# Health Care Reform Idea...



## Big Black Dog (Aug 12, 2009)

I think everybody will agree that the majority of the American population wants to see some form of health care reform.  Health insurance is either too expensive, or nearly so, for a great many people in the general population.  Hospital cost, doctor's fees, and just about anything associated with medical practice here in America is through the roof in cost.  People who don't have insurance are being treated and that cost is being pushed off to patients that do have insurance.  For whatever reason, be it unemployed, or the company you work for doesn't provide health insurance, a large group of people don't have health insurance.  Many don't have it out of personal choice.  Health care in general is a problem in this country.  It's been that way for probably 30 years or more.

Now, along comes the government and wants to change a 30 year old problem almost overnight by trying to push off onto America a bill that few of the Congressmen have even read and there are several versions of the bill being tossed around in Congress - all of which none of the Congressmen have read.  We are told that members of their staff have read portions of it.  The President is going around trying to sell a bill that hasn't even been completely written, yet alone read by anybody in it's entirety.  Members of Congress are all up in arms saying that if you disagree with them you are somehow unAmerican or a Nazi.  A bill to revise health care in America is trying to be rammed through Congress just as fast as it can be just so the politicians can say during the 2010 elections that they were responsible for making it happen for America.

Well, like the refs at a football game, the whistles have been blown and the yellow flags are flying.  The support for this health care reform idea is loosing popularity more and more every day.  People are leary and distrust Congressmen on this issue and rightfully so.  What's the big rush?  Health care in this country has been a chronic long-term problem that can't be fixed over night.  If congress continues to try, any attempt will fail.  Nothing will be solved.

My idea is simply this.  Put this issue on the back burner for a month or so and let everybody take a deep breath and relax a little bit.  Then throw everything that has been written to date in terms of HR 3200 into the trash can.  Begin the process over but this time think about what you want to accomplish and do it in a reasonable and more acceptable way for the citizens of America.  Everybody wants change.  The thing that Washington is ignoring is that we want that change to be reasonable and something we can all afford.  No secrets.  No bait and switch sales tactics.  Everything above board and out in the open.  Have the Congressmen read the bill so they will know what they are talking about when they try to sell the idea to America.  This is how you get reform.  Not the way it is being handled now.  All that is happening right now is the dividing of America on this issue.


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## veritas (Aug 12, 2009)

> Now, along comes the government and wants to change a 30 year old problem almost overnight



Ted Kennedy collapsed from his brain tumor in May, 2008. He was steadily working before that on health care reform, and has been since, along with many other people. How is this "overnight"?


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## Big Black Dog (Aug 12, 2009)

> Ted Kennedy collapsed from his brain tumor in May, 2008. He was steadily working before that on health care reform, and has been since, along with many other people. How is this "overnight"?



If they've been working on this for that long and this is the best they could come up with maybe they need a new line of work.

Maybe they could think about what they're doing and come up with something reasonable that can be paid for and something that the American public would like to have.


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## veritas (Aug 12, 2009)

Maybe you should read the bill and make some suggestions rather than making blanket statements.


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## toomuchtime_ (Aug 12, 2009)

Big Black Dog said:


> I think everybody will agree that the majority of the American population wants to see some form of health care reform.  Health insurance is either too expensive, or nearly so, for a great many people in the general population.  Hospital cost, doctor's fees, and just about anything associated with medical practice here in America is through the roof in cost.  People who don't have insurance are being treated and that cost is being pushed off to patients that do have insurance.  For whatever reason, be it unemployed, or the company you work for doesn't provide health insurance, a large group of people don't have health insurance.  Many don't have it out of personal choice.  Health care in general is a problem in this country.  It's been that way for probably 30 years or more.
> 
> Now, along comes the government and wants to change a 30 year old problem almost overnight by trying to push off onto America a bill that few of the Congressmen have even read and there are several versions of the bill being tossed around in Congress - all of which none of the Congressmen have read.  We are told that members of their staff have read portions of it.  The President is going around trying to sell a bill that hasn't even been completely written, yet alone read by anybody in it's entirety.  Members of Congress are all up in arms saying that if you disagree with them you are somehow unAmerican or a Nazi.  A bill to revise health care in America is trying to be rammed through Congress just as fast as it can be just so the politicians can say during the 2010 elections that they were responsible for making it happen for America.
> 
> ...



I would just add that the way to get this process started again would be to appoint a bipartisan panel of respected ex politicians and medical, legal and insurance experts, much in the same spirit as Reagan and Tip O'Neill did in the 1980's to consider SS's problems, to define the problems with our present system we might want to address, affordable access, portability, cost containment, etc., explore all the ways in which we might address those problems, costing out each solution and suggesting how that money might be raised, and then write up suggested solutions and publish the report and only then have Congress begin to debate what to do so that we will all, voters, the WH and Congress, will be better informed and better able to make the right decisions.


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## Big Black Dog (Aug 12, 2009)

veritas said:


> Maybe you should read the bill and make some suggestions rather than making blanket statements.




According to the most recent polls, less than 42% of the American public wants it.  That's good enough for me.


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## Skull Pilot (Aug 12, 2009)

veritas said:


> Maybe you should read the bill and make some suggestions rather than making blanket statements.




suggestion 1  Fix medicare first

suggestion 2 allow insurance companies to sell health insurance across state lines.


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## Big Black Dog (Aug 12, 2009)

Skull Pilot said:


> veritas said:
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Both are excellent ideas.  Mind running for Congress?


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## Amanda (Aug 12, 2009)

Here's my idea... 

Either give us the benefits they enjoy or make them use whatever system they push on us. I'd be fine with either 1.


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## strollingbones (Aug 12, 2009)

this is all just crazy...we are not gonna push out the old people....the home visits are to help young mothers...do you realize how many children are born to unwed young mothers?  they need all the health they can get with new babies...

it is time for deep reform....the american medical system is just a bad idea....why are bureaucrats (hmo's) telling doctors what they can do with their patients?  i mean how fucked up is that? as long as you allow corportate interests to run the medical system...the patient is fucked with or without insurance...i am amused that people with insurance thinks that will save them...no it wont..cause the insurance companies arent gonna pay for any treatment they dont have to pay for...they dont care if someone dies from denial of treatment all they care about is the bottom line....profit or not?  is that the way to run a system?  most insurance will simply try to stall till the patient dies...nice people right.


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## veritas (Aug 12, 2009)

Skull Pilot said:


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Both are covered in HR 3200.

Medicare would be streamlined to cut costs and find waste and effect better delivery. The CBO says it would extend Medicare's solvency from 2017 to 2022 for starters.

Insurance forms would be uniform and so would the laws in each state. I'm sure private insurers which have contracted [gobbled and merged and taken over] to the "big six" can figure this out. For instance in my state, 39% of private insurance is from one carrier.


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## toomuchtime_ (Aug 12, 2009)

Skull Pilot said:


> veritas said:
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Absolutely.  Allowing insurance companies to sell across state lines will increase competition and drive down insurance premiums.  If we require employers to allow employees the choice of either accepting the company's plan or using the company contribution to buy an individual plan, the demand for individual health insurance will go up, increasing competition and driving premiums even lower, while at the same time making health insurance portable for those who choose the individual plan so that they can move from job to job and state to state without the fear of losing their health insurance because of pre existing conditions.  Good for the people and good for our economy.

Add to this meaningful tort reform and most our the health care problems are solved.  We spend between $100 billion and $200 billion a year on defensive medical tests and referrals because of doctors' fears of litigation.  Take malpractice suits out of the courts and have them decided by panels of medical experts that will offer limited damages for emotional distress but no punitive damages; rather they will be empowered to suspend or revoke the licenses of physicians who are found to be careless or negligent.  This could reduce health care costs by tens of billions of dollars a year; add to this the savings from the reduced need to purchase expensive diagnostic equipment and the lower rates for doctors' malpractice insurance, and we have dramatically reduced health care costs across all private and public plans.  

Just these three items alone will lower health insurance premiums so that some who cannot now afford insurance will be able to buy it for themselves and if we decide to help others to buy it, it will cost us much less to do so.  

Once you put ideology and politics aside, these problems are just not that hard to solve and it certainly doesn't take 1,000 pages to describe the solutions.


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## Big Black Dog (Aug 12, 2009)

> I would just add that the way to get this process started again would be to appoint a bipartisan panel of respected ex politicians and medical, legal and insurance experts, much in the same spirit as Reagan and Tip O'Neill did in the 1980's to consider SS's problems, to define the problems with our present system we might want to address, affordable access, portability, cost containment, etc., explore all the ways in which we might address those problems, costing out each solution and suggesting how that money might be raised, and then write up suggested solutions and publish the report and only then have Congress begin to debate what to do so that we will all, voters, the WH and Congress, will be better informed and better able to make the right decisions.



Not a bad idea at all.  Thanks for the input.


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## Big Black Dog (Aug 12, 2009)

> Either give us the benefits they enjoy or make them use whatever system they push on us. I'd be fine with either 1.



Excellent idea.  Thanks.


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## midcan5 (Aug 12, 2009)

Procrastination at its finest. Given that attitude, would anything ever get accomplished. This is eighty years of *'we can't.'* Weird how the European nations are doing it and no one is running on a platform of repeal. 

Sorry folks, if everyone had your attitude we'd still be in caves howling at the moon. Actually a few of town hall participants are still there. 

http://www.usmessageboard.com/healt...241-answers-to-all-your-questions-on-uhc.html

"Teddy Roosevelt first called for (health care) reform nearly a century ago."


http://www.politifact.com/truth-o-m...goes-back-to-his-Republican-roots-on-health-/


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## twogreen2c (Aug 12, 2009)

toomuchtime_ said:


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They won't do these simply 3 things because there is a powerful force pushing a bigger agenda.  Some of the clowns in Congress share this same agenda, others are just following the party line, and the rest may be just plain stupid to see what is happening.  They know Americans are lazy so they go on passing whatever legislation they want without really giving consideration as to what's best for the country and its people.  Well Obama and company aren't getting away with slipping this health care reform package thru.  I don't think they expected such an extreme resistance.  The Dems have the votes to pass some form of health care reform, but they are running scared now that they some angry folks got up in their faces.  They aren't use to having to answer to the people.  I hope we are seeing a permanent change in the tide.


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## The T (Aug 12, 2009)

Big Black Dog said:


> veritas said:
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Same here, and the List grows daily, as people read the legislation, but Obama, continues to play the Joker, and LIE about it.

Obama will take the Democrats down with him, and Obama is correct. If he doesn't get this? His presidency is finished.

(And remember? This is All about HIM, and NOT the people he is sworn to serve)...


