable Care Act will be higher than it would be otherwise. So if cost of the ACA was a real concern to Republicans, they would cooperate in its implementation rather than keep trying to block it.

  57. Growth Izzue

    Here’s a different view:
    [url]http://www.forbes.com/sites/theapothecary/2013/05/30/rate-shock-in-california-obamacare-to-increase-individual-insurance-premiums-by-64-146/[/url]

    [quote]Last week, the state of California claimed that its version of Obamacare’s health insurance exchange would actually reduce premiums. “These rates are way below the worst-case gloom-and-doom scenarios we have heard,” boasted Peter Lee, executive director of the California exchange. But the data that Lee released tells a different story: Obamacare, in fact, will increase individual-market premiums in California by as much as 146 percent.[/quote]

  58. medwoman

    [quote]We will also see companies that currently provide insurance, opt out and the result will be a lower quality individual plan for many employees.[/quote]

    Or it may be that these employees will now move into non fee for service plans such as Kaiser and continue to enjoy quality health care. We simply do not know how this is going to pan out. As with any new plan, there are likely to be some advantages and some advantages, but to dismiss it as a disaster before it even is implemented is to me simply playing an ideologic card without considering what the pros and cons are likely to be.

    Some pros for my family and many of my patients are already being realized by young women being covered on their parents plan until age 26. In my field this means them being able to avail themselves of contraception, cervical cancer screening and STD screening and treatment. Prevention is highly important in my field and saves us money in terms of prevention of unintended pregnancy, costly future treatment of cancer and the sequelae of delay in treatment of infections. I think it is wrong headed to only consider costs, and not demonstrated benefits.

  59. Frankly

    [i]A big part of reducing overall costs was the expansion of Medicaid via federal subsidy of the state’s costs. But with Republican governors refusing to accept that, even at 100% reimbursement, the cost of the Affordable Care Act will be higher than it would be otherwise. So if cost of the ACA was a real concern to Republicans, they would cooperate in its implementation rather than keep trying to block it.[/i]

    Oh here we go again. It is the wind-up and the pitch and the… whiff.

    Let’s rev-up that blame Republicans template now that this Democrat disaster of a bill is heading toward healthcare catastrophe. You guys crack me up!

  60. Frankly

    States with limits on medical malpractice…

    [quote]◾California & Colorado
    ◾Florida
    ◾Kansas
    ◾Maryland
    ◾Massachusetts
    ◾Michigan
    ◾North Carolina
    ◾Texas[/quote]

    Healthcare costs by state…

    [img]http://www.cscdc.org/miscjeff/healthspending.jpg[/img]

    [url]http://kff.org/other/state-indicator/health-spending-per-capita/[/url]

    I will post data on different countries later.

  61. Don Shor

    [quote]this Democrat disaster of a bill is heading toward healthcare catastrophe[/quote]

    Here’s what the ACA does:

    1.Guaranteed issue (eliminates pre-existing condition refusal).
    2.Partial community rating.
    3.Individual mandate.
    4.Health insurance exchanges.
    5.Federal subsidies on a sliding scale.
    6.Expands Medicaid eligibility to 133% of the poverty level (effectively 138%). Subsidized that expansion to the states. The Supreme Court upheld the right of governors to refuse it.
    7.Minimum standards for health insurance policies.
    8.Annual and lifetime coverage caps banned.
    9.Firms employing 50 or more people but not offering health insurance pay a fee/penalty.
    10.Very small businesses able to get subsidies.
    11.Co-payments, co-insurance, and deductibles eliminated for select health care insurance benefits.
    12.Restructuring of Medicare reimbursement from “fee-for-service” to “bundled payment

    What part of that is a disaster? What part is a catastrophe?

  62. wdf1

    Frankly might also be pleased to know that ACA also covers preventive fluoride treatment for children without fluoride in their water source.

    That would bolster his argument against putting fluoride in the local drinking water, and enhance his appreciation of Obamacare at the same time.

    source ([url]http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html[/url])

  63. medwoman

    [quote]In other states and other counties where there are limits to awards and clamps on frivolous law suits, healthcare costs are lower.[/quote]

    I am a little confused. You have provided a list that includes only 9 states. Of these 1/3, Massachusetts, at the second most costly, Maryland and Florida are above what is listed for the US overall. Kansas is barely below this number with Michigan only two hundred dollars less. Only three are in the 10 least expensive states. I honestly cannot see this as strongly supportive of your assertion. Am I missing something ?

  64. JustSaying

    The assertion is: limits on malpractice result in lower medical costs. However, two lists prove nothing. At the very least, we need to see the costs before limiting legislation took effect and the current costs. Then, if Texas dropped from, say, tenth to 46th, Frankly’s got a point. Once that point gets proved, we can talk about the quality and outcomes for states with very low limits.

  65. Frankly

    Related to the cost of US healthcare, I think this article in Forbes covers it nicely.

    [url]http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s-health-care-costs-so-high/[/url]
    [quote]Professor Reinhardt cites several other factors contributing to higher health care costs: pharmaceutical pricing, higher administrative costs for medical payments relative to single-payer models, and the highly-developed U.S. tort system and resulting defensive medicine. McKinsey Global Institute estimates that the first two items cost $50-$100 billion each, 5%-10% of the gap (source). Interestingly, Reinhardt dismisses the aging of the baby boom generation and better quality or better outcomes as realistic explanations for our higher costs.

    In business, bad problems call for plain talk. The data I found says the dominant problem with U.S. health care costs is a labor problem with medical professionals. Wages and work rules (i.e., referral decisions leading to over-utilization, staffing levels in hospitals) have driven costs to a level that is now unbearable (see my earlier post). The situation reminds me of the U.S. airlines in their hey-day: growth and sloppy regulation allowed labor costs to soar; senior pilots were paid about what specialist doctors earn today and had enough free time that many ran side businesses; and high costs would soon gut the air lines financially. Twenty years on, the major air lines of that era have all disappeared or gone through Chapter 11, mainly to restructure their labor costs. Safety has been maintained, however, and there is still an ample supply of pilots.[/quote]
    This second paragraph identifies the main problem, and it gets little attention from a media ideologically sympathetic to unionized labor.

    I find it interesting how much effort is exerted by the protectors of the status quo to try and debunk or diminish the fact that US medical malpractice insurance, claims, defense and defensive medicine contribute to the higher costs of US healthcare costs. So, it is .5% to as much as 5% of the total costs of US healthcare based on several studies I have read. The protectors of the status quo make the case that tort reform will not make much of an impact in the cost. But then it is clear that no single issue is responsible for the high cost of US healthcare costs. The higher cost of malpractice is just one of a handful of things we should be working to fix. By focusing on each single thing independently we can always make the case that the impact would be less than a complete solution.

