ObamaCare - exchanges ,report your states options!

[Snorri1234]

Doctors don't directly order unnecessary medical tests to cover malpractice insurance.

Actually they do.

Which is logical. Try to get as conclusive evidence as possible. Even if it's really not needed because one test already proves you're going in the right direction.

This is especially so when you're dealing with a jury. Which is fucked up. Normal countries have a board of other medical professionals who judge on this shit.

Also: Often doctors just do it for the extra pay, not for the security.

I'm a doctor, I need more money to cover my outrageous medical bills. How do I get more money? Well, the insurance companies will pay me for $5,000 for running this unnecessary test and have $500 for this two minute follow-up appointment. Let's do that. So the insurance company shells out $5,500 unnecessarily, the insurance company raises rates for employers, who pay employees less and take more out of their paychecks to cover medical insurance, President Obama gets elected and vows to fix the insurance system. The insurance bill gets passed and nothing happens with medical malpractice insurance. Doctors do the same shit. Wheee.

But that doesn't matter. Because those extra tests still are a marginal part of the total expenses.

[Symmetry]

I'm not saying medical malpractice reform is the only answer, but it must be an answer. And right now it's not an answer.

As a related note, it's not an answer because the American Bar Association has major political influence. I've toyed with the idea of renouncing my membership to that particular institution, but I'm too scared.

That's something I can get on board with. Reform of malpractice laws seems to me to be one of the roads to removing motivation for unnecessary tests. At least then doctors will be, perversely, more responsible for the healthcare they provide. It won't be possible to fall back on fears of malpractice as an excuse for unnecessary testing.

But yes, anything else would be me repeating myself.

[PLAYER57832]

Attorneys getting money has nothing to do with the insurance companies, but it comes back to the culture again. A country full of people who feel they are entitled to all these things, even if they don't work a day for it.

It is also due to a system whereby someone seriously injured more or less has to sue to get any kind of compensation, including just getting their medical bills paid.

[PLAYER57832]

The best health care is to eat healthy and exercise. Beyond that, major injuries or medical issues need to be addressed. If the taxpayer is to pay for the medical care of individuals I say NO more obesity tolerated, NO more lazy f*** who sit around and play xbox waiting for the first, and NO more Ciggarettes/Booze/or any other type of stupid shit.

When this happens, I will be glad to pay your medical bills.

-A hard working American

NO ONE is asking YOU to pay their medical bills. In fact, your current subsidy for Medicaid, etc is likely to go down. And, in exchange for a small portion of our taxes going to subsidize purchase of policies by low income WORKING people, hard-working people, not deadbeats, you will get a reduction in your healthcare costs.

[thegreekdog]

The best health care is to eat healthy and exercise. Beyond that, major injuries or medical issues need to be addressed. If the taxpayer is to pay for the medical care of individuals I say NO more obesity tolerated, NO more lazy f*** who sit around and play xbox waiting for the first, and NO more Ciggarettes/Booze/or any other type of stupid shit.

When this happens, I will be glad to pay your medical bills.

-A hard working American

NO ONE is asking YOU to pay their medical bills. In fact, your current subsidy for Medicaid, etc is likely to go down. And, in exchange for a small portion of our taxes going to subsidize purchase of policies by low income WORKING people, hard-working people, not deadbeats, you will get a reduction in your healthcare costs.

First of all, yes, people are asking us to pay their medical bills. I have no beef with that, but let's not say that's not what's happening.

Second of all, it's not a "small portion of our taxes," which again, I have no beef with, but let's not say it's a small portion of our taxes.

Third of all, there is projected to be a reduction in healthcare costs. Let's see where we are in five years adding together taxes for the programs, departments, etc. plus whatever costs we pay in five years.

[PLAYER57832]

So much to address... I knew it was a mistake to come back in this thread.