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## Skull Pilot (Aug 13, 2009)

veritas said:


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what you don't mention is that medicare reimbursements to doctors will be cut. So in effect services will be cut.  You'll have the government saying "Go ahead and do all the MRIs and surgery you want but we're going to pay you less for them"

tell me what do you think will happen?  will seniors get the same medical care they did before?

And that insurance forms will be standardized is not the same as allowing insurance companies to sell their products across state lines.

If insurance companies in your neighboring states were allowed to sell in your state, you would see real competition and not what the government calls competition.  Prices would drop like a stone.


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## Diuretic (Aug 13, 2009)

Sometimes you just have to wipe the whiteboard and start again.

Is it - and please accept this as a question/suggestion/idea that isn't borne out of a partisan political view - the case that perhaps now is a good time to work out how health care should be paid for?  I know that's a really simplistic question but sometimes simplistic questions have to be asked.  Call it the curse of the naive if you wish.  

If you were given the power to devise a model for health care for your citizens what sort of model would you favour?


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## toomuchtime_ (Aug 13, 2009)

Diuretic said:


> Sometimes you just have to wipe the whiteboard and start again.
> 
> Is it - and please accept this as a question/suggestion/idea that isn't borne out of a partisan political view - the case that perhaps now is a good time to work out how health care should be paid for?  I know that's a really simplistic question but sometimes simplistic questions have to be asked.  Call it the curse of the naive if you wish.
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> If you were given the power to devise a model for health care for your citizens what sort of model would you favour?



That's a good question, and another good one is, what sort of model would your citizens favor?  

This process began with broad bipartisan consensus that our health care system needed to be improved, but the WH and Congress squandered that consensus by putting politics ahead of policy.  Instead of beginning the process by examining all the ways we might address the things we wanted to change and crunching the numbers to see what benefits each approach might bring us and what each would cost, the President and the Congress decided the important thing was to get the House and Senate bills finished before the summer recess so the law could be signed just before the 2010 campaign season began.  Those in Congress who agreed this was the proper way to go about changing our health care system are receiving the treatment they deserve from their constituents at the town hall meetings.


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## Diuretic (Aug 13, 2009)

toomuchtime_ said:


> Diuretic said:
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That seems like a pretty fair point.  I'd be more fulsome but I don't fully understand the competing policy positions in depth.  Could it be though that the proponents of change realised that my suggestion of clearing the decks to start again would be impossible in practice?  Could it be that they've decided to work with what they have and to try to achieve a policy position in full acknowledgement that they have to do what's both possible and practical?

I suppose my theoretical suggestion of wiping the board was directed to people who post here rather than putting it as a a position that could possibly be adopted  by the legislature.  In essence I'm asking if posters here could remove the competing ideologies from the issue of health care, what would it look like?


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## JakeStarkey (Aug 13, 2009)

The point is simple: the time is now for reform.

The health insurance companies have compromised the over all health of the American population while getting rich denying insurance to those who need it.

Be part of the solution, because if you oppose it, you will simply get walked over as the screamers and yellers are being walked over by the administration right now.


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## Diuretic (Aug 13, 2009)

As always, politics is the art of the possible and, as always, timing is imperative.


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## Skull Pilot (Aug 13, 2009)

JakeStarkey said:


> The point is simple: the time is now for reform.
> 
> The health insurance companies have compromised the over all health of the American population while getting rich denying insurance to those who need it.
> 
> Be part of the solution, because if you oppose it, you will simply get walked over as the screamers and yellers are being walked over by the administration right now.



one of the reasons health care is so expensive is that the government got involved.

so the solution is more of the very thing that raised costs in the first place?

If you want to see what government mandated insurance does, look at Massachusetts.

health insurance costs there are now above the national average.

the mandates in the minimum "acceptable" coverage will include a lot of things that a lot of people don't want or need and for which they shouldn't have to pay

seriously if a woman is not planning to get pregnant, why should she pay for insurance that covers in home prenatal visits?

If i don't need substance abuse counseling or mental health counseling, why should I pay for a policy that covers those things? 

http://www.sbecouncil.org/uploads/SBEC%20polseries%2033%20-%20SBSI-Health%5B1%5D%202-3-09.pdf



> Additional negative factors in the health care equation are government mandates and regulations.For example, some elected officials think it is a good idea to mandate that insurance companies provide certain kinds of coverage. But each mandate and regulation comes with added costs. No matter what the intentions of elected officials or policymakers have been, government intervention in markets &#8211; including regulations and mandates &#8211; comes with costs.


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## dilloduck (Aug 13, 2009)

Diuretic said:


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Health care is fine. Competing ideologies IS the issue. Who should pay for those who cannot afford health care is the issue isn't it ?


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## editec (Aug 13, 2009)

Big Black Dog said:


> I think everybody will agree that the majority of the American population wants to see some form of health care reform. Health insurance is either too expensive, or nearly so, for a great many people in the general population. Hospital cost, doctor's fees, and just about anything associated with medical practice here in America is through the roof in cost. People who don't have insurance are being treated and that cost is being pushed off to patients that do have insurance. For whatever reason, be it unemployed, or the company you work for doesn't provide health insurance, a large group of people don't have health insurance. Many don't have it out of personal choice. Health care in general is a problem in this country. It's been that way for probably 30 years or more.
> 
> Now, along comes the government and wants to change a 30 year old problem almost overnight by trying to push off onto America a bill that few of the Congressmen have even read and there are several versions of the bill being tossed around in Congress - all of which none of the Congressmen have read. We are told that members of their staff have read portions of it. The President is going around trying to sell a bill that hasn't even been completely written, yet alone read by anybody in it's entirety. Members of Congress are all up in arms saying that if you disagree with them you are somehow unAmerican or a Nazi. A bill to revise health care in America is trying to be rammed through Congress just as fast as it can be just so the politicians can say during the 2010 elections that they were responsible for making it happen for America.
> 
> ...


 

The reason that we cannot impose a SIMPLE easy to understand solution to this problem is that we cannot easily migrate from the byzantine mess of programs we have now to a simple solution because there are far too many vested interests who want the system we have now to continue.

the simple solution is singly payer universal HC coverage.

I'm NOT saying I think that will work, of course...merely that that is the simply approach that we probably would impose if we didn't already have the system we have now.


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## dilloduck (Aug 13, 2009)

Why cant' people pay for health care ? Is it too expensive or do people not make enough money ?


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## Skull Pilot (Aug 13, 2009)

dilloduck said:


> Why cant' people pay for health care ? Is it too expensive or do people not make enough money ?



Maybe the government takes too much of our money.

The president pines that health care comprises 17% of GDP but the government chews up more than twice that.

If spending 17% of GDP on health care will "bankrupt" us, what on earth will  spending over 40% of GDP on government do to us?

US Government Spending As Percent Of GDP in United States 2009-2010 - Federal State Local


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## PoliticalChic (Aug 13, 2009)

veritas said:


> Maybe you should read the bill and make some suggestions rather than making blanket statements.




That's exatly what John Mackey, founder of Whole Foods did in the WSJ yesterday:

&#8201;Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems.

&#8201;Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not

&#8201;Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

&#8201;Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

&#8201;Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.


And more. Read the article at 
John Mackey: The Whole Foods Alternative to ObamaCare - WSJ.com


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## Skull Pilot (Aug 13, 2009)

PoliticalChic said:


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One of the first things to go if the health crae bill passes will be the high deductible HSA plans.

so much for being able to keep what you have if you like it.


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## Diuretic (Aug 13, 2009)

dilloduck said:


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Or is it HOW it should be paid for?  

I'm not avoiding your point, it's well made.  But I would suggest it's not ideologies as much as practicalities that should be examined.  

Should anyone have to pay for services delivered by doctors and/or hospitals?


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## dilloduck (Aug 13, 2009)

Diuretic said:


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"Only if you use them" would be my answer


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## Diuretic (Aug 13, 2009)

dilloduck said:


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So that's a yes.  

Now, what if they can't afford to pay for the services?


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## dilloduck (Aug 13, 2009)

Diuretic said:


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My answer would be "Why is it that you cannot afford to pay for the services" ?
Do you waste money that could go to medical bills on things you really don't need ? Do you not save money every month to go for medical needs ? Do you live a healthy life style to keep you from needing medical care ?  etc etc


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## Diuretic (Aug 13, 2009)

dilloduck said:


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Let's say that they can't pay for the services they need because they don't earn a lot of money.  Now what?


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## Skull Pilot (Aug 13, 2009)

Diuretic said:


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there are government programs for those truly in need.  No one is calling for an end to those programs.

the point here is the government should not be telling those of us, including businesses that provide insurance benefits, what is acceptable coverage.


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## Diuretic (Aug 13, 2009)

Skull Pilot said:


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So people who can't afford to pay for those services should get them at no cost?

Is that right?


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## xotoxi (Aug 13, 2009)

Skull Pilot said:


> the mandates in the minimum "acceptable" coverage will include a lot of things that a lot of people don't want or need and for which they shouldn't have to pay
> 
> seriously if a woman is not planning to get pregnant, why should she pay for insurance that covers in home prenatal visits?
> 
> If i don't need substance abuse counseling or mental health counseling, why should I pay for a policy that covers those things?


 
What if the woman above becomes pregnant?  Would she be able to get coverage at that point?

And how about you...if something happened suddenly that necessitated that you have mental health counseling?  Would you be able to get it then?  Or would you never be able to get that coverage as you would now have a "pre-existing condition"?


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## JakeStarkey (Aug 13, 2009)

skullpilot above has given us the answer: a two-tier system.  Also 

&#8226;&#8201;never repeal state laws which prevent insurance companies from competing across state lines. Insurance companies will grow into even monopolistic structures screwing the customer while trying to get ever possible dollar they can.

&#8226;&#8201;never repeal government mandates regarding what insurance companies must cover. It is a lie that "what is insured and what is not insured [will] be determined by individual customer preferences and not through special-interest lobbying."  That is exactly what the insurance bean counters do.  They get between you and your doctor's decision making process.


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## Old Rocks (Aug 13, 2009)

Universal Health Care is a form of social insurnance. It would prevent a major illness from wiping out all that one had worked for all their lives. It would also do away with the excuses for not covering someone after they had such an illness. 

Yes, it must be paid for. So how do the other Democratic nations pay for it? Which of the ways that they do would work best for us? 

We see nations in Europe that have standards of living that now exceed ours providing all with health care, we see none of their citizens going bankrupt because of medical bills. And they have much better results for their systems than we do for ours, even though ours is costing twice as much, per capita. 

