Let's talk about health care

[Roguish Lawyer]

Originally posted by Doc T
at what point do you advocate insurance or some third party payer kicks in?

doc t.

It should depend on the agreement between the insurance company and the patient. Carriers would have an incentive to pay quickly if the patient was the one buying the insurance. But I like your suggestion of civil or other penalties.

[Sacamuelas]

Originally posted by Roguish Lawyer
My view is that it should be harder to sue doctors, easier to sue insurance companies, and much, much easier to sue dentists.

Well, all your solution would end up doing is making Doctor's happier, healthcare insurance premiums go sky high for the average american, more lawyers get rich off the average american, and necessitate a lot more pain than is necessary for every lawyer that happens to like sweets or get trauma to the oral cavity....


All it would do is INCREASE the cost of healthcare for the American citizen...or do you not think the insurace companies would pass the cost of lawsuits or your penalties on to the consumers in the end?

edited: OOPs, Sorry Doc T. I said I was going to quit, but RL keeps pickin on me. haha

[Roguish Lawyer]

http://www.cato.org/research/article...ow-030616.html

Two Choices for Health Care Reform
by Doug Bandow

June 16, 2003

Doug Bandow is a senior fellow at the Cato Institute and James Madison Scholar with the American Legislative Exchange Council.

Health care is emerging as a critical political issue. Costs are rising, people are worrying about losing medical benefits, Democrats are pushing for drug coverage for Medicare beneficiaries and universal care for everyone else, and Republicans are scrambling to offer their own "reform" packages.

States are attempting to impose price controls on pharmaceuticals. Ambitious attorneys general and left-wing interest groups have joined to target drug makers for a host of alleged offenses.

Doctors across the nation have sued nine major health insurers over their reimbursement policies. Aetna has broken industry ranks, agreeing to a $300 million settlement, but the rest of the class-action lawsuit continues.

Fixing the health-care system seems more difficult than ever.

The focus of much criticism has been on health maintenance organizations, which are designed to limit care. While they are an important option in a competitive medical industry, government and businesses are increasingly pushing reluctant patients into HMOs.

Doing so is supposed to save money. Yet Hewitt Associates reports that HMO premiums will rise 22 percent this year.

The percentage of the public viewing HMOs as doing a good job fell from 51 percent to 29 percent between 1997 and 2001. This has led nearly half of all states to pass any-willing-provider laws mandating that managed-care networks accept any doctor or hospital agreeing to its fees and rules. Consumers get more choice, but HMOs lose bargaining power to exact lower fees.

Individual managed-care companies have become the target of special disdain. For instance, California's WellPoint Health Networks, the nation's third-largest system (by enrollment), has been criticized for the high salary of its CEO, Leonard Schaeffer – No. 19 among America's top 500 firms – and its takeover of nonprofits, such as Blue Cross/Blue Shield of Georgia and Missouri.

A WellPoint cost-cutting tactic is to lobby the Food and Drug Administration to move drugs from prescription to over-the-counter status. In 1998, the company petitioned to shift the anti-allergy drugs Allegra, Claritin and Zyrtec to OTC. Last year, WellPoint filed a similar motion for Clarinex.

Normally, drug makers lead the push for OTC status; Claritin was moved to OTC in December only after manufacturer Schering-Plough dropped its opposition. But now FDA Commissioner Mark McClellan is considering acting on his own initiative.

By allowing patients to self-medicate, OTC increases consumer choice and reduces costs. However, most insurers, including WellPoint, do not cover OTC medications. So in the near term, at least, only insurers save money – indeed, patients actually may have to spend more money for the same medicine.

Insurers, and especially HMOs, also make it hard for patients to receive competing prescription drugs. For instance, Dr. Lewis Kanter, an allergy specialist in Camarillo, north of Los Angeles, complains that he is "bombarded with paperwork" from insurers if he doesn't direct patients to OTC Claritin.

Some insurers simply drop coverage. Last fall, Aetna requested permission to stop paying for non-sedating antihistamines altogether. California responded by advising insurers not to drop coverage for an entire class of drugs just because one went OTC. This rule, like state any-willing-provider laws, expands choice, but only by increasing insurer costs.

The problem with HMOs is not HMOs per se, but the environment in which they operate. Government policy inadvertently discourages provision of quality health care, as exemplified by the artificial emphasis on HMOs.

