# WHY health care needed reform



## Bfgrn (Sep 5, 2011)

WHY did health care need reform? Because Wall Street took complete control of the health care industry. Profit driven incentives create REAL death panels for Americans. Insurance corporations are incentivized to deny patient coverage and push more and more of the costs onto consumers. 

For anyone who wants an insider's knowledge of this, I recommend investing a half hour of your time to listen to what this man has to say...

*Wendell Potter* is former Vice President of corporate communications at CIGNA, one of the United States' largest health insurance companies. In June 2009, he testified against the HMO industry in the U.S. Senate.

Looking back over his long career, Potter sees an industry corrupted by Wall Street expectations and greed. According to Potter, insurers have every incentive to deny coverage  every dollar they don't pay out to a claim is a dollar they can add to their profits, and Wall Street investors demand they pay out less every year. Under these conditions, Potter says, "You don't think about individual people. You think about the numbers, and whether or not you're going to meet Wall Street's expectations." 


*Profits before Patients - Wendell Potter*






*WATCH VIDEO*
*READ TRANSCRIPT*








Following a 20-year career as a corporate public relations executive, Wendell left his position as head of communications for CIGNA, one of the nations largest health insurers, to help socially responsible organizations  including those advocating for meaningful health care reform  achieve their goals.

In widely covered testimony before the Senate Commerce, Science and Technology Committee in June of 2009, Wendell disclosed how insurance companies, as part of their efforts to boost profits, have engaged in practices that have resulted in millions of Americans being forced into the ranks of the uninsured. Wendell also described how the insurance industry has developed and implemented strategic communications plans, based on deceptive public relations, advertising and lobbying efforts, to defeat reform initiatives.

Since then Wendell has testified before two House committees, briefed several members of Congress and their staffs, appeared with members of Congress at several press conferences, spoken at more than 100 public forums, and has been the subject of numerous articles in the U.S. and foreign media.

At CIGNA, Wendell served in a variety of positions over 15 years, most recently as head of corporate communications and chief corporate spokesperson. Prior to joining CIGNA, Wendell headed communications at Humana Inc., another large for-profit health insurer. Before that he was director of public relations and advertising for the Baptist Health System of East Tennessee and a partner in an Atlanta public relations firm. He also serves as a consumer liaison representative for the National Association of Insurance Commissioners.

Wendell Potter's News Articles


As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill; they are rewarded for it. All of this is in service of meeting what this former executive called, Wall Streets relentless profit expectations.  President Barack Obama, Remarks to Joint Session of Congress, September 9, 2009

It is the job of thinking people not to be on the side of the executioners.
Albert Camus


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## AnnieInMexico (Sep 5, 2011)

Bfgrn said:


> WHY did health care need reform? Because Wall Street took complete control of the health care industry. Profit driven incentives create REAL death panels for Americans. Insurance corporations are incentivized to deny patient coverage and push more and more of the costs onto consumers.
> 
> For anyone who wants an insider's knowledge of this, I recommend investing a half hour of your time to listen to what this man has to say...
> 
> ...



Wendell Potter from Cigna should know, his was one of the companies that denied the most claims.  I'm quite sure he knows the system inside and out.

I worked for Cigna and could only hack it for three months before I had to quit.  Same with the county hospital in Phoenix.  That's when I decided to out it on my own and I provide far better care as a nurse than I ever could working for those places.

Mayo is the exception to the rule of medical care.


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## Bfgrn (Sep 6, 2011)

AnnieInMexico said:


> Bfgrn said:
> 
> 
> > WHY did health care need reform? Because Wall Street took complete control of the health care industry. Profit driven incentives create REAL death panels for Americans. Insurance corporations are incentivized to deny patient coverage and push more and more of the costs onto consumers.
> ...



Good for you AnnieInMexico.

Wendell Potter's story is interesting; what made him decide to walk away from a very lucrative position to become an advocate for the people. He explains that in the half hour interview with Bill Moyers and how Wall Street has complete control of the industry and punishes companies the pay out too much in benefits and treatments.

Whenever a separation is made between liberty and justice, neither, in my opinion, is safe.
Edmund Burke


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## Bern80 (Sep 8, 2011)

Very few people would disagree that our health care system needed to be reformed. But doing something.....anything is not always an improvement. The 'how' it is being reformed via Obamacare is the problem.