But all we hear is that we cannot do it. Are the Europeans and Asians that much smarter than we are? That they can do it, and provide a standard of living that is the equal, or even better than ours in some nations, says that we are not doing something right.


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## Old Rocks (Aug 13, 2009)

Skull Pilot said:


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Sure. Let the insurance companies determine that. Then when you cost the insurance company a few pennies on the dollars you have paid them, they throw you onto a government program that has been cut to the bone by the Conservatives eliminating "welfare". 

We have been down that path. Time to join the rest of the industrial Democracies, leave the 19th Century, join the 21st, and adopt a Universal Health Care System for all citizens.


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## Diuretic (Aug 13, 2009)

Old Rocks said:


> Universal Health Care is a form of social insurnance. It would prevent a major illness from wiping out all that one had worked for all their lives. It would also do away with the excuses for not covering someone after they had such an illness.
> 
> Yes, it must be paid for. So how do the other Democratic nations pay for it? Which of the ways that they do would work best for us?
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The thing that should scare the crap out of someone when they're told they have a serious illness is the knowledge they have a serious illness - not the prospect of bankruptcy.


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## editec (Aug 13, 2009)

dilloduck said:


> Why cant' people pay for health care ? Is it too expensive or do people not make enough money ?


 
Yes...both


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## editec (Aug 13, 2009)

Diuretic said:


> Old Rocks said:
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Of course people are quite rightly scared by both things.

Their health is failing them and that means they will likely go broke in the process.


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## Diuretic (Aug 13, 2009)

editec said:


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Double whammy.  But okay if you can afford the health care, single whammy.


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## toomuchtime_ (Aug 13, 2009)

Diuretic said:


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Speaking of the real world process going on, the polls show that most Americans are still proponents of change to achieve broad health care goals, such as reining in costs, increasing affordable access to health care, increasing portability of health insurance coverage, etc., but the polls also show most people now oppose the House bill and they show that opposition is growing.  The point is that almost everyone is a proponent of change, but only a minority, a shrinking minority at that, are proponents of the particular change the President is espousing and which is embodied in the House bill.  

The real world debate about this bill, which can fairly be said to represent the President's positions regardless of how cagey his answers to questions are, is all about ideology on both sides at this point and not at all about the benefits and costs involved.  How could it have been otherwise since the President and Congress were only willing to discuss achieving changes in our system by adopting elements of a welfare state?  From the beginning the process launched by the President and the Congress was motivated by ideological and political ambitions and that is why the opposition it has engendered is also political and ideological.  It neither preserves the system we have nor replaces it with another that can efficiently address our needs and goals; rather it is a jumble of disparate elements that is too expensive, impractical and so confusing that its advocates for the most part can only respond to criticisms by mumbling something about private insurance companies being bad.

As for the debate on the message board, if we put ideological biases aside, what is there to debate?  Without first crunching the numbers to cost out the relative costs and benefits of the various ways in which we might change our system, we simply don't know enough to decide which way might be best.  However, even if we had done all the cost benefit analyses possible, we could still not project very far into the future how these various changes might work out or what effect they might have on our economy with any justifiable confidence, so I would argue that we should only proceed through incremental changes that would first attempt to lower costs and increase access by such discrete measures as allowing health insurance companies to sell national health insurance policies, allow workers to use the company contribution to purchase individual health insurance policies and tort reform in malpractice cases that would cap awards for emotional distress and do away with punitive damages in favor of suspending or revoking medical licenses on a national basis, etc.  

To the extent these measures failed to reduce health care costs and health insurance premiums sufficiently to allow everyone to buy health insurance, we might then consider government assistance for those who still couldn't afford it, but to the extent these measures did lower costs and premiums, it would be less expensive for us to offer this aid than it is now.  Only after all these measures left us still unsatisfied with the system should we consider making fundamental changes in it.


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## Skull Pilot (Aug 13, 2009)

xotoxi said:


> Skull Pilot said:
> 
> 
> > the mandates in the minimum "acceptable" coverage will include a lot of things that a lot of people don't want or need and for which they shouldn't have to pay
> ...


----------



## Emma (Aug 13, 2009)

Skull Pilot said:


> suggestion 2 allow insurance companies to sell health insurance across state lines.



Do you agree with the Health Insurance Exchange that was proposed? I think that is an _excellent_ idea.


----------



## chanel (Aug 13, 2009)

These are excellent suggestions but I have a far more cynical view of what HR3200 is about. It's just another nail in the coffin of capitalism.


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## dilloduck (Aug 13, 2009)

chanel said:


> These are excellent suggestions but I have a far more cynical view of what HR3200 is about. It's just another nail in the coffin of capitalism.



And competition.


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## veritas (Aug 13, 2009)

> what if all of a sudden I become a criminal, should i be put in jail now?



That's an option that will get you free gov't health care.


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## Skull Pilot (Aug 13, 2009)

Emma said:


> Skull Pilot said:
> 
> 
> > suggestion 2 allow insurance companies to sell health insurance across state lines.
> ...



My main problem with this bill is that it mandates minimum coverages which will include some things that a lot of people don't need but will have to pay for and that if you have a policy that you like and are comfortable with, the government can deem it unacceptable and tax you because you don't buy what they tell you to buy.

An exchange would not be needed if health insurance was sold across state lines like every other insurance.


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## Skull Pilot (Aug 13, 2009)

veritas said:


> > what if all of a sudden I become a criminal, should i be put in jail now?
> 
> 
> 
> That's an option that will get you free gov't health care.



lol not to mention a free college eduation


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## toomuchtime_ (Aug 13, 2009)

veritas said:


> > what if all of a sudden I become a criminal, should i be put in jail now?
> 
> 
> 
> That's an option that will get you free gov't health care.



Would that include periodic end of life counseling?


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## Harry Dresden (Aug 13, 2009)

Skull Pilot said:


> veritas said:
> 
> 
> > > what if all of a sudden I become a criminal, should i be put in jail now?
> ...



and free Health Club Membership...


----------



## Meister (Aug 13, 2009)

Harry Dresden said:


> Skull Pilot said:
> 
> 
> > veritas said:
> ...



Not to mention an "open" relationship with Bubba


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## Harry Dresden (Aug 13, 2009)

midcan5 said:


> Procrastination at its finest. Given that attitude, would anything ever get accomplished. This is eighty years of *'we can't.'* Weird how the European nations are doing it and no one is running on a platform of repeal.
> 
> Sorry folks, if everyone had your attitude we'd still be in caves howling at the moon. Actually a few of town hall participants are still there.
> 
> ...



so folkes this whole thread was a waste of time.....Midcant....the smartest guy in the world just said so.....your all a bunch of procrastinators and cave dwellers...with a bad attitude....Midcant the Sphincter dweller has spoken....


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## The T (Aug 14, 2009)

Harry Dresden said:


> midcan5 said:
> 
> 
> > Procrastination at its finest. Given that attitude, would anything ever get accomplished. This is eighty years of *'we can't.'* Weird how the European nations are doing it and no one is running on a platform of repeal.
> ...


 
And of course that poster cites the *EU*? (And how many times have we pulled thier collective asses out of the fire for Liberty sake)?

Yeah the EU is a fine example to follow, isn't it? And the Statists here in this country want to mirror their high unemployment, and long lines for Healthcare?

But then too, the Statists want to be "liked" by emulating them...

Great post sir.


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## Diuretic (Aug 14, 2009)

The T said:


> Harry Dresden said:
> 
> 
> > midcan5 said:
> ...



The EU?  None.


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## midcan5 (Aug 14, 2009)

Diuretic said:


> The EU?  None.



Diuretic,  you'll confuse them if you mention facts.  Also I think in WWII they forget Russia's role but that sort of thinking confuses the wingnuts who get their information from the likes of Palin and Limbaugh.


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## PoliticalChic (Aug 14, 2009)

Emma said:


> Skull Pilot said:
> 
> 
> > suggestion 2 allow insurance companies to sell health insurance across state lines.
> ...



Then again you are the healthcare expert who claimed that when these mandates are added to the price of a healthcare insurance policy, 

1. have guaranteed issue and renewal

2. no exclusions for pre-existing conditions

3. , no lifetime or annual limits on benefits,

4. family policies would have to cover children up to age 26.

5. to cover essential health benefits, as defined by a new Medical Advisory Council (MAC), appointed by the Secretary of Health and Human Services. The MAC would determine what items and services are essential benefits. The MAC would have to include items and services in at least the following categories: ambulatory patient services, emergency services, hospitalization, maternity and new born care, medical and surgical, mental health, prescription drugs, rehab and lab services, preventive/wellness services, pediatric services, and anything else the MAC thought appropriate.
6. compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). 

7. prohibits engaging in other discriminatory practices. cover smokers, parachute jumpers, and race car drivers.

8. Caps total out-of-pocket spending 


the price of the policy would go down.

Based on same, I'll take your view with a grain of salt.


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## PoliticalChic (Aug 14, 2009)

chanel said:


> These are excellent suggestions but I have a far more cynical view of what HR3200 is about. It's just another nail in the coffin of capitalism.



I think you hit the nail on the head.

And the folks who 'claim' not to see this, and view it as a healthcare plan are viewing through the prism of their political aims.

The proof?

The single largest factor in the cost of US healthcare is not the mythical money grabbing CEOs and insurance companies, but is the threat of lawsuits by trial lawyers.

The defensive medicine being practiced in this country costs fifteen- that is 15- times the amount of profit the industry makes.

And nowhere in the Democrat 'plan' is the tort reform that would obviate this.


While malpractice litigation accounts for only about 0.6 percent of U.S. health care costs, the fear of being sued causes U.S. doctors to order more tests than their Canadian counterparts. So-called defensive medicine increases health care costs by up to 9 percent, Medicare's administrator told Congress in 2005. "
Canada keeps malpractice cost in check - St. Petersburg Times

Now, compare those with these:
"Also, its worth noting that while these figures sound like a lot of money  and few would dispute the fact that health insurance company CEOs make healthy salaries  these numbers represent a very small fraction of total health care spending in the U.S. In 2007, national health care expenditures totaled $2.2 trillion. Health insurance profits of nearly $13 billion make up 0.6 percent of that. CEO compensation is a mere 0.005 percent of total spending."
FactCheck.org: Pushing for a Public Plan


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## The T (Aug 14, 2009)

Diuretic said:


> The T said:
> 
> 
> > Harry Dresden said:
> ...


 
Nevermind (and I highlighted it for you), I meant EU as in Europe as a whole. So please? Correct yourself?


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## Diuretic (Aug 14, 2009)

The T said:


> Diuretic said:
> 
> 
> > The T said:
> ...



Don't be embarrassed, it was a minor error.  