    Over-paid and underworked healthcare labor is one factor. High drug and medical equipment costs are factors. The high cost of medical malpractice is a factor. Lack of multi-state insurance carrier competition is a factor. Burdensome government regulations are a factor. There are a number of factors, and Obamacare does little to address the most critical of these. Obamacare will result in accelerated increase in premiums, higher taxes, reduced employee benefits, and lower quality (longer, waits, fewer doctors available, etc.). It will cause fewer people to want to become doctors. It will lower the investment in new drugs and new medical technology. It will make a mess out the current best healthcare system in the world. The solution should be simply to implement policy to lower costs, not to dismantle and destroy the existing system because poor people cannot or will not buy insurance.

  66. Don Shor

    Items 4, 5, 6, 10 and 12 on my list above deal with cost.
    Access and arbitrary refusal or partial coverage were major issues. There is no reason to believe that health insurers would have willingly provided greater access or less restrictive coverage.
    There is no reason to believe it will accelerate the increase in premiums for most people.
    The higher taxes are specific and for the purpose of reducing the overall cost. Most people will not pay higher taxes.
    The loss of employee benefits will occur at some firms; many others will likely offer health insurance in lieu of paying the fine, so that will be an increase in employee benefits.
    There is no reason to believe most people will see “lower quality.” For those who have no access to health insurance, the quality of their health care will greatly improve.
    New drugs will remain highly profitable. The ACA does nothing to reduce the profitability of new drugs or new medical technology.

  67. Don Shor

    [quote]the current best healthcare system in the world.[/quote]
    The United States does not have the best healthcare system in the world.

  68. medwoman

    [quote]Professor Reinhardt cites several other factors contributing to higher health care costs: pharmaceutical pricing, higher administrative costs for medical payments relative to single-payer models, and the highly-developed U.S. tort system and resulting defensive medicine. [/quote]

    How interesting that two people can read the same information and come to such dramatically different conclusions. First on Professor Reinhardt’s list is pharmaceutical pricing. This is due to a lack of, not too much regulation. One recent example of “innovation” the drug company way. When it’s drug “Yasmin” was about to lose the exclusivity of its formula thus allowing generics to be sold, its manufacturer minimally changed the dose of one of the ingredients, conducted a “study” that proved it could do what all birth control pils have the ability to do to greater and lesser degrees, and marketed this at greatly increased cost as a “new pill”. This is all about profit, not about innovation, and this is just one small example.

    Second on the list:

    [quote]higher administrative costs for medical payments relative to single-payer models[/quote]

    It seems that you missed this statement Frankly. You make no statement at all about the completely needless and wasteful process that doctors go through with insurance companies that provide no added value but drive up cost by demanding additional unnecessary visits, testing and procedures. A simple example. A woman presents to my office with abnormal bleeding. She and I decide that a biopsy is needed and I do it immediately at the same appointment. She has her result in 72 hours. In fee for service care through an insurer, the woman and doctor decide on the biosy. She leaves the office. The doctor’s staff contacts the insurer for pre approval from a non medical staff person who confirms that it is indicated and that the insurance will cover the cost.
    A separate appointment is made and the patient takes yet more time off from work, may have another copay, and returns for the same procedure that I did within a single 15 minute appointment. Please note the phrase,
    relative to single- payer models. Clearly, eliminating the need to consult with multiple insurance companies to find out if you will be paid for what is obviously medically indicated is not a value. Those who argue, falsely, that the government will be dictating what care you can and cannot receive, do not seem to appreciate that their own insurance company is frequently dictating now what procedures and tests must be done and in what order in order for their doctor to receive payment. It is only within the military and Kaiser like systems, both “pre paid”
    and not “fee for service” that the doctor and the patient actually make the final decision about medical care.

  69. medwoman

    [quote]Obamacare will result in accelerated increase in premiums, higher taxes, reduced employee benefits, and lower quality (longer, waits, fewer doctors available, etc.). It will cause fewer people to want to become doctors. It will lower the investment in new drugs and new medical technology. It will make a mess out the current best healthcare system in the world. The solution should be simply to implement policy to lower costs, not to dismantle and destroy the existing system because poor people cannot or will not buy insurance.[/quote]

    With regard to reduced employee benefits, if this helps in the long run to decouple the provision of health care from the patients work status, I see it as a gain rather than a loss. I would have preferred a single-payer system but I see subsidization for individuals and small employers as a step in the right direction. Health care should be a basic provision of a society, not something that is dependent upon an individuals employment status. Our current means of financing health care is not only inhumane, but tremendously inefficient and costly driving the poorest and least able to pay to the highest cost care available, the emergency room. For those who do not care about the human cost of not providing preventive and basic medical care to all of our people, just look at the cost of an ER visit as compared to a visit to a Nurse Practitioner, Physician Assistant, or Family Practitioner. It does not take an MBA to realize which will be the most cost effective care.

    I would like to see your actual evidence that “it will cause fewer people to want to become doctors”. I think that just the opposite will occur. I believe that most of the people who wanted to be doctors will still want to do this.
    The difference will be that with more medical schools opening ( a comment of mine that went unacknowledged)
    we will be training more of the people who were obviously fully qualified, but were kept out of medical school by the artificially maintained low number of medical school slots available so as to maintain egregiously high doctors fees. Holding down the number of doctors and not allowing mid level providers to work to their capacity and training effectively kept doctor’s earnings high, but is hardly a good way to provide medical care for those in need. By training more doctors and allowing NPs, PAs and pharmacists to practice commensurate with their skills and training, I believe that the wait times for care will at least hold steady, if not improve.

  70. medwoman

    [quote]Over-paid and underworked healthcare labor is one factor.[/quote]

    I agree, but with one modification. My interpretation is ” overpaid health care administrators and providers” are one factor. From my perspective, having worked in both hospitals and clinics for 30 years, it is not the unionized workers that are the largest problem. It is the top administrators and doctors that are the most over compensated for the work that is actually done, not the front line nurses. True, we do not have unions and therefore are not such an easy target. The pay scale has been maintained artificially high not by union activity,
    but by limiting access. This has been done at several levels. First we have chosen to limit the number of doctors available by training far too few. We are now belatedly starting to address this by the opening of a number of new medical schools. I do not believe that Obamacare will lead to fewer qualified people wanting to be doctors, I believe it will lead to the necessity of training more who already have indicated their desire but were previously excluded. The second factor is that doctors have effectively blocked provision of care by midlevel providers including Nurse Practitioners, Physician Assistants and clinical pharmacologists by not allowing them to work up to their level of competency and expertise. This has artificially maintained high physician compensation and prevented many people from obtaining care in a timely fashion. I am hopeful that the recognition that more people having access to care will drive us in the direction of providing more readily available and affordable care.