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## Bfgrn (Sep 8, 2011)

Bern80 said:


> Very few people would disagree that our health care system needed to be reformed. But doing something.....anything is not always an improvement. The 'how' it is being reformed via Obamacare is the problem.



The Affordable Healthcare Act is almost a carbon copy of the "Health Equity and Access Reform Today Act of 1993"...proposed by Republicans when Clinton tried to pass reform.

Including the BIG Republican idea...the INDIVIDUAL MANDATE.


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## Greenbeard (Sep 8, 2011)

Bern80 said:


> Very few people would disagree that our health care system needed to be reformed. But doing something.....anything is not always an improvement. The 'how' it is being reformed via Obamacare is the problem.



The point of the OP and the subsequent posts in this thread is that the incentives in the health insurance market are perverse, or at the very least lead to undesirable outcomes. If the "how" you prefer is simply to further deregulate health insurance markets and find ways to undermine regulations in those states where they exist (as it generally is when someone makes a statement like yours), that doesn't really address the point here.


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## Bern80 (Sep 8, 2011)

Bfgrn said:


> Bern80 said:
> 
> 
> > Very few people would disagree that our health care system needed to be reformed. But doing something.....anything is not always an improvement. The 'how' it is being reformed via Obamacare is the problem.
> ...



I wasn't aware of the act of 1993, but I guess my question is what is your point in telling me? That I'm going to change my opinion based on what side of the political aisle proposed the policy. Wrong is wrong Bf. It doesn't matter to me if the opposition came up with something similar before. I don't know how long it will take the board regulars to get this but, I'm not a Republican. I'm a libertarian which means I dislike the bulk of the Republican part nearly as much as I dislike Democrats.


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## Bern80 (Sep 8, 2011)

Greenbeard said:


> Bern80 said:
> 
> 
> > Very few people would disagree that our health care system needed to be reformed. But doing something.....anything is not always an improvement. The 'how' it is being reformed via Obamacare is the problem.
> ...



As I have said in another thread, what business doesn't have an incentive to keep its expenses down? Your insurance plan is a contract. It does not stipulate that your insurance company pays for your health care. It stipulates that under x circumstances they will cover x health care expenses. So does an insurance company have an incentive to not pay for what it is not contractually obligated to pay for? Ummmmm, YES.

I still get the impression that their is a pretty good chunk of people that admittedly or not think health care is a service that people should not have to pay for. So that's question one in determining how best to reform the system. Should health care be 'free' (as in payed for by taxes) and provided as a right by government, or is it a service that medical professionals deserve to be compensated for by those obtaining service from them?

If you're answer is it should be 'free' well then we're kinda fucked because that's an entirely different debate where we have to determine what the most efficient means of delivering service is based on that funding model. Basic economics says it won't be efficient at all, but feel free to prove me otherwise.

If it's the latter than that is something we can more easily talk about. It's interesting in touched on the concept of incentives. Because that concept is a huge part of the issue, you're just wrong on who it's the bigger issue for. The problem is the incentive (or lack of in this case) of the consumer. They have little incentive to understand their plan because they have little choice in plans and because it is an insurance model they have little incentive to understand what the costs of services really are because they don't have to deal with them. These are basic economic concepts that determine what the cost of service will be and yet people like yourself and Bf are dumbfounded by the costs of medical care. And also, sorry to take a jab here, but because you are liberals and the very last person you will hold accountable for way the things are is yourself.

How do you fix it? It really isn't that hard.
Addressing your concern first of insurance companies propensity to deny claims; First the consumer needs to be responsible enough to understand what there plan really covers. There are certainly things that can be done to incentivize people to do that which we can talk about in a minute. But one regulation I would be for is stricter legal regulation in terms of making the specifics of your plan legally binding. Create a penalty system that makes it unthinkable to to insurance companies to deny claims they know they should cover.

Secondly, if the insurance industry is so awful maybe we should consider not depending on them so heavily.  Here's a crazy idea, how about you the consumer just pay for the services he provides you? Again part of why costs are what they are is because the actual consumer of the product currently has little to no incentive to find out who offers the best deal on the service they need. I know this going to be a tough exercise for a lot of you, but humor and start thinking of 'repairing' your body like repairing your car and I promise you you will see prices fall. 