Europe, the EU, easy to conflate.  I mean Europe is a continent while the EU is an economic union of some of the countries on the continent of Europe.  

Russia isn't in the EU but it's in Europe (and Asia).  

During WWII Russia, as the Soviet Union, fought the Great Patriotic War against Hitler's Germany.  The rest of Europe was either Axis, occupied or neutral.  Britain, now part of the EU but back then not thinking of itself as being part of Europe ("Fog in Channel, Continent Cut Off"), was a combatant nation but unoccupied (except for the Channel Islands).  

The beginning of the end for the German forces in occupied Europe and for her Axis allies was Operational Overlord where substantial forces from the United States, Britain, Canada and other Allied nations invaded the Normandy beaches (Xenophon is good on this stuff).  There were casualties on all sides as you would expect.

There are some very good books about this as well as some terrific documentaries.  

The history of the EU is a bit bland, save for the boofhead de Gaulle and his famous "non" as a response to Britain's request for entry to the European Common Market at it was called at the time.


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## Harry Dresden (Aug 14, 2009)

midcan5 said:


> Diuretic said:
> 
> 
> > The EU?  None.
> ...



why dont you go suck some Neo-leftist balls asshole....people with hateful attitudes toward anyone who disagrees with them are destroying this country....and your definatly one of them...the only difference is you come from the far left....FUCK YOU....


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## veritas (Aug 14, 2009)

> why dont you go suck some Neo-leftist balls asshole....people with hateful attitudes toward anyone who disagrees with them are destroying this country....and your definatly one of them...the only difference is you come from the far left....FUCK YOU....




Colbert? Izzat you?


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## oreo (Aug 14, 2009)

Big Black Dog said:


> I think everybody will agree that the majority of the American population wants to see some form of health care reform.  Health insurance is either too expensive, or nearly so, for a great many people in the general population.  Hospital cost, doctor's fees, and just about anything associated with medical practice here in America is through the roof in cost.  People who don't have insurance are being treated and that cost is being pushed off to patients that do have insurance.  For whatever reason, be it unemployed, or the company you work for doesn't provide health insurance, a large group of people don't have health insurance.  Many don't have it out of personal choice.  Health care in general is a problem in this country.  It's been that way for probably 30 years or more.
> 
> Now, along comes the government and wants to change a 30 year old problem almost overnight by trying to push off onto America a bill that few of the Congressmen have even read and there are several versions of the bill being tossed around in Congress - all of which none of the Congressmen have read.  We are told that members of their staff have read portions of it.  The President is going around trying to sell a bill that hasn't even been completely written, yet alone read by anybody in it's entirety.  Members of Congress are all up in arms saying that if you disagree with them you are somehow unAmerican or a Nazi.  A bill to revise health care in America is trying to be rammed through Congress just as fast as it can be just so the politicians can say during the 2010 elections that they were responsible for making it happen for America.
> 
> ...




I agree with you.  They need to scrap this HR3200--come up with different private options like co-ops--do tort reform--for real effective reform--& then go back to the American public with different options & choices.

If they need too have a national vote--so we the people--can choose our own health care plan--then do it.


----------



## veritas (Aug 15, 2009)

> If they need too have a national vote--so we the people--can choose our own health care plan--then do it.



hmmm.......don't we have a representational republic instead of a true democracy? Seems to me that is what I heard somewhere.......


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## Skull Pilot (Aug 15, 2009)

veritas said:


> > If they need too have a national vote--so we the people--can choose our own health care plan--then do it.
> 
> 
> 
> hmmm.......don't we have a representational republic instead of a true democracy? Seems to me that is what I heard somewhere.......



then let's put this issue to a vote.  i would rather see a ballot initiative on this so we can see what the people really want and not what our so called representatives tell us we want.

we do the same for a number of issues on the state level, so why not let the people vote.

after all this bill is giving government unprecedented control over our lives and I'm sure not trusting my scum bag reps to do what i want.


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## veritas (Aug 15, 2009)

> then let's put this issue to a vote. i would rather see a ballot initiative on this so we can see what the people really want and not what our so called representatives tell us we want.



That would require an amendment to the Constitution. Do you actually know how our government is set up?


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## Skull Pilot (Aug 15, 2009)

veritas said:


> > then let's put this issue to a vote. i would rather see a ballot initiative on this so we can see what the people really want and not what our so called representatives tell us we want.
> 
> 
> 
> That would require an amendment to the Constitution. Do you actually know how our government is set up?



So.  It's time for people to take control from the government and assert our will.

Why would you be against this?

People have been trying for years to do this very thing.

http://www.iandrinstitute.org/National%20I&R.htm

People ask for Constitutional amendments for the most trivial shit such as the definition of marriage but when it comes to putting more power in the hands of the people on proposed laws that increase government control we balk


----------



## Emma (Aug 15, 2009)

PoliticalChic said:


> Emma said:
> 
> 
> > Skull Pilot said:
> ...


I really couldn't care less. 

The point I made on at least 2 other threads was that this would produce savings in the long-term. I believe I also provided data regarding the cost of complications of chronic diseases, (and the complications of those complications), lost productivity, disability, etc. So if you're going to attribute something to me, at least be honest about what I said, and put it in context. 

But aside from that, it makes sense that competition and a larger consumer base will drive down the cost of policies.


----------



## PoliticalChic (Aug 15, 2009)

Emma said:


> PoliticalChic said:
> 
> 
> > Emma said:
> ...



"I really couldn't care less."
No, you couldn't know less.

Adding every possible kind of coverage will cause the cost to go down, pretty absurd.

But it is consistent with the pie-in-the-sky thinking that also says increasing the number covered by millions, with no comensurate increase in healthcare providers will result in 
a) no rationing
b) better quality of care
and, your favorite,
c) lower costs.

"it makes sense that competition and a larger consumer base will drive down the cost of policies."
This is only true if you remove the myriad mandates that liberal states have shoveled into policies. The idea is dirctly from a list of suggestions that I posted, several times.   

Where do you find this in the ObamaCare plan? Nowhere. The opposite is true: more mandates, you know, the ones you claim will lower costs.  Absurd.


No matter that every other universal care plan as shown the opposite: less care, rationing, making it illegal to buy additional coverage out of your own pocket, far, far, higher costs.

And you seem not to be aware of the reasons for trying to rush the plan through (before folks actually know what is in it), and the reasons for declining to give Americans access to courts when they get a big "NO" for care from bureaucrats.

Since you are not stupid, the only explanation must be that you want what you want, and will turn a blind eye to expericence and logic.

So typical of what has been come to be called the '60's generation'.

I can't wait for the adults to be back in charge.


----------



## veritas (Aug 15, 2009)

Skull Pilot said:


> veritas said:
> 
> 
> > > then let's put this issue to a vote. i would rather see a ballot initiative on this so we can see what the people really want and not what our so called representatives tell us we want.
> ...




Against it? That wasn't what we were talking about. Methinks you didn't know that national referendums weren't a part of the US Constitution and went looking for something to bolster your position after I brought it to your attention.



> People ask for Constitutional amendments for the most trivial shit such as the definition of marriage but when it comes to putting more power in the hands of the people on proposed laws that increase government control we balk



People propose stupid crap and not so so stupid crap all the time. We still don't have an equal rights amendment either, even though people think we got it. [don't get me started about that one] But what you propose would be a two parter, amend the entire process then vote on whatever. That's not the way things are set up. And it is a ridiculous argument to foist when the prospect is so unlikely. I still think you really didn't know. But now you do, so you learned something.


----------



## JakeStarkey (Aug 15, 2009)

Harry Dresden said:


> midcan5 said:
> 
> 
> > Diuretic said:
> ...



We lost 6,000 guys and several women, give or take, at Normandy at D-Day, in a war that ended with atomic weapons.  _That 6,000 was the average *every day *on the Eastern Front _from June 22, 1941, to the fall of Berlin at the end of April/first of May, 1945.

Emma, you are an idiot, plain and simple.  Even a kook like Elvis can learn, but you simply, along with Avatar, sit on your parrot perch squawking.


----------



## veritas (Aug 15, 2009)

PoliticalChic said:


> Emma said:
> 
> 
> > PoliticalChic said:
> ...



You are so typical of the "I got mine, so screw you" mindset. Just lumping the uninsured into medicare would lower the overall risk significantly. The pool would be larger so the income would increase. Medicare is concerned with mainly geriatric medicine and those practitioners that specialize in that field. If the pool was enlarged to include younger people, then more and other different practitioners would be in the mix. Just because I have insurance doesn't mean all of a sudden I am going to start utilizing it at the rate an older person does, quite the opposite is true. In fact, other than having children, I haven't needed much medical services at all in my lifetime so far. I used to have a dangerous occupation, [I have never been a skydiver] so you want to leave people with dangerous occupations out of the mix? I was never injured doing what I did, but only when helping one of my employers do what she wanted to do as a favor. Things happen. She paid for it, it was her fault and I didn't receive much care at all even though we went to Chevy Chase to the most expensive osteopath in the DC area. I muddled through and fixed myself. And what of my employer? She was doing almost the same level of what I was doing for pleasure, should the insurance company have ramped up her premiums? Excluded her?

Then there are victims of violent crime and motor vehicle accidents caused by people with inadequate [or uncooperative] insurance. There is no healthcare available past the shock trauma part of those types happenstances. And so what if "some guy" gets foreclosed upon because he was sick or injured, doesn't affect you does it? Well yes it does, it means less state and local taxes are getting paid and states aren't allowed to run deficits like the Federal government. So on which end would you like to take up the slack? The one that goes in a positive direction or the one that says screw you? You're only an accident away from being on the other side of this argument, perilously close unless you've got a million in cash stuffed in the couch.


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## veritas (Aug 15, 2009)

Jake said:



> Emma, you are an idiot, plain and simple. Even a kook like Elvis can learn, but you simply, along with Avatar, sit on your parrot perch squawking.



What'd  I miss?


----------



## Emma (Aug 15, 2009)

PoliticalChic said:


> Emma said:
> 
> 
> > PoliticalChic said:
> ...



Sorry you can't see beyond the immediate. Like I said (multiple times), I'm looking at long-term savings. Not that either one of us will ever be proven right, as it isn't going to pass regardless.


----------



## Emma (Aug 15, 2009)

veritas said:


> Jake said:
> 
> 
> 
> ...



Yeah, that was a bit confusing.