  71. medwoman

    As for the issue of “reduced employee benefits”, I say great. The faster we decouple health care from one’s employment status, the better. Health care should be an essential provision of a society and not dependent upon one’s current employment status. I favored a single party payer system. I didn’t get it. But what we did get is, I believe, a number of steps in the right direction. I daily see the travesty of a patient who has waited to be seen, sometimes for a major medical problem, until it is much more costly ( both in terms of her health and the economic cost of management ) because her multiple part time jobs did not provide enough income or insurance for her to be able to afford non emergent care. This is wrong both morally and financially and serves no one, and yet it has been our “system”.

    [quote]the current best healthcare system in the world.[/quote]

    Please name one statistically verifiable area in which we provide “the best health care in the world”.
    The reality of health care in the US today is that we do not have a “system” at all. We have a highly rigged and manipulated ( not free) market in which only those who are independently wealthy or have access to very high cost insurance get the “best” medical care. And even then, we do not provide “the best” at costs many are willing to pay even if able. An example. One patient in my practice recently chose to go outside the country for a highly technical infertility treatment, not because she could not obtain it here, but because she could not obtain it here for the same price that she could get for a boutique like experience outside the country. In my experience, we are not “the best” for the poor, we are not “the best” for the middle class, and increasingly, we are not “the best” even for the wealthy…..so tell me Frankly, by what objective standard are we currently the best ?

  72. Frankly

    [i]Please name one statistically verifiable area in which we provide “the best health care in the world”. [/i]

    There are numerous.

    Suffice to say that there is no other country in the world other than the US that I personally would select to get many healthcare services for myself and my family.

    People from all over the world come to the US to get many procedures. Canada’s past Prime Minister left his country of socialized healthcare to get heart surgery, because Canada was still cracking open ribcages and in the US we had moved to laparoscopic technology long before.

    Hey, I have and idea. If we simply go back to bleeding people when they are sick, everyone could afford healthcare!

    [I]doctors have effectively blocked provision of care by midlevel providers including Nurse Practitioners, Physician Assistants and clinical pharmacologists by not allowing them to work up to their level of competency and expertise.[/I]

    Not only doctors, but insurance carriers, ambulance-chasing lawyers and suffocating government regulation. Here is one of the remedies we might agree with. I am in complete favor of using these professional resources to deliver more healthcare service. But to get that done, we need legislation that the trial lawyers will not like. Hence, it is not done since the Democrats in power like the money provided them by the trial lawyers’ lobby.

    One last point before I completely run out of steam on this topic.

    The US is not like other countries. We are the third most populated country on the planet. We are the most diverse country on the planet. We have the largest and strongest economy on the planet (despite with Obama and Brown are doing to destroy it). We have higher expectations in terms of choice and service quality. We are harder working and more productive than people in other countries. We move faster.

    I have friends that renovated a country home in Italy. It took forever. They had to resolve one government hurdle after another. They had to hire unionized contractors that would just not show up for work some days. I use this as an example of how we are different… most of us would not accept these types of delays and crappy service living in the US. We would yell and scream and blog and attend meetings. We do not have the same tolerance for incompetence. We move fast. We want our services right now. We don’t like to wait. In fact, we can’t wait because we have business to attend to.

    Obamacare will screw with this. It will take us closer to a system that is more like what people have learned to tolerate in Europe and other countries where you have to wait six months for a MRI, and 2-3 years for a knee or hip replacement.

    The bottom line is that all successful societies grow sophistication in their services and expectations. The inevitable growing income gap between some and others is a symptom of this, not the fault of the 1% or the 10% or the 20% top wage earners. Healthcare has increased in cost for a number of reasons, some that are problems that we can solve. However, other reasons are connected to the simple fact that successful Americans have advanced in their economic and social expectations, and service providers have risen to the occasion to meet those expectations.

    The less successful see these high-end service and they become envious and then entitled. Then liberals feel their own heart bleed and come to the rescue to loot from those that are successful to redistribute to those not yet successful… while claiming that more and more things in life are rights, and not earned privileges.

    There certainly is a moral argument to be made here. If access to healthcare is a right and not just something we all have to pay for, then the obvious dilemma is how do we net out fairness from a top-down controlled delivery system without wrecking service quality? We can’t. We won’t.

    For me, I would rather we put our effort into moving more currently economically unsuccessful people into the ranks of successful. I would rather we help people generate enough of their own earnings to pay for their own healthcare services. At the same time I would welcome government intervention to help keep costs a low as possible.

    Obamacare is not designed this way. It is designed to loot from people that have earned enough economic success to pay for their healthcare to supplement those that have not yet earned enough economic success to pay for their healthcare (or that just chose to do other things with their money). Obamacare will have disastrous consequences. It will accelerate healthcare costs and reduce service quality and access for those that currently pay for their own healthcare.

    But then the economically less successful will feel less envious and all the liberals will have their hearts bleed less in their quest to care for all those little people they see as incapable of caring for themselves.

  73. Don Shor

    
[quote]Suffice to say that there is no other country in the world other than the US that I personally would select to get many healthcare services for myself and my family. 


    People from all over the world come to the US to get many procedures. Canada’s past Prime Minister left his country of socialized healthcare to get heart surgery, because Canada was still cracking open ribcages and in the US we had moved to laparoscopic technology long before. 


    Hey, I have and idea. If we simply go back to bleeding people when they are sick, everyone could afford healthcare! 
[/quote]
    If this is the best you can do, I simply rest my case. You have no argument for your ongoing, preposterous claim that the US has “the best health care system in the world.” We don’t. You can’t prove it, so you resort to silly anecdotes.

    [quote] There certainly is a moral argument to be made here. If access to healthcare is a right and not just something we all have to pay for, then the obvious dilemma is how do we net out fairness from a top-down controlled delivery system without wrecking service quality? We can’t. We won’t.[/quote]
    Oh, but we can, and we will. We are doing that. That is what you are fighting tooth and nail. That is why HHS is establishing minimum standards. That is why the health plans will be regulated. That is something I strongly support.
    I believe access to reasonable health care is a basic human right. You don’t. That is a fundamental difference in our world view. Government is the method we use to set and enforce the definition of reasonable.