Because the federal government doesn't tax employer-provided health insurance, businesses provide insurance, which means they choose providers and plans. Most companies, understandably, are more interested in constraining health care costs than expanding coverage. Thus their ever-stronger push, mirrored by government policy, to get patients into managed care.

The system makes no sense. Employers don't provide auto or homeowner's insurance.

Similarly, people need to be able to tailor health insurance to their own circumstances, and thus choose the right balance between cost savings and coverage limitations. One solution is placing medical savings accounts on a level playing field with traditional insurance, thereby returning health-care decisions to employees.

There are only two reform paths for today's broken system. The first is to fully nationalize the system, which would sacrifice coverage and quality to save money. The alternative is to reintroduce consumer choice and industry competition to medicine.

Congressional Democrats and Democratic presidential candidates want to take the first course. For the American people's sake, the Bush administration and Congress must travel the second.

This article originally appeared in The San Diego Union-Tribune on June 16, 2003.

[Roguish Lawyer]

"Power to the People" -- why NDD should agree with me.

http://www.cato.org/dailys/08-11-99.html

August 11, 1999

The Wrong Health Care Debate
by Michael Tanner

Michael Tanner is director of health and welfare studies at the Cato Institute.

Once again Washington has it wrong. The current debate over health insurance reform has been cast as a choice between letting health management organizations (HMOs) control your health care choices or letting the government do it. That's a choice that is guaranteed to make you sick.

But there is a third choice -- a better choice -- that is being left out of the debate: giving consumers control over their own health care decisions.

Today most Americans have no choice of health insurance. They must accept the plan their employer chooses for them. Employers, understandably concerned about rising health care costs, are increasingly choosing managed care plans that hold down costs by restricting access to certain services and specialists. Workers, stuck in plans they dislike, have turned to the government for relief.

Think what would happen if you went to buy a new car and were told that just one model was available. Since cost was an issue, the sole choice was a stripped-down model without any options. If you wanted a stereo or power steering, even if you could afford to pay for it, you'd be out of luck. It wouldn't be long before Congress started a movement for a car buyers' bill of rights, with Democrats and Republicans arguing over what color the one model of car should be painted.

Of course that doesn't happen with cars, because you can always go to the lot next door and pick a different model. Why can't you do that with health insurance?

The reason lies in an anomaly in our tax code. If your employer gives you health insurance, it is tax-free for you. But if you purchase health insurance on your own, you receive no such tax break. That means that if you don't like the insurance plan your employer offers, you cannot go elsewhere and buy your own coverage without incurring a substantial tax penalty.

Here's an example: Let's assume that you earn $30,000 and your employer supplies a health insurance plan with the local HMO that has a value of $5,000. You pay taxes on only $30,000. What if you don't like that HMO and want to go someplace else for your health care? You could tell your boss to give you that $5,000 he was spending on your HMO coverage and then go out and buy your own insurance. But if you did, you would have to pay taxes on $35,000 instead of on $30,000. That could cost you an additional $2,000 or more in taxes. You are effectively stuck with your boss's policy, like it or not.

In health insurance, as in so many other things, whoever controls the money controls the game. If the government controls health care spending, the government will control health care. If your boss controls your health care money, your boss will control your health care. But if you control the money, you can control your own health care.

Rather than debating how to best regulate your boss's policy or whether you should be able to sue the HMO that your boss chose for you, Congress should be seeking ways to give you a greater choice of health plans. In short, Congress should put the money back in your hands so that if you don't like your boss's plan you can simply go someplace else and buy one you do like. Some people will stick with HMOs, accepting slightly fewer services and less choice of doctors, while pocketing the extra money. Others will choose to spend a little more to get more choice and extra services. The choice would be up to each individual worker.

Congress can do this by changing the tax code to give individually purchased health insurance, or for that matter health care you pay for out of your own pocket, the same tax break as you get for employer-provided health insurance. Congress should create a universal health care tax credit available to all Americans, regardless of where they buy their health insurance. That would empower individual Americans to choose the health insurance plan best for them.

It doesn't have to be more power to the government or more power to the HMOs. It could be power to the people.