----------



## Emma (Aug 15, 2009)

veritas said:


> You are so typical of the "I got mine, so screw you" mindset. Just lumping the uninsured into medicare would lower the overall risk significantly. The pool would be larger so the income would increase. Medicare is concerned with mainly geriatric medicine and those practitioners that specialize in that field. If the pool was enlarged to include younger people, then more and other different practitioners would be in the mix. Just because I have insurance doesn't mean all of a sudden I am going to start utilizing it at the rate an older person does, quite the opposite is true. In fact, other than having children, I haven't needed much medical services at all in my lifetime so far. I used to have a dangerous occupation, [I have never been a skydiver] so you want to leave people with dangerous occupations out of the mix? I was never injured doing what I did, but only when helping one of my employers do what she wanted to do as a favor. Things happen. She paid for it, it was her fault and I didn't receive much care at all even though we went to Chevy Chase to the most expensive osteopath in the DC area. I muddled through and fixed myself. And what of my employer? She was doing almost the same level of what I was doing for pleasure, should the insurance company have ramped up her premiums? Excluded her?
> 
> Then there are victims of violent crime and motor vehicle accidents caused by people with inadequate [or uncooperative] insurance. There is no healthcare available past the shock trauma part of those types happenstances. And so what if "some guy" gets foreclosed upon because he was sick or injured, doesn't affect you does it? Well yes it does, it means less state and local taxes are getting paid and states aren't allowed to run deficits like the Federal government. So on which end would you like to take up the slack? The one that goes in a positive direction or the one that says screw you? You're only an accident away from being on the other side of this argument, perilously close unless you've got a million in cash stuffed in the couch.


For the record, this is what I previously posted that she is referring to: 



> Common sense tells you that preventative/maintenance health care is cost-effective. *The direct and indirect costs of just one condition alone, diabetes (lol), costs $174 billion a year (that was from 2007, most likely has increased).* Treatment itself is expensive, of course, but add to that the cost of all the complications (every system in the body is affected), lost work days and lost productivity from earlier death, disability, etc.
> 
> I'm not even for sure they factored in the extended costs of those complications... the complications of the complications, as it were.
> 
> I'm constantly amazed that people who wouldn't think of allowing their automobile to run until it broke down, never changing the oil or getting a tune up or whatever, think it's just fine that for far too many we're practicing crisis management instead of healthcare in this country.






> I don't believe it's going to be the utopia that many on the left seem to put forth; I also don't believe it's going to bring about all the horrors the right keeps ranting about. But I do believe it will be an improvement over what passes for a healthcare system now.
> 
> *Also, I do expect that costs will rise initially, then decline as so many more (again, not all) have access to preventative/maintenance care.* And frankly, though I can't speak for my colleagues or docs I work with, I'm tired of crisis management and putting out fires. Sure, there are still going to be people who won't go to a doc until they are in serious shape. That's a given. *But in the long term, this is going to save money now spent treating preventable complications (and the complications of those complications), disability benefits, lost productivity, etc. *
> 
> *So I guess my short answer is I'm looking ahead, not just at the immediate effects but long-term*, and I like what I see. I don't believe this will pass, however. And I will be pissed.


----------



## veritas (Aug 15, 2009)

> Sorry you can't see beyond the immediate. Like I said (multiple times), I'm looking at long-term savings. Not that either one of us will ever be proven right, as it isn't going to pass regardless.



I think it might just pass. I think its opponents think so too, or they wouldn't have resorted to telling the most easily impeachable lies as they have been.

Obama never said we were going to start saving money right off the bat, nobody did. It was always a comprehensive fix that has to absorb more people and move toward an endpoint. Nothing happens in a vacuum, it didn't help that AIG was hanging fire with all their bogus instruments and was too big to let crash. What most people don't understand is that all insurance is related and if AIG fell nobody would have health insurance or car insurance or _any_ insurance at all, the whole house of cards would have come tumbling down, including the stock market and the entire world's markets. The majority of the money IN the stock market is insurance money gathered by people paying premiums, that's how it works. In fact, Credit Default Swaps _were_ insurance, but not called that so the regulations on their trade were not checked or verified to assure there was the proper collateralization behind them so they wouldn't fail. They failed. Epic fail. This is big picture, complicated stuff and most people don't have the first clue. 

Add to that the fact that we are more centralized as far as delivery and underwriting because health care insurance has contracted to a few large mega corps [less than 10, nation wide] and we have a veritable regional monopoly without real competition nor safeguards or alternatives. [AIG again]. People don't realize how close they are to not having insurance, period. Their arrogance about liking their situation just fine is based on a total ignorance of how the world financial system works. It's scary stuff. Instead we are bogged down on "death panel" shit from morons like Palin and Grassley.


----------



## Harry Dresden (Aug 15, 2009)

Skull Pilot said:


> veritas said:
> 
> 
> > > then let's put this issue to a vote. i would rather see a ballot initiative on this so we can see what the people really want and not what our so called representatives tell us we want.
> ...



does it matter Skull?...in the state referendums the losers seem to always file a lawsuit...i can see the same happening here.....


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## The T (Aug 16, 2009)

The FIRST THING? Government needs to get their collective noses OUT from under this tent. Healthcare Insurance was created BY the private sector, and thus should remain.

ANYTHING Foisted by Government will be an abject FAILURE.

Just look at Medicare? Socialist Security? VA Medical?

These are RED FLAGS FOLKS.

Government just needs to shut the HELL UP...and move out of the way.


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## PoliticalChic (Aug 16, 2009)

Emma said:


> PoliticalChic said:
> 
> 
> > Emma said:
> ...



You mean like the long term savings we've seen in Medicare?

"In fact, every federal social program has cost far more than originally predicted. For instance, in 1967 the House Ways and Means Committee predicted that Medicare would cost $12 billion in 1990, a staggering $95 billion underestimate. Medicare first exceeded $12 billion in 1975. In 1965 federal actuaries figured the Medicare hospital program would end up running $9 billion in 1990. The cost was more than $66 billion. 

In 1987 Congress estimated that the Medicaid Special Hospitals Subsidy would hit $100 million in 1992. The actual bill came to $11 billion. The initial costs of Medicare's kidney-dialysis program, passed in 1972, were more than twice projected levels. 

The Congressional Budget Office doubled the estimated cost of Medicare's catastrophic insurance benefit  subsequently repealed  from $5.7 billion to $11.8 billion annually within the first year of its passage. The agency increased the projected cost of the skilled nursing benefit an astonishing sevenfold over roughly the same time frame, from $2.1 billion to $13.5 billion. And in 1935 a naive Congress predicted $3.5 billion in Social Security outlays in 1980, one-thirtieth the actual level of $105 billion. "

Doug Bandow on Medicare on National Review Online


Good job, Aunt Em, but we're not in Kansas anymore.


----------



## PoliticalChic (Aug 16, 2009)

veritas said:


> PoliticalChic said:
> 
> 
> > Emma said:
> ...



"You are so typical of the "I got mine, so screw you" mindset.

And youve shown your customary quick command of unknown facts.

I'd like to see the dots you've connected to arrive at that contusion.

Since you've shown an inabilty to either read or intuit, let's review.

What I want is for you to show that ObamaCare would result in savings, as hinted in " The pool would be larger so the income would increase."

This was not the case for Medicare, for other universal schemes in Massachusetts, Oregon, Hawaii, or Tennessee.

As usual, the mantra from the witless is "It's different this time."


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## Emma (Aug 17, 2009)

PoliticalChic said:


> Emma said:
> 
> 
> > PoliticalChic said:
> ...


Question... _why_ is the cost of Medicare more than was predicted in the mid-60's? It's certainly not that they didn't anticipate the number of elderly who would qualify for coverage. 

And thank you for bringing up Medicare coverage for those on disability, as it makes my point.



> Common sense tells you that preventative/maintenance health care is cost-effective. *The direct and indirect costs of just one condition alone, diabetes, costs $174 billion a year* (that was from 2007, most likely has increased). Treatment itself is expensive, of course, but *add to that the cost of all the complications (every system in the body is affected), lost work days and lost productivity from earlier death, disability, etc.*
> 
> I'm not even for sure they factored in the extended costs of those complications... the complications of the complications, as it were.
> 
> ...


 
Your example of Medicare providing for dialysis treatment fits right into what I said above. Want to guess the number one cause of chronic renal failure? How 'bout number two? 

Diabetes and hypertension. Together, they account for almost 71% of the primary causes of renal failure. Two conditions that, with proper maintenance health care, can be controlled and their complications (including renal failure) avoided altogether or greatly reduced or delayed. 

_Care_ for renal failure cost (in '05) nearly $32 billion (and that doesn't take into account drugs, transportation, etc). _"Together, CKD and ESRD patients consume 27.6 percent of general Medicare expenditures and 33.5 percent of those for the dually enrolled population, making kidney disease a central issue for public policy considerations."_

 Now add to that the cost of medications, supportive care, hospitalizations, treatment of complications of the complications, disability and lost productivity. And that's the cost of just *one* complication of two easily manageable conditions. 

ADR

Sorry. You will NEVER convince me that this will not provide long term savings overall.


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## PoliticalChic (Aug 17, 2009)

Emma said:


> PoliticalChic said:
> 
> 
> > Emma said:
> ...




I never expected to convince you, once you convinced me that you were a dyed-in-the-wool lemming.

I believe that Einstein had you in mind when he said The definition of insanity is doing the same thing over and over again and expecting different results.

The question was cost savings, and you deftly changed the subject to give a lecture as to why there were no cost savings with Medicare, and in fact had cost overruns by a factor of 9 or 10.

I have no fear that you will look behind the curtain, Auntie Em.


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## Emma (Aug 17, 2009)

PoliticalChic said:


> Emma said:
> 
> 
> > PoliticalChic said:
> ...



I noticed you didn't answer the question. _Why_ does Medicare cost more than it was predicted back in the mid-60's? 

I also gave you an example of just *one* complication (of two easily manageable conditions) that accounts for nearly a _third_ of Medicare expenditures --- for _care_, not including the cost of medications, supportive care, hospitalizations, treatment of complications of that complication, disability and lost productivity. And that those two easily manageable conditions are the primary cause of 71% of cases of renal failure.

Now if you can explain to me how providing routine maintenance care would NOT in the long term save money spent on this _one_ complication of these two easily manageable conditions, I'm all ears. And consider too that diabetes and hypertension affect _every_ system in the body.

 And hell, that's only _two_ conditions that preventative/maintenance care can control. Heart and vessel disease is the number one killer of Americans (and diabetes / hypertension are two major contributors to same); while there isn't much you can do about genetic influences, access to routine maintenance health care can keep it under control, reducing the incidence --- and _cost_ --- of heart attacks and strokes. And again, that doesn't factor in the cost of treating their complications, the complications of _those_ complications, disability, lost productivity, etc. 