  74. Frankly

    [quote]Five factors went into WHO’s calculation:

    • Health level, as defined by a measure of life expectancy, which shows how healthy a country’s population is. This factor gets a 25 percent weight.

    • Responsiveness, which includes factors such as speed of health services, privacy protections, choice of doctors and quality of amenities. This factor gets a 12.5 percent weight.

    • Financial fairness, which measures how progressive or regressive the financing of a country’s health care system is — that is, whether or not the financial burdens are borne by those who are economically better off. This factor receives a 25 percent weight.

    • Health distribution, which measures how equally a nation’s health care resources are allocated among the population. This factor receives a 25 percent weight.

    • Responsiveness distribution, which measures how equally a nation’s health care responsiveness (which we defined above) is spread through society. This factor gets a 12.5 percent weight.[/quote]
    See the categories and the weighting? They should be make any activist for social justice very happy. However, it does little to assess the quality of service for those that afford it.

    What is missing? For one, there is no measure of access to innovative treatments, drugs and technology. They also conveniently weigh “responsiveness” the least. Social engineers developed this model.

    Another consideration here. Lefties support the flood of poor uneducated people into the country. Our ranking is directly impacted by this. How convenient for lefties. They get to harvest the votes from this crop of new moochers, and also claim that our healthcare system is crappy because of the way they screw up the statistics from these socialist-oriented organization like WHO.

    Don, you keep defending our crappy education system telling me the majority of Americans say they are satisfied with their schools. Well, the vast majority of Americans say they are satisfied with their healthcare. Seems that the basis for your arguments conveniently shifts to cover your ideological bent.

  75. Don Shor

    [quote]Lefties support the flood of poor uneducated people into the country. [/quote]
    Not sure who you’re arguing with here. I support comprehensive immigration reform.

    [quote]Our ranking is directly impacted by this. How convenient for lefties. They get to harvest the votes from this crop of new moochers, and also claim that our healthcare system is crappy because of the way they screw up the statistics from these socialist-oriented organization like WHO. [/quote]
    Nice of you to disparage immigrants as moochers.

    [quote]Don, you keep defending our crappy education system telling me the majority of Americans say they are satisfied with their schools. Well, the vast majority of Americans say they are satisfied with their healthcare. Seems that the basis for your arguments conveniently shifts to cover your ideological bent.[/quote]

    I’ve never known you to be swayed by what “the majority of Americans say,” but here is some nuance to your assertion:
    [url]http://www.realclearpolitics.com/articles/2009/08/13/the_health_care_reform_paradox__97866.html[/url]
    Bottom line: Americans support health care reform.

  76. myview

    David, it seems like you didn’t get much sympathy on your health situation. I sympathize with your issue. My husband is disabled and bath time is a real issue. We have no in-home care, so my daughter thought since he was elderly and disabled that MediCal would help with this problem. Well I received a packet that listed the qualifications to MediCal. You have to be near starvation and no MONEY or personal worth to qualify. I was surprised. My opinion is that anyone that gets MediCal surely deserves it.

  77. Frankly

    Public opinion of Obamacare:

    [img]http://www.cscdc.org/miscjeff/aca1.jpg[/img]

    [img]http://www.cscdc.org/miscjeff/aca2.jpg[/img]

    [img]http://www.cscdc.org/miscjeff/aca3.jpg[/img]

  78. Don Shor

    We weren’t discussing the “public opinion of Obamacare,” nor do I have any idea what point you were trying to make with that poll. So when I read this:
    [i]While the public is divided on the law as a complete package, many of its component parts are quite popular, some on a bipartisan basis. Majorities of the public are favorable towards the law’s tax credits for small businesses who offer their employees insurance (88 percent, including 53 percent very favorable), closing the Medicare “doughnut hole” (81 percent, 52 percent very favorable), and the provision allowing young adults to stay on their parents’ health plans up to age 26 (76 percent, 54 percent very favorable). Three of the hallmark features of the law – the health insurance exchanges, subsidies to help individuals purchase insurance, and the Medicaid expansion – are also popular, with between seven and eight in ten Americans favoring each (80 percent, 76 percent, and 71 percent, respectively). But consistent with previous polls, the individual mandate falls at the bottom of this list, with six in ten feeling unfavorable about this provision of the law.

    Even some of the law’s most fervent opponents like many of the things the ACA has done or will do. A majority of Republicans feel favorable towards seven of the 11 provisions asked about in the March poll, with seven in ten or more favoring tax credits to small businesses, closing the Medicare “doughnut hole”, and the exchanges. Less popular among the GOP: the highly politicized Medicaid expansion (42 percent favorable), increased Medicare payroll tax for those with higher incomes (37 percent), the employer and individual mandates (36 percent and 21 percent, respectively).[/i]

    … I don’t think you’ve really demonstrated anything in particular about your previous claim. Republicans don’t like the Affordable Care Act. We know that.

  79. Frankly

    Democrats and independents also do not like many things about Obamacare.

    Over 60% believe it is going to cause health care costs to rise. That number has not changed much from three years ago.

    My points have been completely demonstrated in response to your claims of denial and requests for proof.

    I also expect that more people will like it less and less as time goes on and they discover how much it diminishes their own healthcare access and quality and accelerates costs.

    The larger point is that the ONLY problem with US healthcare has been high costs and insurance company rejection of some people having pre-existing conditions. The later was a bipartisan supported problem. The former was not solved by Obamacare as Obama and Democrats cut out ALL GOP participation in the design of the legislation that Notsee Peloski said we had to pass so she could see what was in the bill. Obamacare will do the exact opposite. By the time all the tax increases are levied, employees lose their current employer-provided healthcare, premiums rise and access and quality drop, it will be too late to turn back. But then why would someone that thinks that healthcare is a right, that access is currently unfair, and that a single-payer system is what we should have anyway… care?

    The bottom line Don, and this is a principle I think you should agree with, you don’t get something without paying a price. You are happy with the something, but you deflect and deny the price. That causes me to have trouble with accepting your credibility on the topic. Obamacare provides benefits to a poor minority at a price of higher taxes, higher costs and reduced access and quality to those that currently pay their own way. It looks to me that those in defense of Obamacare have joined him in this mindset that we can just keep piling on debt, printing money and ignoring the unsustainability of the looter policies being layered on.

    Keep in mind, if I made less money like I used to not too long ago, health insurance would be my main priority. It would come before just about everything else except survival necessities. It is a cost of living in this great country. In the end, if you cannot afford it, then I think you might need to work more so that you can.