(1) The insurance industry is not motivated by employer costs, it is motivated by healthcare costs. Healthcare costs are controlled by, among other things, the cost of medicines, doctors, procedures, etc., etc. Among the factors in rising healthcare costs is the lack of preventative care and the overabundance of charity care for those that cannot afford to purchase health insurance or healthcare. And what I said to you, Player, was not baloney, but fact. In fact, if you read your last post (the baloney one), you'll see that your discussino had nothing to do with how much money insurance companies make in income; rather, you discussed related issues regarding employer costs and the like. This is why it frustrates me to have this discussion with you. You argue points attendant to the main point. Sorry. Anyway, I'm not saying the current healthcare system is great; I'm saying there needs to be incremental change to the current healthcare system that is not either (1) the current healthcare bill or (2) universal government-controlled healthcare.

You are going to have to back up your reasoning, because everything I have seen is that while yes, healthcare costs are universally increasing, the problems with insurance is more due to our employer-based payor system. This both removes people from the costs of healthcare, meaning that some people get extremely good, even ridiculous health coverage (I mean policies like some unions in CA get that covers everything and has no penalty for missing even expensive appointments... policies that cover the most frivolous of health needs, ranging from spa treatments to fully voluntary plastic surgary) and pay comparatively little for it, while others pay far more for very little.

Healthcare costs themselves are spiraling, yes. And while it certainly does impact insurance costs, it is not something directly controlled by insurance reform, except when it comes to making individuals more responsible. Again, a lot of that comes back to having individuals and not employers pay.

(2) Let's assume, for a second, that the reason price gouging occurs is because people don't purchase their own insurance. Why don't people purchase their own insurance? Why do people rely on employers? Can we make it so that people can purchase their own insurance without relying on employers?

thought we tackled this earlier.

The short version, off the top of my head (sketchy on a few details) is a small company offered health insurance for teachers down in Texas (I believe it was Blue Cross, but not 100% on that). Anyway, fast forward to WWII and employers were restricted by law from increasing wages. They could offer benefits, so many began to offer this new medical coverage plan. Later, I want to say in the 50's, but I would have to look back to be sure, there was either a change in the law or a Supreme court judgement (cannot remember which,or both) that established that these benefits were not subject to taxes. This meant that employers could offer "more bang for the buck" by offering insurance. Ergo, virtually by accident, it was not long before employer-offered insurance became the norm.

If you want the real and full story, I can dig up the NPR story on it. (It was a special, not a regular program)

(3) Mr. Adams point (and mine) regarding public education is that the problems with public education are not solved by and are in some cases exacerbated by the "public" part of that phrase. I don't want to argue about public education, because I think we can all agree that it is a failed system for many kids (obviously some exceptions, obviously not the government's fault). The point is that we think the government is some panacea that will fix healthcare in the United States. Why? You guys berate me constantly for assuming that private industry is a panacea, so why don't you guys tell me why government is the panacea?

First, this bill is not bringing a government system. It is widening the subsidies available for insurance and mandating certain levels of coverage (but not costs).

Second, although education under the government is not perfect, it IS better than a private system would be. Too many people would be left out, the type of education offered would quickly become too "targeted" (i.e. biased). This is not just esoteric thinking, this is what has been shown to happen, both in our own country, in the past and elsewhere.

Similarly, the major reason I believe government health care would work (yes, I like it, but it is not what the bill is about), is evidence from other countries. We, not they pay more and, with only a few exceptions, get far less. Further, what's worse, even those who have nice insurance now have absolutely no gaurantee they will keep it when they really need it.

(4) Malpractice is not a small percentage of costs. I have a friend that is a doctor. Do you know what his second biggest cost is? Yep, malpractice insurance. Do you know why? Frivolous lawsuits. Do you know why he charges exobritant prices for procedures? To pay his ridiculous malpractice insurance. Malpractice insurance is also a major factor in insurance costs. If a doctor has to up his prices from $1000 to $2000 to pay for malpractice insurance, insurance companies have to up their coverage to account for that. It's pretty simple.