> The question was cost savings, and you deftly changed the subject to give a lecture as to why there were no cost savings with Medicare, and in fact had cost overruns by a factor of 9 or 10.


I didn't change the subject. I provided you with data explaining how renal failure alone accounts for nearly a third of Medicare expenditures, and that it can be prevented or delayed by effectively managing the two conditions that account for 71% of the cases of same --- thereby reducing the _cost_.


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## PoliticalChic (Aug 17, 2009)

Emma said:


> PoliticalChic said:
> 
> 
> > Emma said:
> ...



Yesterday on Fox News Sunday, the question of "Now if you can explain to me how providing routine maintenance care would NOT in the long term save money ..." was actually discussed.

According to Chris Wallace, the analysis by the journal _Circulation_ stated that prevention of diabetes would cost approximately ten times what treating those who ultimately developed diabetes would cost.  This is because we cannot tell in advance who the diabetics would be.

Now, back to the subject at hand.

Your post simply indicates that those proposing the healthcare plan are unable to predict costs.

Unable, incompetent, have an agenda,...who knows.

But always,  always  inderestimate the costs by many, many fold.

That is what experience teaches us.

Not you, but those who actually learn from the past.


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## Emma (Aug 17, 2009)

PoliticalChic said:


> You mean like the long term savings we've seen in Medicare?



In addition to what I posted above, consider the savings (again, looking at the long-term) of having an overall healthier client base as they enter into the Medicare program because they have had access to routine maintenance health care during their younger years. 

BTW, are there any studies estimating the impact on healthcare costs for the elderly and disabled had Medicare NOT been available? Crisis management is more expensive. 

Also, there are Medicare regulations that have reined in costs for all (including privately insured). We're seeing that in my hospital with the recent regulations I referenced for you in another thread (refusal of Medicare to pay for certain hospital-acquired conditions) which are resulting in less intensive care, fewer complications, and shorter hospital stays (in addition to savings for treating those problems after discharge).


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## PoliticalChic (Aug 17, 2009)

Emma said:


> PoliticalChic said:
> 
> 
> > You mean like the long term savings we've seen in Medicare?
> ...



You might want to see post # 89.

"... Medicare regulations that have reined in costs for all ..." Are you proposing that Medicare costs are declining?

"...an overall healthier client base as they enter into the Medicare program because they have had access to routine maintenance health care during their younger years."

Consider:

". Prevention instead of treatment?  Nancy-Ann De Parle, director of the White House Office of Health Reform, said on March 23 that "we have to get to a system of keeping people well, rather than treating the sickness." That would make sense if all disease were behavior-related, but many cancers and other diseases are linked to genetics or unknown causes. De Parle's pronouncement echoes how Sir Michael Rawlins, a British health official, explains his nation's low cancer survival rates. The British National Health Service, he said, has to be fair to all patients, "not just the patients with macular degeneration or breast cancer or renal cancer. If we spend a lot of money on a few patients, we have less money to spend on everyone else. We are not trying to be unkind or cruel. We are trying to look after everybody." 

This approach is deadly for those with serious illness. In the U.S., about 5 percent of the populace needs 50 percent of treatment dollars. The drumbeat for shifting resources from treatments to prevention should worry any family dealing with M.S., Alzheimer's, Parkinson's, or cerebral palsy, or with a history of cancer." 

Defend Your Health Care


Although I am not conversant with your hospital, the following is generally true:
Medicaid pays hospitals $.86 for $1 healthcare provided
Medicare pays hospitals $.97-.98 for each $1 healthcare provided
Private Plans pay hospitals about $1.32 for each $1 of healthcare provided.

So any ObamaCare plan that results in fewer private healthcare plans will result not in savings but in dimunition of healthcare, and increase in costs.

There are no saving associated with nationalized healthcare plans. See Massachusetts, Tennessee, Hawaii, Oregon, UK...

And, have you seen this as of this morning?
"SASKATOON  The incoming president of the Canadian Medical Association says this country's health-care system is sick and doctors need to develop a plan to cure it.
Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country - who will gather in Saskatoon on Sunday for their annual meeting - recognize that changes must be made.
"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doing said in an interview with The Canadian Press.
"We know that there must be change," she said. "We're all running flat out, we're all just trying to stay ahead of the immediate day-to-day demands."
The Canadian Press: Overhauling health-care system tops agenda at annual meeting of Canada's doctors


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## Emma (Aug 17, 2009)

PoliticalChic said:


> Yesterday on Fox News Sunday, the question of "Now if you can explain to me how providing routine maintenance care would NOT in the long term save money ..." was actually discussed.
> 
> According to Chris Wallace, the analysis by the journal _Circulation_ stated that prevention of diabetes would cost approximately ten times what treating those who ultimately developed diabetes would cost.  This is because we cannot tell in advance who the diabetics would be.


_Treating_ those with diabetes. Thanks for making my point. It is an easily manageable condition where providing routine maintenance care is _cost-effective_. Prevention? How about _early detection and routine treatment_ (see citation below)?

I'd be interested in reading the cited study. Do you have a link to that? 

I'm not sure if this is the article referenced:

_Collectively, cardiovascular disease (including stroke), cancer, and diabetes account for approximately two thirds of all deaths in the United States and about *$700 billion in direct and indirect economic costs each year*. Current approaches to health promotion and prevention of cardiovascular disease, cancer, and diabetes do not approach the potential of the existing state of knowledge. _

_ Although the public often expresses confusion about the many health messages that are now available to them, especially when they try to take multiple health risks into consideration, in fact individuals can best protect themselves by following advice that is simple, effective, and agreed upon by the 3 major voluntary health organizations. The 4 key strategies are as follows: (1) Dont smoke, (2) follow a healthy diet, (3) be physically active, *and (4) see your medical caregiver regularly to assess your risk and prevent disease or catch it early, when it can be best managed.*_

_*In addition, there are too many individuals who are not able to benefit from the well-demonstrated effects of preventive care and counseling because of a lack of or insufficient healthcare coverage, disparities in the delivery of care, or a lack of recognition that science has indeed discovered information that is important to their lives.*_

_Cardiovascular disease,* cancer, and diabetes account for nearly 2 of every 3 deaths in the United Statesclose to 1.5 million people in 2001.1 These diseases undermine health, shorten life expectancy, and cause enormous suffering, disability, and economic costs. However, much of this disease burden could be avoided if there were systematic application of what is known about preventing the onset and progression of these conditions. By addressing the underlying causes of cardiovascular disease, cancer, and diabetes, and by improving the systems to detect and treat early-stage disease when interventions are most effective, *significant reductions in disability and premature mortality could be achieved*.

*Despite the incontrovertible evidence supporting the medical and economic benefits of prevention and early detection*, current disease-control efforts are underfunded and fragmented. While healthcare costs skyrocket, the national investment in prevention was estimated at less than 3% of the total annual healthcare expenditures._

_*The evidence base with regard to the efficacy and cost-effectiveness of specific components of prevention and early detection* is reviewed regularly by many health organizations, including the American Cancer Society (ACS), the American Diabetes Association (ADA), and the American Heart Association (AHA). Healthy People 2010 provides the most current and comprehensive health agenda for the nation.4 It addresses 476 specific objectives in 28 focus areas that include nutrition and overweight, physical activity and fitness, tobacco use, cancer, diabetes, cardiovascular disease, and access to quality health services. The US Preventive Services Task Force periodically reviews more than 200 preventive services offered in primary care settings.5 The US Preventive Services Task Force currently recommends routine screening for cervical, breast, and colorectal cancers; hypertension and lipid disorders; obesity; and tobacco use; as well as the provision of treatment for tobacco addiction in adults. The Centers for Disease Control and Prevention (CDC) provides similar reviews with regard to community, population, and healthcare system interventions related to cancer, cardiovascular disease, diabetes, and other chronic diseases.6 Criteria for evaluating the delivery of preventive services by managed care plans are provided by the National Committee for Quality Assurance. The Health Plan Employer Data and Information Set measures a broad spectrum of preventive services, including provision of breast, cervical, and colorectal cancer screening; blood pressure control; comprehensive care for diabetes; and treatment for tobacco dependence.7 Despite the abundance of data, guidelines, and objectives, progress in the nations health falls well short of its true potential, and some trends are worsening._

Circulation -- Eyre et al. 109 (25): 3244 Table BL1

*Prevalence and Economic Costs*

_*The prevalence and economic costs of the major chronic diseases are equally sobering.* Approximately 1 in 4 adults is hypertensive, and the majority of individuals with hypertension do not have adequately controlled blood pressure.12 More than 100 million adults have elevated cholesterol levels; of this group, more than 35 million adults have cholesterol levels that qualify as high risk and that require aggressive medical intervention.4 Recent estimates from the Third National Health and Nutrition Examination Survey indicate that among insured individuals, 28.6% of adults with hypertension and 51.2% of adults with hypercholesterolemia were undiagnosed.13 According to extrapolations from the Third National Health and Nutrition Examination Survey,10,14 about 64 400 000 Americans (22.6% of the population) had prevalent cardiovascular disease in 2001; between 1988 and 1994, approximately 1 individual in 10 was hospitalized each year for treatment of a cardiovascular problem.

Approximately 9.6 million Americans who have been diagnosed with cancer were alive in 2000. This estimate includes individuals living with cancer as well as those who were cancer free.11 The estimate does not include persons with cancers that have not yet been detected. Substantial numbers of adults are diagnosed with advanced cancers each year because of lack of screening. Approximately one third of breast and cervical cancers and nearly two thirds of colorectal cancers are diagnosed at an advanced stage.11

An estimated 18.2 million Americans had diabetes in 2002.15 This includes individuals who had been diagnosed (13 million) and those who were as yet undiagnosed (5.2 million). According to the CDC, approximately 33.8% of the population have impaired fasting glucose (IFG) levels, 15.4% have impaired glucose tolerance (IGT), and 40.1% have prediabetes (IFG, IGT, or both).16

*The economic costs of cardiovascular disease, cancer, and diabetes in the United States in 2003 were estimated at $351.8 billion, $189.5 billion, and $132.0 billion, respectively.17,18 The combined costs of these 3 diseases thus comprises 32% of the $2256.5 billion in total illness costs.19 This amount includes both direct medical costs and indirect economic costs from lost productivity due to illness or death. The estimates for healthcare expenditures include the cost of physicians and other professionals, hospital and nursing home services, medications, and home health care. These medical care costs also include treatment for diseases resulting from diabetes. For example, patients with diabetes, particularly if poorly controlled, may develop blindness, end-stage renal disease, cardiovascular disease, neuropathy, and many other complications, each of which incurs economic as well as personal costs.*2022_

Preventing Cancer, Cardiovascular Disease, and Diabetes: A Common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association -- Eyre et al. 109 (25): 3244 -- Circulation





> Your post simply indicates that those proposing the healthcare plan are unable to predict costs.
> 
> Unable, incompetent, have an agenda,...who knows.
> 
> ...