  80. Growth Izzue

    Frankly:
    [quote]In the end, if you cannot afford it, then I think you might need to work more so that you can. [/quote]

    No Frankly, you’ve got it all wrong. Here’s how it should read:

    In the end, if the looters can’t afford it, then they think you have to work more so that they can.

  81. Frankly

    GI, You got that right. While I am paying my way for everything else too. That is so unfair that I get to pay my way for everything. How dare I. I should be taxed more so I cannot afford to write my own checks. I should be like everyone else that needs payments from the government to survive!

    Lefties have have had this bug up their butts about the US being such and embarrassment because we don’t have European-style socialized healthcare. They couldn’t get it so they ramrodded this shoddy bill down our throats with the understanding that by giving away enough free stuff, they can get just enough support… and that with passage, it would be a step in the direction of their single-payer dream. If it turns out to make a mess out of things (which it will), then they could also step in to leverage the crises (Joe reminds us that a good Dem never lets a good crises go to waste) that and demand reforms that move more it to the government.

    What we are seeing now is a concerted effort to distance themselves from the chaos that will ensue. They are squirming like eel to find ways to pin the GOP on their inevitable failures looming. As is typical these days, they will get cover for this political tactic from a liberal-biased main media filled with their political insurgents and propaganda masters.

    The Democrats have made a giant Obamacare mess on the floor, and now they want to blame others and refuse to admit it is their doodle.

  82. Don Shor

    It is obvious that Republicans are very desperate to paint the Affordable Care Act as a failure before it is even implemented, to make every effort to de-fund it, to refuse to implement it at the state level, and to try to make it an issue in 2014 and 2016. Because once it is in place, there will be do rescinding it.
    In the past, when major reforms were passed, corrective legislation was always enacted. I expect that will be the case in 3 – 5 years with the ACA as well. Unforeseen issues, people responding to mandates in greater or lesser numbers than projected — all of that. So it will be a work in progress. But it needs to be funded, the states need to comply, and the opponents need to accept that it is now the law of the land.

    [quote]Democrats and independents also do not like many things about Obamacare.

    Over 60% believe it is going to cause health care costs to rise. That number has not changed much from three years ago. [/quote]
    Dems and Independents like almost everything about the ACA. Your own link shows that. And again: I didn’t know you put so much stock in polls.

    [quote]The larger point is that the ONLY problem with US healthcare has been high costs and insurance company rejection of some people having pre-existing conditions. [/quote]
    Those aren’t/weren’t the “ONLY” problems with US healthcare. But if that’s what you believe, then there isn’t much point in further discussion. You guys lost. You lost this battle, you lost the election, you lost at the Supreme Court. It’s the law of the land.

  83. Frankly

    I think the bigger problem for Democrats is that they won the election and have 100% full responsibility for this crappy pile of stinking legislation.

    The GOP not only lost, but they were cut out of the job of participating in the legislation. The Democrats didn’t welcome their ideas, and then leveraged their absolute power to do it their way.

    So Don, as you are bloviating about your Party’s winning ways, impress me with the corresponding agreement that you will agree to take responsibility for what your Party has done and is doing. Don’t cry me a river that the GOP is not supporting the Democrats. Obamacare is something they absolutely disagree with. They were cut out of the job to participate in its creation. So, put on the big boy pants and accept responsibility and accountability. That is something I have never really seen any Democrat leader do these days. In terms of leadership (or the American Idol presentation that Obama substitutes for it), it seems the blamer-in-chief has established excuses and blame for all his mounting mistakes and failures, and expectations that he will continue to be the Teflon Messiah.

    Well, I will work hard to keep scraping the shine off that man. He absolutely is shaping up to be one of the biggest failures of a President in the history of this once great nation. Obamacare will be his just legacy.

  84. Frankly

    Don – I apologize. My poor choice of words and tone. I am on the grumpy and grouchy chair for this topic and letting it get the better of me. I respect your opinions even as I disagree with them, but there is no excuse for me going personal.

  85. medwoman

    [quote]The larger point is that the ONLY problem with US healthcare has been high costs and insurance company rejection of some people having pre-existing conditions.[/quote]

    You are joking right ? You don’t consider the following to be problems?
    1) Arbitrarily limiting the number and scope of providers so as to artificially maintain physician salaries ?
    2) Insurance companies making medical decisions rather than leaving those in the hands of doctors and patients?
    3) Insurance companies refusing to pay for services once a patient is diagnosed with a serious illness because
    if a patient forgetting to note that they had been diagnosed with acne as a teenager or had had mild anemia
    in the first few weeks after a delivery ?
    4) The person who has worked for a company for 25 years, gets laid off and loses their insurance and thus
    cannot pay for their previously covered health care ? Not a problem for you ?
    5) How about the unequal distribution of health care with some areas vastly underserved ?
    6) How about the discrepancies in cost of the same procedure from one area of the country to another ?

    But let’s suppose that you literally believe that the only problem with American health care is the high cost.
    Then as a fiscally conservative kind of guy, wouldn’t it make more sense to provide care at the least expensive level possible? One thing we know for a fact is that prevention and early treatment are much, much less costly than emergency treatment when things reach a crisis and a patient presents to the ER desperately ill. So unless you are making the argument that you would be willing to let people die rather than subsidize needed care, it simply makes no sense to pay for their ER care, but not to pay for care which would make these visits unnecessary. If you have an alternative suggestion about how to provide cost effective care for those who are unable to obtain it for themselves, I would love to hear it.

  86. B. Nice

    Do children get to chose wether they are born into a family with, however the gained them, enough resources to provide them with private healthcare, or to family for some reasons don’t? Is it a poor child’s fault that their dad didn’t “work two jobs” and thus can pay for him/her to see a doctor. All children are entitled to some basic things, food, shelter, education and healthcare, wether they are lucky enough to be BORN into a family that can afford these things or not.

  87. Frankly

    Medwoman, boy your expectations are certainly very high. Do you expect a single-payer system to remedy these, and not inject additional and different problems?

    [b]For every situation where you replace one system with another, you simply trade one set of problems for another set of problems.[/b] In fact, most, if not all, of the problems you list exist in all the other countries that you socialized-medicine advocates like to laud. Our healthcare system is the best in the world for people that can afford it. We can improve it without replacing it. By attempting to replace it – and you know that is the aim of Obamacare – you will destroy all they things that are great. You will create a whole new list of problems.