He is either unusual or is talking only about his direct costs from his salary. In fact, industry-wide Malpractice only represents 1-2%. The largest cost, by far is adminstration. How many clerks, receptionists and nurses does your doctor friend have to help him fill out paperwork and so forth. (not talking about adminstering shots and other direct medical care that helpers might well do.. just the paperwork). If they are not directly in his office, there is a good chance he is "outsourcing" billing and such. You, like I, are probably old enough to remember when a doctors offices often has 1 nurse/receptionist for 2 doctors.
(think "Marcus Welby"). Now, my son's doctor has about 5. My doctor has 4. Both "outsource" billing, with the result that I have spent months fighting over $20 bills that I already PAID TWICE! Until my kids got Medicaid, I had to fight the billers over just about every bill. Now, suddenly, they are under more scruteny and so don't make so many "mistakes" ( I DO check, even though the money is no longer coming wholly from my pocket).

(5) Crossing state lines is not bullshit and is completely relevant to this discussion; it doesn't stop being relevant just because you wish it to be irrelevant.

I don't believe I said it was bullshit.

Anyway, the reason it won't help is just as Snorri said.. it will simply mean that every company will go to the state with the friendliest insurance rules and make it far more difficult for individuals to challenge anything. This is exactly what happened with Credit Cards and was part of what caused that industry to spin so far out of control. Its no cooincidence that so many companies are based in Delaware.

I actually would like to see one uniform set of rules, but it would have to be a system with a floor. That is basically what is being suggested now, with the insurance exchanges. The details on who would regulate and so forth are difficult. I believe it needs to go from state to federal control, but that impinges on state's rights in many people's minds.

(6) I'm not sure about the drug company issue as I have not thought about it. I think your ire might be better directed at pharmaceutical companies than at insurance companies if this is your beef.

Again, I think this refers to someone else's comments. This time, I think I did a decent job of staying off tangents.

(7) The government will never, ever, ever, ever, ever stop subsidizing bad habits. Ever. You know why? Bad habits are a major source of tax revenue. You know what else will soon be a major source of tax revenue? Going to the doctor's. I'm telling you right now, the worst thing that could possibly happen to the government is that people eat healty, stop drinking, and stop smoking.

You are going to have to explain this one!

Other than smoking taxes, which actually don't pay for the cost to society from smoking (by every study I have ever seen), I fail to see how you can say this.

(8) By the way, this bill will not be universal health coverage. Just fyi. Not sure what you guys are reading.

I agree this is technically true, but unless things have changed a lot since my last reading (certainly possible), it comes pretty close. What, exactly did you mean?

Attendant note - I'm not talking about public universities Player; c'mon. I'm talking about the high school in West Philly or the high school in Podunk, Pennsylvania.

They are all part of the public system. However, I suppose you say that none of those high schools send kids to the colleges?

See, as much as I will step forward and criticize education, the problems with schools in the big cities and many other areas has more to do with overall problems in the communities than it has to do with the government being in charge of the schools. Ironically enough, schools are still (even with no child left behind) managed locally.

[PLAYER57832]

The best health care is to eat healthy and exercise. Beyond that, major injuries or medical issues need to be addressed. If the taxpayer is to pay for the medical care of individuals I say NO more obesity tolerated, NO more lazy f*** who sit around and play xbox waiting for the first, and NO more Ciggarettes/Booze/or any other type of stupid shit.

When this happens, I will be glad to pay your medical bills.

-A hard working American

NO ONE is asking YOU to pay their medical bills. In fact, your current subsidy for Medicaid, etc is likely to go down. And, in exchange for a small portion of our taxes going to subsidize purchase of policies by low income WORKING people, hard-working people, not deadbeats, you will get a reduction in your healthcare costs.

First of all, yes, people are asking us to pay their medical bills. I have no beef with that, but let's not say that's not what's happening.

Second of all, it's not a "small portion of our taxes," which again, I have no beef with, but let's not say it's a small portion of our taxes.

Third of all, there is projected to be a reduction in healthcare costs. Let's see where we are in five years adding together taxes for the programs, departments, etc. plus whatever costs we pay in five years.

According to the latest "fact checking" report I saw, Neither of your assertions are correct.

However, since I don't have that link right now (will look for it, but I am busy with that other CC function .. playing a game .. lol), show me where you get your information.