Thirdly, you can't argue with basic laws of economics. The more competiveness there is for a good or service the lower the cost of that good or service is going to be. That applies to both insurance plans and actual services. This is where deregulating various things comes in. Instead of mandating that employers above a certain size must provide a health care plan, take the money they would spend per individual on a plan and just give them the money instead and let them shop for the health care plan they want. Having choice is a key mechanism in keeping costs down to consumers. Look at all of the choice government has removed from the market.  They have removed the choice of how an employer wants to provide the health care benefit to its employees and they have removed coverage options of the insurer. They have told employers you must provide this benefit and they have told the insurance companies what they must cover. And you really wonder why costs are as high as they are?


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## Bfgrn (Sep 8, 2011)

Bern80 said:


> Bfgrn said:
> 
> 
> > Bern80 said:
> ...



Do yourself a favor, invest a half hour of your time and listen to the interview with Wendell Potter. It is enlightening.

Watch the video


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## Bern80 (Sep 8, 2011)

Bfgrn said:


> Bern80 said:
> 
> 
> > Bfgrn said:
> ...



I can't say that anything in there really shocks me. Another 'regulation' if you will that I left out, and a statement by Obama that intitally disagreed with but would, is that contributing to politicians should not be considered a form of free speech. Crony capitalism as it's called needs to end.

But I was right about one thing I said prior to watching that; we are far far far too dependent on the insurance model for paying our healthcare.  The two big themes of that piece were the crookedness of the insurance companies and how struck Potter was by people not having an insurance. The last part I just don't get. As if not having an insurance plan is the end game. The notion that if you don't have one you're basically dead. That totally misses the picture in my opinion. If you don't like the problems insurance companies have created why are we trying to come up with solutions that play by insurance company rules? It doesn't strike you as odd to malign insurance companies, but at the same time try to enact law that gets everyone on one of their plans? The goal should not the ability of people to afford health care insurance. The goal needs to be the ability for people to afford health care.


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## Greenbeard (Sep 8, 2011)

Bern80 said:


> Addressing your concern first of insurance companies propensity to deny claims;



The larger issue here isn't claims denials or rescissions, it's medical underwriting in general. A great many folks feel that people who behave responsibly shouldn't be unduly punished for on factors like medical history or gender. That's why most people are largely shielded from medical underwriting by HIPAA.



> Secondly, if the insurance industry is so awful maybe we should consider not depending on them so heavily.  Here's a crazy idea, how about you the consumer just pay for the services he provides you?



The answer here shouldn't be mysterious. We rely on the structure we do because health spending is extremely concentrated: half the population incurs virtually none of the nation's health costs (and thus is associated with almost none of its expenditures), while a mere one percent of it incurs almost a quarter of the costs (accounting for a hugely disproportionate share of national health spending). It's a wonderful thought that we should forgo health insurance and pay all expenses out of pocket. Wonderful until you happen to slip into that top 50% of spenders, or the top 15%, or--heaven forbid--the top 1%. If that happens, you'd better have a damn big piggy bank. Most folks don't, nor is it necessarily a good idea to give up that much disposable income just in case.  Hence the insurance model.








> Again part of why costs are what they are is because the actual consumer of the product currently has little to no incentive to find out who offers the best deal on the service they need. I know this going to be a tough exercise for a lot of you, but humor and start thinking of 'repairing' your body like repairing your car and I promise you you will see prices fall.



It should be well-known that the market for health care isn't just like the market for any commodity in an econ textbook. Arrow laid out some of the key special characteristics of health care markets in his classic 1963 paper: the nature of demand for health services, the expected behavior of physicians, product uncertainty (and in here he rolls the vast information asymmetries between patients and physicians), supply conditions, and pricing practices.

You won't find a bigger proponent for pursuing value (health outcomes achieved per dollar spent) than me. But it's not as simple as deregulating the insurance markets and leaving the consumer to face providers blind. It requires building the capacity to capture the data/information needed to measure and target improvements at quality, transparent pricing (which, I suspect, will require all-payer rates), and a steadily growing evidence base on which to base medical decisions and guide clinical processes. There's nothing wrong with using cost-sharing to incentivize high-value decisions from consumers, and there's certainly nothing wrong with modifying reimbursements to providers to reflect the value of the services they offer. I favor both approaches.