Originally posted by Roguish Lawyer
It should depend on the agreement between the insurance company and the patient. Carriers would have an incentive to pay quickly if the patient was the one buying the insurance. But I like your suggestion of civil or other penalties.

carriers would still not have the incentive to pay quickly...after all they make interest on money that is within their grasp...

lots of america does buy their own insurance, more today than ever i would imagine...and the companies don't pay any quicker on their claims...

the red tape would still exist only the sick and injured patients would pay the price by being bankrupt instead of the MDs sucking up the costs.

just don't see this as a solution.

eventually we will probably see some kind of socialized system with private insurance for the rich that will pay so that they can receive over and above what is deemed necessary medical care. It will be the definition of NECESSARY care that will interesting to me.

t.

[Sacamuelas]

Those articles don't solve anything. They are a proposed solution for a reality that doesn't exist except in a think tank vacuum.

You take away health care provided by the employer and let people check into the cost of "private" insurance policies. Making 30k a year and the author thinks that people will shop around for the most inclusive and best optioned plan??? YEah right, if you make 30 k a year, you take the cheapest premium plan you can get so that your kids can still obtain the things they need for survival. Mom and DAD end up skipping all their routine medical visits to save cash and even the kids don't go in early for common ailments. You end up with an emergency/acute driven healthcare system that studies show is less cost efective in the long run than a preventitive medicine approach in which diagnosis and treatment of the disease is accomplished at an earlier and easier to treat stage. common ex. diabetes

Exactly what happens to the probably 50% of the people that don't carry a policy that adequately pays for the medical care that is going to be needed jsut to save a few bucks? In this new law, will Congress pass a tort reform act that dissolves all liability to a physician or other HCP that denies treatment to someone based on inability to pay. After all, in this perfect world, I am going to demand payment up front since everyone is going to be wealthy from all this imaginary savings.

[myclearcreek]

Originally posted by Doc T
at what point do you advocate insurance or some third party payer kicks in?

doc t.

When hospitalization or intensive home-care is required. By intensive, I mean requiring home-health visits. One friend has seven children from 20s to about 10 and only major medical health insurance. She is on her third round of cancer treatment within a decade.

They chose this route rather than driving new cars and a larger house. They live debt-free on a modest income.


Edited for spelling.

[pulque]

How does that tax credit actually reform the HMO-patient-provider triad? the article doesn't say.

Some employers offer a flexible spending account as an alternative. It means that the employee decides how much they want to spend on health care that year (copays, deductables, premiums, prescription and OTC meds), and they get that amount taken out pre-tax.

[Ockham's Razor]

Do these institues, CATO, Heritage, and others, propose more than just a glossing over of the problem, or actual solutions. I have yet to see a sentient argument from any DC or other Think Tank.

Not even one argument about the administrative costs of health care and their costs to the sector? I hear a lot about this free market lassiez faire thing, but see no realisation in the lowering of healthcare costs.

Perhaps a solid question would be why is it that most western governments bargain for lower drug prices and we say, screw that, let the market decide?

The only counter-argument I hear is this.. "But you don't understand how high the costs are for R&D to manufacture new drugs!" etc... Well, considering that they are a business, would they not limit their extensive advertising campaigns and throw that money at R&D considering that a pharmaceutical company is only as good as the last drug they roll out?

Why should the United States foot the bill for the totality of R&D and other countries get the same drugs for a fraction of the cost?

The argument over the importation of drugs from Canda astounds me, considering that many of the companies that are saying this are those that sell to Canada. Are they saying that they sell an inferior product to Canada and therefore we can't trust importation? Sounds like a load of BS to me.

[NousDefionsDoc]

Every graduate medical student does one year of social service before getting fully licensed. They work in family practice clinics, ERs in depressed areas, etc. 10% of all social/ welfare payments no longer goes to the individual for cigarettes and crack - it goes to the pool to pay for the program. Pay rates for the young doctors in love are established by COLA determinations for the area. Same program for administrators. Before they get to administrate Peyton Place General Hospital, they have to administrate the Poor Folks Unit for COLA pay as a train up.

Consideration for government payment of medical school costs after graduation and successful social service time.

No more foreign aid to silly countries and no more funding porn as art. That money goes to cover catastrophic illnesses and border hospitals/clinics.

Insurance regulations completely overhauled.

Penalties against plaintiffs for frivilous malpractice suits.

FDA completely overhauled.

[Roguish Lawyer]

Questions for providers:

Is it not true that there are very substantial mark-ups of drugs provided at hospitals, lab tests, disposables, etc.?