Still haven't answered the question.


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## Emma (Aug 17, 2009)

PoliticalChic said:


> "... Medicare regulations that have reined in costs for all ..." Are you proposing that Medicare costs are declining?


I'm saying that there are medicare regulations that have reined in costs, specifically referencing the recent regulations regarding HAC. 
------
Still no answer.


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## PoliticalChic (Aug 17, 2009)

Emma said:


> PoliticalChic said:
> 
> 
> > Yesterday on Fox News Sunday, the question of "Now if you can explain to me how providing routine maintenance care would NOT in the long term save money ..." was actually discussed.
> ...



Excellent research.

No, I do not have the journal, only heard the discussion of same.

But you have yet to explain your claim of cost savings in the light of your acceptance of the huge cost overruns of extant government plans, and the failure of the many attempts by states.


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## Emma (Aug 17, 2009)

PoliticalChic said:


> Emma said:
> 
> 
> > PoliticalChic said:
> ...



I'd like to see the article cited... not sure how to find it, though. 

I do have access at work to certain resources I can't access from home. I'll try to remember to look for that publication and see if I can find that specific article. 

As far as the rest of it, I'll continue to research. Right now, I need to get off of here and actually get some stuff done (and give my swirling brain a rest lol). Nice discussion. I enjoyed it


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## Emma (Aug 17, 2009)

Oh. Something else I saw while poking around was the difference between cost-effective and cost-saving. I'll see if I can figure out where that was; I do recall getting a bit dizzy trying to decipher what they were saying 

ETA: I admit that logic and common sense tells me that routine health care will save money in the long-term, but I realize I need to find studies/research to back that up. I'll do my best to that end.


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## toomuchtime_ (Aug 17, 2009)

Emma said:


> Oh. Something else I saw while poking around was the difference between cost-effective and cost-saving. I'll see if I can figure out where that was; I do recall getting a bit dizzy trying to decipher what they were saying
> 
> ETA: I admit that logic and common sense tells me that routine health care will save money in the long-term, but I realize I need to find studies/research to back that up. I'll do my best to that end.



Cost effective sounds simple enough, but its a tricky idea.  Basically, it measures whether you are getting a good value for your money.  But what criteria do you use to determine value?  About ten years ago cancer treatments in the UK that would extend life for a year but cost over $16,500 were generally not available under the NHS; they were judged not cost effective.

BBC NEWS | Health | Rationing care from limited funds

As it applies to preventive health measures, the CBO considered a procedure cost effective if it produced good health outcomes regardless of cost, and it found 80% of cost effective preventative procedures actually increased overall health care costs.


http://www.cbo.gov/ftpdocs/104xx/doc10492/08-07-Prevention.pdf


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## Emma (Aug 17, 2009)

toomuchtime_ said:


> Emma said:
> 
> 
> > Oh. Something else I saw while poking around was the difference between cost-effective and cost-saving. I'll see if I can figure out where that was; I do recall getting a bit dizzy trying to decipher what they were saying
> ...


Thanks. I'll read that in a bit when I have some time to study it. 

What I have found so far regarding _preventative_ care seems to take into account universal screening rather than screening of those at risk. If that's the case, of course cost is going to be higher and the relative benefits lower.

 I'd like to know if there are any studies regarding cost savings for early detection and routine maintenance care opposed to the cost of treating conditions that are advanced and/or have complications that could have been prevented, delayed or lessened if that care had been available early on.


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## toomuchtime_ (Aug 17, 2009)

Emma said:


> toomuchtime_ said:
> 
> 
> > Emma said:
> ...



That's exactly what the CBO document I posted a link to addresses.  When you find the time to read the CBO letter, you will see:



> Researchers who have examined the effects of preventive care generally find that
> the added costs of widespread use of preventive services tend to exceed the
> savings from averted illness. An article published last year in the New England
> Journal of Medicine provides a good summary of the available evidence on how
> ...



http://www.cbo.gov/ftpdocs/104xx/doc10492/08-07-Prevention.pdf


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## Emma (Aug 17, 2009)

toomuchtime_ said:


> Emma said:
> 
> 
> > toomuchtime_ said:
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Well, no, that's not quite what I was asking. 

_"*widespread use* of preventive services tend to exceed the savings from averted illness"_

That's what I was referring to when I mentioned universal screening and I agree that would be costly. 

I can't find anything addressing the cost benefits for early detection and maintenance care, though. I will read the link, thanks. 



> The researchers found that those steps would substantially reduce the projected number of heart attacks and strokes that occurred but would also increase total spending on medical care because the ultimate savings would offset only about 10 percent of the costs of the preventive services, on average.



I also wonder what the costs are they claim will increase even as incidence of strokes and heart disease are 'substantially  reduced'? It says spending on _medical care_. Is that just for those conditions specifically? Does it include the cost of treating their complications as well? What about the indirect costs of those conditions and complications, for example lost wages and productivity, disability, etc.


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## toomuchtime_ (Aug 17, 2009)

Emma said:


> toomuchtime_ said:
> 
> 
> > Emma said:
> ...



In fact, the example of treating high blood pressure and high cholesterol  to prevent heart attacks and strokes is an example of early detection and maintenance.  These measures are in widespread use only among the high risk population, not among the general population.  If you wait any longer to begin treatment, you are treating the disease, itself, not trying to prevent it.

Obviously, the earlier the detection of risk factors the larger the at risk population will be because many of these will not go on to show other signs or symptoms of impending disease and the more expensive it will be to monitor these people and to try to control risk factors.  

Ever since Hillary made such a big point during her campaign of claiming she would save health care dollars with preventative health measures, there have been loads of studies that have shown that, while preventative health measures are good medicine and produce good health outcomes, nearly all preventative health measures cost more than they save.  Why should it be a surprise that it costs more to produce good health outcomes than to produce poor ones?


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## Diuretic (Aug 17, 2009)

I suppose there's a sound economic argument in there somewhere, about the efficacy of spending x dollars to prevent premature deaths so that individuals can continue to be productive.  Anyway that's an interesting point about prevention costing more than cure.  I don't know why it's a surprise to realise that but I have to say I'm surprised.


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## Emma (Aug 17, 2009)

toomuchtime_ said:


> Emma said:
> 
> 
> > toomuchtime_ said:
> ...



Again, I'd like to see the actual study. I think you are misunderstanding that it's saying; it's talking about the cost of widespread screening, rather than screening those at risk. It seems to be arguing against that specifically, which is pretty much the recommended norm anyway. 



> Obviously, the earlier the detection of risk factors the larger the at risk population will be because many of these will not go on to show other signs or symptoms of impending disease and the more expensive it will be to monitor these people and to try to control risk factors.


That _is_ expensive and why guidelines exist as to who to screen for what and at what age.


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## PeterS (Aug 17, 2009)

PoliticalChic said:


> Although I am not conversant with your hospital, the following is generally true:
> Medicaid pays hospitals $.86 for $1 healthcare provided
> Medicare pays hospitals $.97-.98 for each $1 healthcare provided
> Private Plans pay hospitals about $1.32 for each $1 of healthcare provided.
> ...



This is a bit of a misnomer. Medicare and Medicaid require that as many procedures as possible be combined in as few visits as possible. This doesn't mean that the doctor or hospital is operating at a loss only not allowed to pad the bill. It is also better for the patient because it gets treatment over quicker. Here is an example of what I am talking about. This past winter I had surgery for three skin cancers. Total office visits were 8 and total cost just under 20K. My father-in-law who is retired and on medicare had surgery for 2 skin cancers plus a preventive face peal all done in just 3 visits. Total cost just over 5K In both cases the doctor and health care facility eared a profit. 

This isn't a reduction in quality but just the opposite since the ordeal is over quicker and recovery faster. 

Who ever fed you your talking points did a nice job but accepting both medicare and medicaid patients is done by free choice of the doctor and health care facility. Do you really think they would do so if it were costing them money?


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## veritas (Aug 17, 2009)

> Your post simply indicates that those proposing the healthcare plan are unable to predict costs.
> 
> Unable, incompetent, have an agenda,...who knows.
> 
> But always, always inderestimate the costs by many, many fold.



Predicting costs is a very, very difficult thing to do. Amazingly, there are very few people on the planet that have the necessary expertise to estimate things of this magnitude. One of the main elements in any estimation is the contingency component. In a project such as this, there are elements you haven't even thought of. Contingencies for stationary projects such as building a nuclear power plant could approach 25% and still be within an acceptable margin of error. Things like the stock market losing 10% of it's value in a short time would have to be added into the mix. Unemployment rates and the availability of pertinent skilled labor go into it as well. Education costs and the price of food and war, disease, natural disasters, fraud etc., etc.........an estimation is only good for any proposed snapshot in time with the things actually considered and accounted for, therefore the contingency would have to be quite large. This isn't costing out a sun room.

It isn't about inability or incompetence.


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## toomuchtime_ (Aug 17, 2009)

Emma said:


> toomuchtime_ said:
> 
> 
> > Emma said:
> ...



The example given about monitoring blood pressure and cholesterol levels among diabetics and other with high risk of heart disease and of treating them to prevent heart attacks and strokes, is an example of preventive medicine being used in a high risk group, not of widespread screening.  It studied the effect of widespread use of monitoring and preventive medication within this high risk group, not among a broader population, and it concluded that the cost of preventing heart attacks and strokes that were prevented by this monitoring and treatment among this high risk group was about ten times the cost of treating them if they had occurred.  If you are interested in the effect of applying preventative medicine among high risk groups, this is an example of what that effect will be.  The reason this is so is that the cost of treating the number of heart attacks and strokes that will be prevented among this high risk group of people is much less than the cost of monitoring and treating everyone in this high risk group.  

Preventive medicine is good medicine and produces good health outcomes, but the myth that it also reduces health care costs has been thoroughly debunked and politicians who continue to make this claim are either ignorant of the facts or lying.


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## Emma (Aug 17, 2009)

toomuchtime_ said:


> Emma said:
> 
> 
> > toomuchtime_ said:
> ...


I still believe it's talking about universal (therefore _widespread_) screening. I'll know for sure when I see the study it's referring to. 

I am still not convinced it's a myth. That letter seems to contradict itself at times:



> In particular, Medicare already covers preventive services that have been shown to reduce net costs. Moreover, legislation enacted last summer authorizes Medicare to add coverage of preventive services that improve health, including those that also reduce costs.