I've said it before and I'm sure I'll say it again: If we want to shift toward something like consumer-driven payment, we need to make changes to the way we do business first. We need to start pricing health as an output good, we need transparent indicators (like reliable and accurate quality reporting) to aid shoppers, and we need readily available information on clinical effectiveness to better inform doctor and patient-as-customer alike when it comes to making medical decisions. That said, the insurance model isn't going to disappear because the distribution of health spending strongly advocates for it. Hybridization is the reality here, and the clear path forward is to find and refine the best models for payment and service delivery within those confines.



> Thirdly, you can't argue with basic laws of economics. The more competiveness there is for a good or service the lower the cost of that good or service is going to be. That applies to both insurance plans and actual services. This is where deregulating various things comes in.



Unless you're denying that 1) premiums do in some significant way reflect the price of care providers charge, or 2) that a more competitive insurance market does not reduce _provider_ prices, deregulation doesn't lower the cost of services. The appeal of deregulation (if you indeed find this appealing) is that it allows insurers more flexibility to choose the risk profiles of their pools: that is, jettison the sick or deny them entry.

That isn't lowering the cost of medical services (it's not even clear that lowers national spending), and it's precisely what this thread was created to oppose.



> Instead of mandating that employers above a certain size must provide a health care plan, take the money they would spend per individual on a plan and just give them the money instead and let them shop for the health care plan they want. Having choice is a key mechanism in keeping costs down to consumers.



*This is being done*. It's part of those reforms you don't like. Exchanges can allow for employers to make some fixed health contribution to their employees and release their employees into the exchange to choose any plan they please (paying the difference, if any, between the price of the plan of their choice and their employer's contribution out of their own pocket).


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## Bern80 (Sep 8, 2011)

Greenbeard said:


> Bern80 said:
> 
> 
> > Addressing your concern first of insurance companies propensity to deny claims;
> ...



Why not? Those who incur risk ought to be compensated for it. And those who incur greater risk than others should be compensated better than others. Why is it fair for you to get to pay the same thing I pay if your genetics show that you are predisposed to heart disease when I'm not? Why should you get to pay the same thing I do when it is more likely that you are going to require more medical resources than I am?



Greenbeard said:


> The answer here shouldn't be mysterious. We rely on the structure we do because health spending is extremely concentrated: half the population incurs virtually none of the nation's health costs (and thus is associated with almost none of its expenditures), while a mere one percent of it incurs almost a quarter of the costs (accounting for a hugely disproportionate share of national health spending). It's a wonderful thought that we should forgo health insurance and pay all expenses out of pocket. Wonderful until you happen to slip into that top 50% of spenders, or the top 15%, or--heaven forbid--the top 1%. If that happens, you'd better have a damn big piggy bank. Most folks don't, nor is it necessarily a good idea to give up that much disposable income just in case.  Hence the insurance model.



I'm not saying we forgo insurance all together. I'm saying consider it more akin to your auto insurance policy. Right now pretty much any type of service you need medically will have some portion of it covered by insurance. You don't expect your auto insurer to cover your oil changes do you? Why is it so terribly unreasonable that YOU cover your yearly physical? Instead of the state regulating that insurance companies cover everything under the sun, you deregulate the market so that it can better meet the specific needs of individuals. Allow that 90% to purchase plans that maybe only cover catastrophic illness. Allow those with chronic health issues to purchase insurance that is better suited to their condition





Greenbeard said:


> It should be well-known that the market for health care isn't just like the market for any commodity in an econ textbook. Arrow laid out some of the key special characteristics of health care markets in his classic 1963 paper: the nature of demand for health services, the expected behavior of physicians, product uncertainty (and in here he rolls the vast information asymmetries between patients and physicians), supply conditions, and pricing practices.



And just maybe he's wrong. I hate to beat a dead horse, but maintaining your health is virtually no different than maintaining your car. Both require routine maintenance to ensure their respective longevity. That certain types of cars are more likely to be in accidents (i.e. people who drive sports cars) thus are insured at higher rates is akin to a genetic condition and in both cases certainly unforseen major expenditures could be incurred. The only difference I can come up with is that people value their lives more than their cars, which ironically means yes, your health insurance should cost more than your auto insurance.