    No system is perfect for every person, because we all have different expectations and needs. But, in the list you provide above MOST, if not all, of them can be remedied by CHOICE. You have the choice to use a different insurance carrier. Even most companies these days offer a cafeteria plan with different carriers. You can select different doctors and different clinics and different hospitals. You can contact your health insurance company to make demands for service just like you can for your auto and home insurance company. There are processes to escalate conflicts of opinion.

    We need MORE choice. Obamacare is going to reduce choice. It is going to push more people into a shrinking box of insurance choices and health provider choices because the government will increase the list of requirements for participation and providers will drop out.

    I have said that pre-existing conditions is one of the problems. Republicans agree. So, let’s stop listing related problems as some lefty-owned argument.

    The other is cost.

    Those two are near 100% of the total problem.

    So let’s go down your list and respond:

    1. I think you are smoking something on this one. Sounds like a conspiracy theory without basis of fact. I write small business loans to small medical practice business all the time. There is nothing preventing competition except for regulatory and tax burdens and the high cost of education to become a doctor. You tend to vote for those things, so look in the mirror for the cause and solution.

    2. Insurance companies do not make medical decisions, they make insurance coverage decisions. If you don’t like their answer, escalate the issue. In 100% of the case where this has happened to me or my family, we were able to get the procedure approved and the claims paid. Of course if the procedure being requested is unreasonable, then yes it will probably be rejected. But then the patient can still pay for the unreasonable procedure out of pocket.

    3. Pre-existing conditions. Already covered.

    4. Your politicians and their crappy economic policies that continue to put more people out of work, and do not work to generate enough new jobs. This is not a healthcare system problem. This is a political problem. Again, look in the mirror for how your voting behavior contributes to this. By the way, people that lose their job also lose their house and a lot of other things. If you really care, you would be advocating for policies that increase jobs.

    5. This is ridiculous. How do you expect this to be solved with government-run healthcare? Healthcare companies already have to comply with certain regulations for proximity of care facilities for their covered members. They also use this as a competitive advantage to sell their plans to employers. Again, there is choice. If you live in a rural area lacking medical facilities and you are sickly, you better move. There are many other services that are not available in rural areas. It is simple logical and rational situation, not a healthcare system problem that justifies government control.

    6. Again, you have a choice to move and use a different provider. But, here is one where I do share some agreement with you. I needed an MRI and I could NOT get anyone to quote the actual contracted cost that I would be responsible for. The only thing they would quote was the listed price. So, here is one area I support government regulation on. Just like other pay-for-service business, healthcare costs should be 100% clearly disclosed to all consumers of healthcare service. This will help consumers shop for the best price. Internet services can provide reviews of quality. Consumers can start shopping for value. The industry will have to respond to this and competition will help reduce price and increase quality. These are free-market principles. Moving healthcare to government control will destroy that potential and make it just like the DMV.

  88. Growth Izzue

    Obamacare rate shock coming your way:

    [url]http://wallstcheatsheet.com/stocks/ohio-proof-that-obamacare-rate-shock-is-real.html/?ref=YF[/url]

  89. medwoman

    [quote]For every situation where you replace one system with another, you simply trade one set of problems for another set of problems. In fact, most, if not all, of the problems you list exist in all the other countries that you socialized-medicine advocates like to laud. Our healthcare system is the best in the world for people that can afford it. We can improve it without replacing it. By attempting to replace it – and you know that is the aim of Obamacare – you will destroy all they things that are great. You will create a whole new list of problems. [/quote]

    Now this is an interesting perspective from someone who has frequently advocating destroying our current educational system and starting over from scratch with your preferred ideas.

    I also disagree with you that our system is the best for those “who can afford it” and remain awaiting your statistical evidence to support your assertion. I also disagree that Obamacare will destroy all the things that are great, and did not catch your specific response to Don’s list of the specifics and question to you about how those specific items would destroy health care.

    Where you and I agree is that other problems will arise. This is always true with implementation of a new process. And I am confident that those problems can be addressed one by one as they are identified.

  90. medwoman

    [quote]There is nothing preventing competition except for regulatory and tax burdens and the high cost of education to become a doctor. You tend to vote for those things, so look in the mirror for the cause and solution. [/quote]

    1.I do not belong the the group of physicians who believe in supporting incomes by limiting the number of doctors and limiting the practices of mid level providers, but I know many, many doctors who do. And if you do not believe that this has been a driving force in medicine in the US, then it is not me that has been smoking too much of something

    [quote]Insurance companies do not make medical decisions, they make insurance coverage decisions.[/quote]

    2. This is a quibble over words. If an insurance company will not pay for a procedure, many doctors will not do it for free. If the “escalation” doesn’t go in the patient’s favor, many people will simply give up which is what the insurance companies are counting on. This is frequently a delay in necessary medical care that I have seen happen over and over again. Now, I am very happy for you that you have always had a favorable outcome for you and your family members, but over the 30 years that I have been in medicine, I have seen many, many unhappy outcomes based on arbitrary insurance limitations of coverage. I believe that with 30 years of experience, my “n” is probably considerably larger than yours.

    [quote]Pre-existing conditions. Already covered. [/quote]

    3. Already covered by what. Until Obamacare, people were being dropped or denied on a regular basis based on pre existing condition.

    4. [quote]If you really care, you would be advocating for policies that increase jobs.
    [/quote]

    4. I do. But unlike you, I think that employment by the government for necessary jobs is as valid as employment the private sector which seems to be the only jobs that you see as of value.

    [quote]How do you expect this to be solved with government-run healthcare?[/quote]

    5. I have answered this previously and am happy to do so again. I believe that more doctors should be trained with their training being paid for by the government. They could then serve in underserved areas year for year as I did to pay back their obligation. Upon completion of their obligation, they could serve to stay on in the underserved area as a couple of our practitioners had chosen to do, or they could move on to a location or practice more in line with their interests as I did. This is a win/win situation and I honestly don’t see what objection could be made to this.

    [quote]Moving healthcare to government control will destroy that potential and make it just like the DMV.[/quote]

    Now why would you assume that. Why not entertain the idea that moving health care to government control might make it more like the military which you seem to favor, or more like the military health care system which seems to get high marks from its users, or more like the Kaiser system which has been steadily gaining in reputation for quality and service and is now considered one of the potential models for health care.

  91. Frankly

    [i]Now this is an interesting perspective from someone who has frequently advocating destroying our current educational system and starting over from scratch with your preferred ideas[/i]

    Thee primary reasons:

    1. I have choice for healthcare. Everyone has choice for healthcare. There is not enough choice, but there is choice. I do not have choice for education. The state and country takes the money from me without any choice on my part. And they take A LOT of money. So much money that at the time my kids started school, I could not afford to send them to private school.