Also, a link provided in the letter: 

Approximately 100 million elderly will enter Medicare over the next 25 years. We consider the potential benefits of interventions that would reduce or eliminate the most important risk factors for disease and spending. *Effective control of hypertension could reduce health care spending $890 billion for these cohorts while adding 75 million disability-adjusted life years (DALYs). Eliminating diabetes would add 90 million life-year equivalents at a cost of $2,761 per DALY. Reducing obesity back to levels seen in the 1980s would have little effect on mortality, but yields great improvements in morbidity (especially heart disease and diabetes) with a cost savings of over $1 trillion.* Smoking cessation will have the smallest impact, adding 32 million DALYs at a cost of $9.045 per DALY. While smoking cessation reduces lung disease and lung cancer, but these are relatively low prevalence compared to the other diseases. Its impact on heart disease is negligible. The effects on overall social welfare are unknown, since we do not estimate the costs of these interventions, the costs of any behavioral modification, or the welfare loss due to providers from lower medical spending.


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## Emma (Aug 17, 2009)

And btw, 



> *Reducing obesity back to levels seen in the 1980s* would have little effect on mortality, but yields great improvements in morbidity (especially heart disease and diabetes) with a cost savings of over $1 trillion.



That is just sad.


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## toomuchtime_ (Aug 17, 2009)

Emma said:


> toomuchtime_ said:
> 
> 
> > Emma said:
> ...



Clearly, the example given in the CBO report refers to widespread use of preventative measure within a group that is at high risk for heart attacks and strokes, diabetics, people with hypertension and others with high risk factors for heart disease.  

As the CBO report points out, the report you are quoting did not calculate the cost of preventing disease, which is what the discussion is about: is the cost of preventing disease more or less than the cost of treating the diseases if they had not been prevented.  



> One recent study that analyzed the interactions of different chronic conditions and
> the costs of treating thembut did not address the costs of avoiding the
> conditionsfound that cutting obesity rates in half would reduce total medical
> spending by the elderly Medicare population by roughly 10 percent in 2030.5



The CBO report states that about 20% of preventive measures actually do save money, so there is no contradiction in stating that Medicare already provides some of these.

You do realize, don't you, that Douglas Elmendorf, the director of CBO, was appointed by the Democratic Congress in January on this year, so there is no reason to suspect he would report anything that did not support the Democratic agenda unless he felt compelled to by the facts.


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## cunclusion (Aug 17, 2009)

toomuchtime_ said:


> Emma said:
> 
> 
> > toomuchtime_ said:
> ...



Ok that makes no sense, it costs way less to prevent a problem than to fix the problem when it happens. Its like your car if you do periodic maintenance on it, it lasts longer and you have fewer major issues with your vehicle. This is the same with the human body if a person takes control of their body (eg exercise, eat right, and get checkups) is way cheaper than trying to fix something.


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## Emma (Aug 17, 2009)

Reducing Health Care Costs by Reducing the Need and Demand for Medical Services


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## toomuchtime_ (Aug 17, 2009)

Emma said:


> And btw,
> 
> 
> 
> ...



Actually, I made the same article about obesity and smoking just a few weeks ago, and some one responded by sending me to this study:



> Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention.





> Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.



PLoS Medicine: Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure

I argued against this study as strenuously as you are arguing against the CBO report, and while I can find reasons to question it, the conclusion makes sense.


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## Emma (Aug 17, 2009)

toomuchtime_ said:


> Emma said:
> 
> 
> > toomuchtime_ said:
> ...


I'm not saying I suspect him of anything untoward. The letter uses the term "widespread". I concede that widespread screening is costly. 

I'm trying to dig around in the citations listed, and have found others. One thing I have noticed is there doesn't seem to be a consensus. I'm finding articles arguing both points. 

I'm still looking for information regarding cost savings for early detection and routine maintenance care opposed to the cost of treating conditions that are advanced and/or have complications that could have been prevented, delayed or lessened if that care had been available early on. One article I found touched on it by saying that their study _didn't_ take that into account. Many of these seem to only focus on the medical costs, and ignore indirect costs (as I describe above).

 And something else I find very interesting... in the articles describing the cost of treatment (even with early detection) it's the price of _medications_ that seem to be the primary factor driving up the cost. _That_ I believe. The cost of medication in this country is obscene. I wonder what these cost studies would look like if they plugged in the cost of those same medications as they're priced in ... say ... Canada ... or any other country where the same damn pills cost a fraction of what they do here. 

There's more to this than meets the eye, methinks.


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## Emma (Aug 17, 2009)

toomuchtime_ said:


> Emma said:
> 
> 
> > And btw,
> ...



Well, they seem to be saying that those who are not obese tend to live longer, thus eating up more health care resources as they age. Then again, reducing obesity decreases the risk for disease conditions that are common as we get older. 

And I keep coming back to that letter's own citation: 



> Approximately 100 million elderly will enter Medicare over the next 25 years. We consider the potential benefits of interventions that would reduce or eliminate the most important risk factors for disease and spending. Effective control of hypertension could reduce health care spending $890 billion for these cohorts while adding 75 million disability-adjusted life years (DALYs). Eliminating diabetes would add 90 million life-year equivalents at a cost of $2,761 per DALY. Reducing obesity back to levels seen in the 1980s would have little effect on mortality, but yields great improvements in morbidity (especially heart disease and diabetes) with a cost savings of over $1 trillion.



Cost _savings_. I don't see how they can argue there is an increase net cost spending and at the same time produce evidence of HUGE cost _savings_. 

I think it all boils down to _targeted_ screening. The letter claims that is 'difficult'. I disagree.


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## Emma (Aug 17, 2009)

Ok, my head is spinning again 

I'll have to let this one go for tonight. Have a good one.


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## toomuchtime_ (Aug 17, 2009)

cunclusion said:


> toomuchtime_ said:
> 
> 
> > Emma said:
> ...



I agree that the conclusion that prevention will cost more than treatment in 80% of cases seems counterintuitive, and so does Elmendorf, but he explains:



> That result may seem counterintuitive. For example, many observers point to
> cases in which a simple medical test, if given early enough, can reveal a condition
> that is treatable at a fraction of the cost of treating that same illness after it has
> progressed. In such cases, an ounce of prevention improves health and reduces
> ...



So while your reasoning is correct with regard to any one person, prevention costs less that treatment, since even in  a high risk group such as the one cited in the CBO letter, doctors don't know which members of the group will have heart attacks or strokes even with the preventative care or which ones wouldn't have heart attacks or strokes without the preventative care, so the cost of preventing one heart attack has to include the cost of providing preventive care to many people who either had heart attacks or wouldn't have even without the treatment.  

If doctors could pinpoint, or nearly pinpoint, those individuals who would benefit from preventative care, then it is likely prevention would generally be less expensive than treatment, but with regard to the major diseases such as heart disease and most cancers, doctors simply can't narrow the group of high risk patients to the extent where prevention is less expensive than treatment for the whole group.  However, even if you could pinpoint an individual whose life would definitely be saved by preventive measures, wouldn't you have to add the cost health care during the years saved to the cost of prevention of that particular disease to determine if money had been saved or not?


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## cunclusion (Aug 18, 2009)

Ok like when I had to go to the hospital for a achilles tear. Now when I was at the hospital they ran a Xray and a CAT Scan. But when I got to my specialist he wanted a MRI you cant see soft tissue real good with a Xray or a CAT Scan so basically I paid for two procedures that were worthless for the situation I was in. This is one of the things that need to be solved. Performing unnecessary procedures for any given situation its a waste of time and money, especially money.


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## Meister (Aug 18, 2009)

cunclusion said:


> Ok like when I had to go to the hospital for a achilles tear. Now when I was at the hospital they ran a Xray and a CAT Scan. But when I got to my specialist he wanted a MRI you cant see soft tissue real good with a Xray or a CAT Scan so basically I paid for two procedures that were worthless for the situation I was in. This is one of the things that need to be solved. Performing unnecessary procedures for any given situation its a waste of time and money, especially money.



Actually a CAT scan is an excellent proceedure for soft tissue.   An XRAY was probably to cover any possible fracture of a bone.  So You had some excellent service in this broken down healthcare system we have to endure.

CT scans of internal organs, bone, soft tissue and blood vessels provide greater clarity and reveal more details than regular x-ray exams.
CAT Scan (CT) - Body


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## Emma (Aug 18, 2009)

Meister said:


> cunclusion said:
> 
> 
> > Ok like when I had to go to the hospital for a achilles tear. Now when I was at the hospital they ran a Xray and a CAT Scan. But when I got to my specialist he wanted a MRI you cant see soft tissue real good with a Xray or a CAT Scan so basically I paid for two procedures that were worthless for the situation I was in. This is one of the things that need to be solved. Performing unnecessary procedures for any given situation its a waste of time and money, especially money.
> ...



MRI is preferred for tendon studies. 


MRI of tendon injuries.

Imaging of orthopedic sports injuries - Google Books

MRI of the musculoskeletal system - Google Books

From your own link: 

Detailed MR images allow physicians to better evaluate various parts of the body and certain diseases that may not be assessed adequately with other imaging methods such as x-ray, ultrasound or computed tomography (also called CT or CAT scanning).


What are some common uses of the procedure?

MR imaging is usually the best choice for examining the:


body's major joints.
spine for disk disease.
soft tissues of the extremities (muscles and bones).

MR imaging is typically performed to diagnose or evaluate:


degenerative joint disorders such as arthritis and meniscus tears (knee).
fractures (in selected patients).
joint abnormalities due to trauma (tendon tears for example).
spinal disk abnormalities (herniated disk for example).
the integrity of the spinal cord after trauma.
sports-related injuries and work-related disorders caused by repeated strain, vibration or forceful impact.
infections (osteomyelitis for example).
tumors (primary tumors and metastases for example) involving bones and joints.
pain, swelling or bleeding in the tissues in and around the joints and bones.


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## cunclusion (Aug 18, 2009)

Emma said:


> Meister said:
> 
> 
> > cunclusion said:
> ...



So the fact is that all the hospital had to do was an MRI and skip the other two options all together because even the analysis they came up with was wrong stated my tear was alot worse than it really was. If they seen it in a MRI they would have seen a partial small tear. So basically a waste of money and an incorrect diagnosis...


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## Emma (Aug 18, 2009)

cunclusion said:


> Emma said:
> 
> 
> > Meister said:
> ...



No, Meister was right. They'll do a regular xray first. I don't see many CTs for musculoskeletal diagnostics tho'.


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