Greenbeard said:


> You won't find a bigger proponent for pursuing value (health outcomes achieved per dollar spent) than me. But it's not as simple as deregulating the insurance markets and leaving the consumer to face providers blind. It requires building the capacity to capture the data/information needed to measure and target improvements at quality, transparent pricing (which, I suspect, will require all-payer rates), and a steadily growing evidence base on which to base medical decisions and guide clinical processes. There's nothing wrong with using cost-sharing to incentivize high-value decisions from consumers, and there's certainly nothing wrong with modifying reimbursements to providers to reflect the value of the services they offer. I favor both approaches.



Why must they go into it blind? Why is it so go damn outrageous to you whiners that people take a modicum of responsibility and research the product they are buying? Why is it so unfathomable to you that a person would find whether what they're buying is going to meet their needs. This is what frustrates me about you liberals to no end. You expect NOTHING of the consumer and have the nerve to wonder why they get screwed and their costs are going through the roof. 




Greenbeard said:


> I've said it before and I'm sure I'll say it again: If we want to shift toward something like consumer-driven payment, we need to make changes to the way we do business first. We need to start pricing health as an output good, we need transparent indicators (like reliable and accurate quality reporting) to aid shoppers, and we need readily available information on clinical effectiveness to better inform doctor and patient-as-customer alike when it comes to making medical decisions. That said, the insurance model isn't going to disappear because the distribution of health spending strongly advocates for it. Hybridization is the reality here, and the clear path forward is to find and refine the best models for payment and service delivery within those confines.



The fact that you obviously like to use big words doesn't mean this is a complicated situation. If we move to consumer driven payment then the service providers will react like any other commodity. As direct competitiveness enters the equation certain hospitals and doctors will develop reputations like any other commodity. They will adjust their quality and their pricing structure accordingly.



> Thirdly, you can't argue with basic laws of economics. The more competiveness there is for a good or service the lower the cost of that good or service is going to be. That applies to both insurance plans and actual services. This is where deregulating various things comes in.






Greenbeard said:


> Unless you're denying that 1) premiums do in some significant way reflect the price of care providers charge,



Yes they do and that is the problem. In most any other commodity the person directly consuming it is the person who directly pays for it. Not so with health care. Is some form of insurance based model probably necessary? yes. But along with that you have to accept that in exchange for coverage for those who would otherwise not be able to pay the cost of those services is going to be greater than it would if there were no such thing as health insurance.




Greenbeard said:


> or 2) that a more competitive insurance market does not reduce _provider_ prices, deregulation doesn't lower the cost of services.



I don't deny that. What I'm saying is direct competition from the consumer instead of through an insurance intermediary, would.



Greenbeard said:


> The appeal of deregulation (if you indeed find this appealing) is that it allows insurers more flexibility to choose the risk profiles of their pools: that is, jettison the sick or deny them entry.



This is nonsensical. Obviously there is a market for insurance for people that are ill or have preexisting conditions. There would most certainly arise markets for such plans, but this is also again where maybe some added regulation in contract enforcement would be called for as well as some responsibility on the part of the consumer. Why exactly would you agree to purchase a health care plan that allows your insurer to dump if you get sick? It would make no sense for you to buy such a plan thus it makes no sense for an insurance company to sell one. I don't know what the issue is here to be honest. I would think an insurance plan that agrees to cover x costs for x conditions for x premium would be legally binding like any other contract. If they deny coverage for what their contract says they cover, you take 'em to court.




Greenbeard said:


> *This is being done*. It's part of those reforms you don't like. Exchanges can allow for employers to make some fixed health contribution to their employees and release their employees into the exchange to choose any plan they please (paying the difference, if any, between the price of the plan of their choice and their employer's contribution out of their own pocket).



Then would that not be a form of deregulation which you claim is bad?


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## Greenbeard (Sep 9, 2011)

Some basic points:

1) The question of whether factors beyond your control, like genetics and gender, should be used against you is philosophical, your answer will depend on your particular brand of ethics. In this case, I prefer to use the veil of ignorance approach to think about health insurance rating. However, the implication that genetics is equivalent to your choice of a car is, of course, absurd, unless we're living in Gattaca now. The real equivalent would be rating on health behaviors; rating variations based on tobacco use are still allowed, even under the modified community rating rules (as are financial incentives for various wellness programs).