    2. We are talking about 100% children with respect to school. Children are only a piece of the healthcare puzzle and the majority of them already get quality care. Conversely, the majority of children get a crappy education.

    3. Healthcare is constantly innovating. Education is being done pretty much the same what it was when cavemen ruled. The teachers unions like it that way.

    Obamacare will make a huge mess out of our existing healthcare system and you and others that pushed it and supported it will share responsibility.

  92. medwoman

    [quote]I do not have choice for education.
    [/quote]

    This is absolutely not true. There are a number of private schools that you could have sent your children to.
    You have consistently maintained on a number of threads that if people want something that they cannot afford, all they have to do is find a better paying job. So why does this philosophy not apply to you ?

    [quote]majority of them already get quality care.[/quote]

    There are many, many children who do not receive quality care.

    [quote]Obamacare will make a huge mess out of our existing healthcare system and you and others that pushed it and supported it will share responsibility[/quote]

    This is your mantra, offered largely without any supportive evidence but with full reliance in your absolute belief in the infallibility of your world view.
    I do not share your pessimism. I will gladly take full responsibility for my part in the provision of what I view as the development of a superior health care provision system. As a matter of fact, my excitement about the ability to provide care for those who are currently underserved is part of the reason I am not yet choosing to retire.
    But I guarantee you that my efforts will include helping to recognize and resolve problems as they arise, not just point fingers at some group I arbitrarily call names and denigrate because I cannot see beyond my personal philosophy to even consider that maybe, just maybe someone who actually works in a field might have some insight into it that I do not have.

  93. Frankly

    [i]You have consistently maintained on a number of threads that if people want something that they cannot afford, all they have to do is find a better paying job. So why does this philosophy not apply to you?[/i]

    Again, your government is taking a large amount of my money out of my pocket to fund crappy education. They are taking money out of my pocket that would otherwise be available for me to send my kids to a private school. Also, because the public education system has a monopoly on education, there is limited choice in my local area. Sop taking my money and let me spend it the way I want to like I do for my health care, and you have a reasonable argument. Otherwise you don’t… no matter how many times you repeat yourself.

    [quote]Sen. Max Baucus (D-Mont.) said Wednesday he fears a “train wreck” as the Obama administration implements its signature healthcare law.

    Baucus, the chairman of the powerful Finance Committee and a key architect of the healthcare law, said he fears people do not understand how the law will work.

    “I just see a huge train wreck coming down,” Baucus told Health and Human Services Secretary Kathleen Sebelius at a Wednesday hearing. “You and I have discussed this many times, and I don’t see any results yet.”
    [/quote]

    [quote]Obamacare’s Health Exchanges: “full of issues, bugs and technological challenges”[/quote]

    [quote]Seven Things (Still) Wrong with ObamaCare[/quote]
    [url]http://www.forbes.com/sites/merrillmatthews/2012/07/05/seven-things-still-wrong-with-obamacare/[/url]

    [quote]When the Obama administration pushed through the Affordable Care Act (“ObamaCare”), it counted on labor unions to be the strongest supporters, but some unions leaders have grown frustrated and angry about what they say are unexpected consequences of the new law. These consequences create problems that could jeopardize the health benefits offered to millions of their members, says the Associated Press.

    The problem lies in the unique multiemployer health plans that cover unionized workers in retail, construction, transportation and other industries with seasonal or temporary employment.
    [/quote]

    [quote]
    A healthcare expert says patients with life-threatening illnesses may choose to go without their medications if prices skyrocket under ObamaCare as they are expected to do.

    Cancer patients could see high prices for medication under the Affordable Care Act, as it allows insurers in some states to charge outrageous amounts to patients who need medications for rheumatoid arthritis, multiple sclerosis, cancer or other life-threatening diseases.

    Drugs for such conditions may cost thousands of dollars each month, but in order to keep premiums low, some states may choose to charge patients who need expensive medications a hefty price tag. In California, for example, patients could pay almost 30 percent of the cost.[/quote]

  94. Frankly

    [quote]The Department of Health and Human Services’ new preventive services guidelines are a disaster for freedom of conscience and an illustration of the political hold “reproductive rights” organizations have on the Obama Administration. [/quote]

    [quote]The Obamacare Medicaid expansion debate continues in the states, and many hospitals are lobbying their state lawmakers to accept the expansion.

    The hospitals argue that because Obamacare cut their payments for charity care—so-called disproportionate share hospital (DSH) payments—they need their states to expand Medicaid coverage so as to increase the number of insured patients to make up for the loss of DSH payments.
    [/quote]

    [quote]The Congressional Budget Office (CBO) issued a new statement on the budgetary effect of repealing the Affordable Care Act (Obamacare) for fiscal years 2014 to 2023. The CBO did not model or update a full scoring of repeal. It found that the cost of Obamacare has increased by $30 billion since last July’s estimate for the fiscal years 2014–2022[/quote]

    [quote]According to updated numbers from the Congressional Budget Office (CBO), by 2023, Obamacare will still leave 31 million people without insurance (this number includes unauthorized immigrants), despite adding nearly $1.8 trillion in new federal spending.

    Here’s what’s happening, as projected by the CBO, in 2023:
    •Obamacare will add an estimated 13 million people into the failing and broken Medicaid program;
    •24 million people will obtain coverage through the law’s exchanges, 19 million of whom will have their coverage subsidized by the government;
    •7 million are expected to lose their current employer-sponsored coverage (breaking that firm presidential promise); and
    •About 5 million people will no longer obtain their coverage in the non-group market.

    Thus, when it’s all added up, the number of uninsured is reduced by only 25 million.[/quote]

    [quote]You may have heard that Obamacare’s main plan for getting people health insurance is to put them on Medicaid.

    Medicaid—which is supposed to be the federal-state partnership that serves low-income children, disabled Americans, pregnant women, and some seniors.

    Medicaid, which is not quality health care and is losing doctors every year.

    Medicaid, which is already so overloaded that the number of people on the program exceeds the population of France, Britain, or Italy.
    [/quote]

    [quote]The 2013 Medicare trustees report reconfirms a basic fact: Seniors and taxpayers face a bleak future.