[PLAYER57832]

Doctors don't directly order unnecessary medical tests to cover malpractice insurance. It's an indirect phenomenon.

I'm a doctor, I need more money to cover my outrageous medical bills. How do I get more money? Well, the insurance companies will pay me for $5,000 for running this unnecessary test and have $500 for this two minute follow-up appointment. Let's do that. So the insurance company shells out $5,500 unnecessarily, the insurance company raises rates for employers, who pay employees less and take more out of their paychecks to cover medical insurance, President Obama gets elected and vows to fix the insurance system. The insurance bill gets passed and nothing happens with medical malpractice insurance. Doctors do the same shit. Wheee.

Actually both reasons cause doctors to order more tests, though malpractice is the one that is the conscious choice.

Doctors, while certainly wanting money, are still among the more altruistic of professionals. They don't intentionally, consciously just order more tests so they can make more money. The insurance payments do certainly influence doctors, but more in forcing doctors to neglect some time-consuming patients -- be it the elderly person who is on the verge of dying and needs to have choices fully explained or the "slow" patient who just needs more time explaining things... or the guy who has a whole list of symptoms, but really just needs someone to talk to, etc.

However, this is part of why both the cost and success rate for many procedures go down when there are more doctors practicing in a region, instead of up. Again, you have to think about classic economics and then realize that people and illnesses are simply not "widgets" coming out of machines. If I go to the one orthopedist within 200 miles, he is going to look at my case and, if its a "borderline" case, is likely to say .. eh, "let's wait". If I go to one of 5 orthopedists in an area, they are more likely to think, unconsciously, "hmm.. if I don't jerry x will..." Its not necessarily that they are even aware of this thinking. Sometimes its also that one doctor does a procedure under xyz conditions. They get together over cocktails at the local Drs gathering and talk "shop" and share views on things. The other doctors are more likely to go more cautious, more intentive ..the "culture" of the area changes in that field. Again, some of this is conscious, but often doctors don't even realize they are doing this.

[Night Strike]

Doctors don't directly order unnecessary medical tests to cover malpractice insurance.

Actually they do.

Which is logical. Try to get as conclusive evidence as possible. Even if it's really not needed because one test already proves you're going in the right direction.

This is especially so when you're dealing with a jury. Which is fucked up. Normal countries have a board of other medical professionals who judge on this shit.

"Normal" countries also don't have a Constitution that says you have a right to a trial by a jury in all criminal cases and civil cases over $20.

[MeDeFe]

Doctors don't directly order unnecessary medical tests to cover malpractice insurance.

Actually they do.

Which is logical. Try to get as conclusive evidence as possible. Even if it's really not needed because one test already proves you're going in the right direction.

This is especially so when you're dealing with a jury. Which is fucked up. Normal countries have a board of other medical professionals who judge on this shit.

"Normal" countries also don't have a Constitution that says you have a right to a trial by a jury in all criminal cases and civil cases over $20.

If you have a point you forgot to tell us what it is.

[stahrgazer]

So much to address... I knew it was a mistake to come back in this thread.
(1) The insurance industry is not motivated by employer costs, it is motivated by healthcare costs. Healthcare costs are controlled by, among other things, the cost of medicines, doctors, procedures, etc., etc.

Wrong. The insurance industry is motivated by its own profits. Check the wages for the average CEO of an insurance company; and know that insurance company 'parent companies' often own banks.

Among the factors in rising healthcare costs is the lack of preventative care and the overabundance of charity care for those that cannot afford to purchase health insurance or healthcare.

Fairly accurate, although lacking in details

Anyway, I'm not saying the current healthcare system is great; I'm saying there needs to be incremental change to the current healthcare system that is not either (1) the current healthcare bill or (2) universal government-controlled healthcare.

Government needs to step in to 1) regulate pricing and 2) ensure preventive and illness care. That's not necessarily the same as "government control" although the insurance companies have done a good job of selling it that way.