2) Contrary to popular belief, infinitely customizable insurance packages are not the hallmark of a well-functioning insurance market. To quote Austin Frakt:



> The whole point of a market-based system is to harness the power of consumer choice. But consumers can&#8217;t send meaningful signals if the market has an incomprehensible structure. One of the conditions for a competitive market is fully informed participants. The notion that seniors&#8211;or anyone&#8211;can meaningfully shop in a market with an unlimited number of plans that vary in all possible ways is ludicrous. (There is already evidence that beneficiaries don&#8217;t optimally select among the scores of Part D plans available now and that reducing the number of available plans would increase welfare.) The Medicare supplement (Medigap) market is a good model of competition within standardization. Making products more similar encourages competition. Allowing them to vary along a small number of dimensions helps consumers make sensible comparisons consistent with individual preference. Isn&#8217;t that the point?




3) 





Bern80 said:


> Why must they go into it blind? Why is it so go damn outrageous to you whiners that people take a modicum of responsibility and research the product they are buying? Why is it so unfathomable to you that a person would find whether what they're buying is going to meet their needs. This is what frustrates me about you liberals to no end. You expect NOTHING of the consumer and have the nerve to wonder why they get screwed and their costs are going through the roof.



Did I not explain _exactly_ why they would be blind interacting with the provider market today? Consumers need reliable quality indicators (which means 1) development and refinement of better outcomes measures, and 2) public reporting by providers), they need transparent pricing information, and they and physicians alike both need better information on comparative clinical effectiveness of treatment options, for starters. Identifying and rewarding value isn't easy even now, it requires building new and improving on existing infrastructure to make it work. But it's absolutely a prerequisite for effective shopping. Putting people on the hook financially is only half of the story. This is the other half. And by "half" I mean "this is the other 90 percent."

I've never said people shouldn't be involved in their care. In fact, I spent a significant chunk of that last post describing to you ways to achieve a health care market in which consumers can legitimately act like consumers. But beyond that, in terms of care delivery I've frequently advocated for more patient-centeredness in our system. That is, I expect significantly more of people that simply choosing the doctor to whom they're most comfortable delegating autonomy. But that requires some shifts, too, and not only (or even primarily) on the patient side. How you can even conceive of consumer-driven payment models without first achieving much greater patient-centeredness in actual care delivery I have no idea.

Now, I get it. I'm wrong, Arrow's wrong, and every health econ textbook ever written is wrong because recognizing the factors that make the market for health care unique interferes with your Mickey Mouse conception of the world. It's just like buying a car, the only problem is that we as a nation are spending too much on, er, "oil changes." Okay, stick with that. I'm not going to draw you up a syllabus and teach you a course, and I certainly can't argue with what intuitively feels right in your gut. Economic analyses and studies of how care is actually sought and delivered in the real world are rarely a match for the appeal of conclusions drawn from simple analogies based on superficial similarities. 

4) 





> Then would that not be a form of deregulation which you claim is bad?



If you want to call the ACA deregulation, knock yourself out. My point is it does _exactly_ what you suggested: allow employers to define some set sum as part of the employee compensation package, then give it to the employees to put toward the plan of their choice selected in a competitive market.


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## Bern80 (Sep 9, 2011)

Greenbeard said:


> 2) Contrary to popular belief, infinitely customizable insurance packages are not the hallmark of a well-functioning insurance market. To quote Austin Frakt:
> 
> 
> 
> > The whole point of a market-based system is to harness the power of consumer choice. But consumers can&#8217;t send meaningful signals if the market has an incomprehensible structure. One of the conditions for a competitive market is fully informed participants. The notion that seniors&#8211;or anyone&#8211;can meaningfully shop in a market with an unlimited number of plans that vary in all possible ways is ludicrous. (There is already evidence that beneficiaries don&#8217;t optimally select among the scores of Part D plans available now and that reducing the number of available plans would increase welfare.) The Medicare supplement (Medigap) market is a good model of competition within standardization. Making products more similar encourages competition. Allowing them to vary along a small number of dimensions helps consumers make sensible comparisons consistent with individual preference. Isn&#8217;t that the point?



But to make his case he has to first assume that it is not possible for people to know or learn what they are purchasing. He's essentially saying that the ability to choose from various boxes of stuff is irrelevent if you can't see what's in the box. Heres a tip to the two of you: OPEN THE GOD DAMN BOX! You keep proving my point Green. You expect nothing of the consumer. Probably the most important service they will require in their life is the one you feel they should be the least responsible for understanding. Great plan! 