    The trustees project that Medicare’s share of the economy will almost triple over the next 75 years, forcing higher taxes to pay for an ever growing program. The recent slowdown in health care spending is a passing phase and largely attributable to the American economy’s poorest performance since the 1970s. While there are claims that Obamacare has improved Medicare’s finances, these claims are easily discarded.
    [/quote]

  95. wdf1

    Frankly: [i]I do not have choice for education.[/i]

    Yes you do. Within Davis and nearby,

    St. James
    Grace Valley
    Davis Waldorf
    Merryhill School (until recently)
    your choice of 9 DJUSD elementary schools in Davis, including Montessori, Spanish Immersion, GATE, and Fairfield small school community
    your choice of 3 JH campuses
    Da Vinci Charter Academy
    DSHS
    DSIS
    and various DSIS/DSHS hybrid combinations

    [i]Conversely, the majority of children get a crappy education.[/i]

    How do you define that?

  96. medwoman

    [quote]Again, your government is taking a large amount of my money out of my pocket to fund crappy education. [/quote]

    By this standard I could equally say that our government takes a large amount of money out of all of our pockets and uses it to kill children around the world in wars that I do not support. Personally I would rather have children getting a crappy education than dead….but I guess that is just me. This argument just won’t work for either of us. We are choosing to live within the framework of this country, so until we decide to reject citizen ship or get the laws we don’t like changed, our taxes will go for things of which we don’t approve.

    [quote]en. Max Baucus (D-Mont.) said Wednesday he fears a “train wreck” as the Obama administration implements its signature healthcare law.
    [/quote]

    Just because Max Baucus fears something doesn’t mean it will come to pass. We are in agreement that there are some problems that will arise from Obamacare. These can be addressed. But they will not be addressed by finger pointing, name calling, and demeaning someone else. They will be addressed by implementing to the best of our ability, determining what works and keeping it, determining what doesn’t and changing it, just like any other proposal. So far, two of the proposals of this law have made life a lot better for a lot of people. I have yet to meet a single patient that does not like keeping children on their parents plan until 26. A very, very good provision for most people, and literally poverty preventing or life saving for some. Likewise, no believes that
    eliminating the pre existing condition restriction or termination of coverage for a trivial reporting error on an application once a serious illness is a bad idea.

    [quote]Thus, when it’s all added up, the number of uninsured is reduced by only 25 million.[/quote]

    As previously stated, Obamacare was not my preferred option. I would have done away with the concept of
    “insured vs uninsured entirely” and adopted a more simple plan. Just as every American is entitled to protection by the US military, I would have every American’s health care paid for by a single party payer, government or government + private collaboration. My feeling about this is that a strong, healthy, well educated population is much more likely to do well in all areas of life than is a society in which only a few have access to systems that enable their success. Why we would not promote this as a group as well as individuals is beyond me and I do not believe that makes me greedy, corrupt, stupid, or evil…..all things you have linked your detested “lefties” to in the past. Obamacare is what we got, in my opinion, because large numbers of people fear the word “socialism” which is trotted out thoughtlessly any time any proposes doing anything more similarly to the Europeans or Canadians no matter how much more successful it may be demonstrated to be, and so would not
    even consider the concept of single party payer. And that omission lies at the door of people who think similarly to you.

  97. medwoman

    [quote]Drugs for such conditions may cost thousands of dollars each month, but in order to keep premiums low, some states may choose to charge patients who need expensive medications a hefty price tag. In California, for example, patients could pay almost 30 percent of the cost.[/quote]

    You do not seem to be aware that this is the situation currently for many people now.
    You also do not seem to be aware that many people currently do without treatment because they do not make enough and their work does not provide insurance but they are not poor enough to qualify for government
    assistance.
    You do not seem to appreciate that money in one’s pocket is dependent not only on what goes out to the government, but also, what goes in, namely what someone is willing to pay you for what you do. You like to deride the government but never once have I seen you criticize an economic system that allows people to work for less than will provide them with food, shelter, clothing and education. Frankly I have no empathy for those who have plenty, as you and I clearly do, and whine about either not making enough, or having too much taken out by the government. My empathy is with those who work hard to the best of their capacity and still cannot provide for themselves and their families. These are not “moochers” or abusers of the system, these are people who are abused by a system that their taxes also support but from which they see little benefit.

  98. Ginger

    [quote]To me, the insurance companies add absolutely nothing of value. I would have vastly preferred a single party payer system such as members of the military have.[/quote]

    This brings up two issues: one, we do have socialized medicine of a sort in the US between the military, Medicaid, Medicare, Indian Health Services, county health clinics, etc. Two…well, let’s have Jon Stewart sum up how things can go very, very wrong when patients have no alternatives: http://www.thedailyshow.com/watch/wed-march-27-2013/the-red-tape-diaries—veteran-benefits

    I have a friend with a young daughter; she lives near Toronto. When her daughter was about 18 months old, my friend began to suspect that she might be autistic. It took years to get a diagnosis as she kept having to wait for appointments for testing, to see specialists, etc. Six month chunks add up fast; her daughter was six years old by the time they had the diagnosis and a therapy program was begun. At that point she’d missed critical early intervention that could have made a huge difference in the quality of her life, as well as my friend’s and any future caregivers. Just another example of how a single party payer system that has ALL control of an individual’s health care can have devastating effects.

    Medwoman- spend some time working in healthcare in Detroit; once you’ve seen patient after patient after patient from Windsor/Toronto/London, etc. paying cash-and heard their stories- you might not be so quick to embrace a single party payer system here. Tens of thousands of Canadian patients pay to avoid long wait times by coming to the US, and some provinces even cover treatment in the US.

    I absolutely agree that it would be ideal to not have our health care be attached to our jobs; the Republican (and I’m adamantly NOT a Republican FWIW) suggestion of portability would have gone a long way towards achieving that goal. Removing that [b]federally mandated[/b] barrier would have opened up true competition (as opposed to the notion that Obamacare is “competition”) and would have reduced administrative costs (creating special plans for each state is a huge bureaucratic task for large companies like BCBS).

    But we shall see. Obamacare is here to stay, as has been repeated in this thread. Despite a lot of promises being broken, from Pelosi’s 400k jobs that we were supposed to get “almost immediately” to nobody would have their premiums raised nor lose their current plan, we’ll see how things shake out in the end.

    And if things do get worse, there will be a lot of people who say that is preferable. Better for ALL of us to have crappy health care than for SOME of us to have crappy health care while others have, “privileged health insurance.” That’s the argument in places like Germany, some Canadian provinces, and the UK where people are allowed to pay for supplemental or alternative plans. Instead of people thinking, “I also want that private supplemental insurance, so I’m going to work hard and try to attain that goal,” people think, “It’s not fair the wealthy have the ability to purchase better health care, so I’m going to fight to remove that option from them.”

    Better for all autistic kids to be diagnosed at age 6 than the rich autistic kids to be diagnosed at age three.

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