If the recovery rate is only 10% and we don't have widespread bankruptcies, doesn't that mean that there is excessive billing on the provider side as well? If so, why? If not, why not?

Originally posted by Roguish Lawyer
Questions for providers:

Is it not true that there are very substantial mark-ups of drugs provided at hospitals, lab tests, disposables, etc.?

If the recovery rate is only 10% and we don't have widespread bankruptcies, doesn't that mean that there is excessive billing on the provider side as well? If so, why? If not, why not?

without a doubt there is excessive markups in some things... the price you pay for a drug though includes it being mixed up into solution in the pharmacy, transported to the floor, given by the nurse,etc...not just the drug but what goes into it from time its ordered to time its given.

most county hospitals mark up more than the private ones...why? to cover for non-funded patients. I brought this up earlier I believe. The county hospital where I trained was the most expensive hospital in city when I was there and many insurance companies wouldn't cover being an impatient there.... And it was done purposefully to have the paying patients offset some of the costs of the nonpayers. The hospital was still going broke...and yes, hospitals often run with a bare minimal margin...usually less than what it costs to run for less than a week ...in the public market.

So no, not a lot of surplus like you might think...hence things like taxing alcohol and cigerettes to give money to money to indigient care, 1/2 cent tax in Miami, extra fines for drunk drivers to go into a trauma fund in texas... every little bit helps hospitals from going BROKE.... it is a real thing. Jackson Memorial Hospital used to run 20-30 million in debt each year prior to the 1/2 cent tax.... it threatened the existence of something that couldn't go away.

doc t.

[Roguish Lawyer]

Originally posted by Doc T
without a doubt there is excessive markups in some things... the price you pay for a drug though includes it being mixed up into solution in the pharmacy, transported to the floor, given by the nurse,etc...not just the drug but what goes into it from time its ordered to time its given.

most county hospitals mark up more than the private ones...why? to cover for non-funded patients. I brought this up earlier I believe. The county hospital where I trained was the most expensive hospital in city when I was there and many insurance companies wouldn't cover being an impatient there.... And it was done purposefully to have the paying patients offset some of the costs of the nonpayers. The hospital was still going broke...and yes, hospitals often run with a bare minimal margin...usually less than what it costs to run for less than a week ...in the public market.

So no, not a lot of surplus like you might think...hence things like taxing alcohol and cigerettes to give money to money to indigient care, 1/2 cent tax in Miami, extra fines for drunk drivers to go into a trauma fund in texas... every little bit helps hospitals from going BROKE.... it is a real thing. Jackson Memorial Hospital used to run 20-30 million in debt each year prior to the 1/2 cent tax.... it threatened the existence of something that couldn't go away.

doc t.

I think this is part of the problem too.

[dickens]

Medicare was doomed to failure from the onset. It is simply socialized medicine and socialized medicine doesn't work. Our medicare system needs to be totally overhauled as an umbrella for the ones that need it....the poor. There is no reason why the taxpayer should pay for Bill Gates' mothers medical care or medication. It should be available to people, based on income and financial need. One size does not fit all and paying the medical care for the rich only takes the limited available funds away from those that need it.
We also need reforms in the tort system to stop some of these lawsuits. A woman drinks and uses drugs her entire pregnacy and then blames the MD when the baby is born is fetal alcohol syndrome. If this kind of thing doesn't stop, we won't have to worry about the medical care because all the doctors will have left the profession because they can't pay their malpractice insurance.

[The Reaper]

Originally posted by dickens
Medicare was doomed to failure from the onset. It is simply socialized medicine and socialized medicine doesn't work. Our medicare system needs to be totally overhauled as an umbrella for the ones that need it....the poor. There is no reason why the taxpayer should pay for Bill Gates' mothers medical care or medication. It should be available to people, based on income and financial need. One size does not fit all and paying the medical care for the rich only takes the limited available funds away from those that need it.
We also need reforms in the tort system to stop some of these lawsuits. A woman drinks and uses drugs her entire pregnacy and then blames the MD when the baby is born is fetal alcohol syndrome. If this kind of thing doesn't stop, we won't have to worry about the medical care because all the doctors will have left the profession because they can't pay their malpractice insurance.

dickens:

First welcome to PS.com and congratulations on being the 500th member.

As to your post, you believe that those who fail to save or plan for their future should be supported by those who are working and trying to save?

From each, to each, eh? Sounds like Socialism to me.

TR