(2) Let's assume, for a second, that the reason price gouging occurs is because people don't purchase their own insurance. Why don't people purchase their own insurance? Why do people rely on employers? Can we make it so that people can purchase their own insurance without relying on employers?

St. Lucie County, Florida, is about to have layoffs, where people will lose their job and their insurance. They're eligible to purchase a Cobra plan. The Cobra plan will cost each employee approximately $800 per month, does not provide preventive care, does not provide prescriptions or dental, or much else besides a hospital stay. Rather hard for unemployed workers to spend way more apiece for insurance than the county pays for them while they're employed.

(3) Mr. Adams point (and mine) regarding public education is that the problems with public education are not solved by and are in some cases exacerbated by the "public" part of that phrase. I don't want to argue about public education, because I think we can all agree that it is a failed system for many kids (obviously some exceptions, obviously not the government's fault). The point is that we think the government is some panacea that will fix healthcare in the United States. Why? You guys berate me constantly for assuming that private industry is a panacea, so why don't you guys tell me why government is the panacea?

Because the government has more power than the individual, to regulate pricing. It's that simple. Had "the government" not stepped in against insurance companies after Katrina, to initiate a class action lawsuit, those poor folk would still be playing in the mud with the sticks of what remained of their houses, like many of us in Florida are, since our government didn't step in to force a class action suit. Many of us have the right to sue, but not the power (money and time).

(4) Malpractice is not a small percentage of costs. I have a friend that is a doctor. Do you know what his second biggest cost is? Yep, malpractice insurance. Do you know why? Frivolous lawsuits. Do you know why he charges exobritant prices for procedures? To pay his ridiculous malpractice insurance. Malpractice insurance is also a major factor in insurance costs. If a doctor has to up his prices from $1000 to $2000 to pay for malpractice insurance, insurance companies have to up their coverage to account for that. It's pretty simple.

So, it's not the malpractice, it's the cost of INSURANCE for it.

(5) Crossing state lines is not bullshit and is completely relevant to this discussion; it doesn't stop being relevant just because you wish it to be irrelevant.

It's pretty crazy that a company plan through Georgia differs greatly from a company plan through Texas or Florida.

(6) I'm not sure about the drug company issue as I have not thought about it. I think your ire might be better directed at pharmaceutical companies than at insurance companies if this is your beef.

Drug companies are allowed to charge extra to compensate for research costs, but after a time, the formula becomes more available and then you get generics that cost less.

(7) The government will never, ever, ever, ever, ever stop subsidizing bad habits. Ever. You know why? Bad habits are a major source of tax revenue. You know what else will soon be a major source of tax revenue? Going to the doctor's. I'm telling you right now, the worst thing that could possibly happen to the government is that people eat healty, stop drinking, and stop smoking.

A bit skewed, but some of the details are true; taxes on fast foods, alcohol, and cigarettes do help the government make some $$.

(8) By the way, this bill will not be universal health coverage. Just fyi. Not sure what you guys are reading.

True, which is why this particular bill sucks.

[Phatscotty]

Seem to me, this entire health care debate comes down to 2 things. Either it's more about providing health care to all Americans, or it is more about, and I lean towards this option, it is more about all Americans sharing the responsibilities ie cost. The cost is coming directly out of the paycheck, ala a new entitlement. Thats what the 16,500 new IRS agents are for

[Night Strike]

Apparently there is officially no such thing as a moderate democrat: they all still follow their far left leadership.

[Phatscotty]

Apparently there is officially no such thing as a moderate democrat: they all still follow their far left leadership.

kind of washes out anyone we send to washington to represent our districts/states.

[Titanic]

Apparently there is officially no such thing as a moderate democrat: they all still follow their far left leadership.

Far left? Apparently pro-life and no public option is far left...get real.

[Neoteny]

Apparently there is officially no such thing as a moderate democrat: they all still follow their far left leadership.

Far left? Apparently pro-life and no public option is far left...get real.

I get a sick chuckle out of the fact that the American right wing thinks that claiming all people are equal (except fags) and supporting basic human rights makes them centrist and everyone else far-left loonies.

[Night Strike]

Apparently there is officially no such thing as a moderate democrat: they all still follow their far left leadership.

Far left? Apparently pro-life and no public option is far left...get real.

Except that everyone knows this is only the first step to getting to public option and single-payer. Obama said it himself in 2007. The same liberals who believe every woman of any age must have access to completely private abortions are about to take away the privacy of all other Americans in every other area of health care. It's hypocrisy at its finest.

[jay_a2j]

Apparently there is officially no such thing as a moderate democrat: they all still follow their far left leadership.

Far left? Apparently pro-life and no public option is far left...get real.

Do I have to find the video's and post them? Obama needs his foot in the door, there WILL BE a public option...it will be the ONLY option when he's done.

[Titanic]

Apparently there is officially no such thing as a moderate democrat: they all still follow their far left leadership.

Far left? Apparently pro-life and no public option is far left...get real.

Except that everyone knows this is only the first step to getting to public option and single-payer. Obama said it himself in 2007. The same liberals who believe every woman of any age must have access to completely private abortions are about to take away the privacy of all other Americans in every other area of health care. It's hypocrisy at its finest.

Yer, they've spent over a year getting this version of healthcare through with huge majorities. Next up an even more ultra "far left" healthcare bill from a congress with less democrats!

@Jay: That proves nothing. I couldn't give a flaming fck what he said before, this proposal does not include it and there is no way they are going down this road against anytime soon.

[Snorri1234]

Apparently there is officially no such thing as a moderate democrat: they all still follow their far left leadership.

Far left? Apparently pro-life and no public option is far left...get real.

Do I have to find the video's and post them? Obama needs his foot in the door, there WILL BE a public option...it will be the ONLY option when he's done.

Because a country where there is so much opposition to even the idea of this is surely going to go far more leftwing than any European country?


Do you guys even know anything about actual european healthcare systems?

[Night Strike]

Yer, they've spent over a year getting this version of healthcare through with huge majorities. Next up an even more ultra "far left" healthcare bill from a congress with less democrats!

@Jay: That proves nothing. I couldn't give a flaming fck what he said before, this proposal does not include it and there is no way they are going down this road against anytime soon.

Once it's passed, they don't need Congress to do anymore. They're already illegally forcing everybody to buy something just because they're alive, so what makes you think they'll actually follow the laws? They'll force any insurance providers that receive government subsidies to force their participants to change their lifestyles if they are living unhealthily. And anyone who thinks they won't do this is deceiving themselves: the EPA has already started down the path to illegally regulating carbon dioxide. Government bureaucracies will ALWAYS take away our personal freedoms. And once it's passed, there's no way we can repeal it.

[PLAYER57832]

Nightstrike, you need to study constitutional law a little more before you start announcing everything you dislike is "illegal". And as for forcing people.. yes, because WE are FORCED to pay for YOUR bills when you go to the hospital without insurance.

[rockfist]

Today is the first round of this fight. The next round will be held in November and believe me we are fired up for November.

[Night Strike]

Nightstrike, you need to study constitutional law a little more before you start announcing everything you dislike is "illegal". And as for forcing people.. yes, because WE are FORCED to pay for YOUR bills when you go to the hospital without insurance.

Article 1, Section 8: "The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;"

16th Amendment: "The Congress shall have power to lay and collect taxes on incomes, from whatever source derived, without apportionment among the several States, and without regard to any census or enumeration."

NO WHERE in the Constitution does it give the Congress the power to tax us on not buying something, nor does it give the government the power to force us to make any purchase on any good produced or service provided. Player, neither you nor any other liberal has the right to tell me how to live my life or what I much purchase just to be an American citizen. This mandate is blatantly unconstitutional, and any justice who does not think so is a blatant revisionist of what our Constitution actually says.

[PLAYER57832]

Read a bit further, but you have been told before by better experts than myself and you wish to believe your own rhetoric.

And, as long as I am required, by law, to pay for your medical care, which I am, I have the right to ask my government to demand that you pay a bigger portion of that bill. Maybe you don't use it now, but you WILL.