In my pie in the sky health insurance market place. There would be numerous isnurance companies that sell directly to consumers (rather than via employers). You tell them what kind of coverage you want, they show you what they offer and what it costs. You sit down and comapre them and you make a decision. Might that be time consuming for the consumer? Probably, but if there is one thing a person buys that they may want to spend a little extra time researching and understanding I would say how your health care is going to be paid for might be it. Please explain to me why this is so completely unrealistic to you.



Greenbeard said:


> Did I not explain _exactly_ why they would be blind interacting with the provider market today? Consumers need reliable quality indicators (which means 1) development and refinement of better outcomes measures, and 2) public reporting by providers), they need transparent pricing information, and they and physicians alike both need better information on comparative clinical effectiveness of treatment options, for starters. Identifying and rewarding value isn't easy even now, it requires building new and improving on existing infrastructure to make it work. But it's absolutely a prerequisite for effective shopping. Putting people on the hook financially is only half of the story. This is the other half. And by "half" I mean "this is the other 90 percent."



Again Green stop talking about this as if it's some complex puzzle. It isn't. Quality indicators and outcome measurements and transparent pricing are all needed. Why aren't they there now? BECAUSE THERE IS NOT INCENTIVE FOR THEM TO DO SO. In a market place those things are not prerequisistes for a consumer, they are a market REACTION to the demands of consumers. A market for and good or service will not provide what a consumer does not demand. Why is there little information concerning the quality of care various hospitals and physicians provide? Because the consumer doesn't have a choice in who they see. Why is there little information as to what an x-ray will cost from hosptial to another? Because the consumer isn't directly paying for it.



Greenbeard said:


> Now, I get it. I'm wrong, Arrow's wrong, and every health econ textbook ever written is wrong because recognizing the factors that make the market for health care unique interferes with your Mickey Mouse conception of the world. It's just like buying a car, the only problem is that we as a nation are spending too much on, er, "oil changes." Okay, stick with that. I'm not going to draw you up a syllabus and teach you a course, and I certainly can't argue with what intuitively feels right in your gut. Economic analyses and studies of how care is actually sought and delivered in the real world are rarely a match for the appeal of conclusions drawn from simple analogies based on superficial similarities.



The problem is as difficult as you choose to make it. The reason it is so complex and convoluted now is because you believe government simply must play a major role in this particular market while you remain blind to the fact that that's where this mess came from in the first place. You are going to have to explan to me why my analogy is superficial and can't pass greater scrutiny. You are going to have to explain to me why your yearly tune up on your car simply can not be looked at the same was as your yearly physical.


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## bill5 (Sep 10, 2011)

Bern80 said:


> does an insurance company have an incentive to not pay for what it is not contractually obligated to pay for? Ummmmm, YES.


 But that is a huge oversimplification as what they are "contractually obligated to pay for" is not always clear and so open to interpretation - THEIR interpretation.  Gee I wonder which way they'll typically swing. 



> question one in determining how best to reform the system. Should health care be 'free' (as in payed for by taxes) and provided as a right by government, or is it a service that medical professionals deserve to be compensated for by those obtaining service from them?


"Yes" is the short answer.  We need a mix of both, though IMO far leaning to the latter.  "Free" care really means someone else pays for it.



> If you're answer is it should be 'free' well then we're kinda fucked because that's an entirely different debate where we have to determine what the most efficient means of delivering service is based on that funding model.


No, we'd be screwed because that means the govt is running it and it would cost so much in taxes as to be unworkable.  It also would only further promote the welfare mentality which is already rampant and causing too many problems in this country.



> If it's the latter than that is something we can more easily talk about. It's interesting in touched on the concept of incentives. Because that concept is a huge part of the issue, you're just wrong on who it's the bigger issue for. The problem is the incentive (or lack of in this case) of the consumer. They have little incentive to understand their plan because they have little choice in plans


I call BS.  There are many diff kinds of plans out there.  I know having just gone through this.  You don't HAVE to choose your employer's option and it is increasingly wise to go it on your own anyway IMO, as they are providing less and less financially advantageous options.  

Saying one shouldn't understand their own plans is ridiculous on a variety of fronts.  Knowledge is power and ignorance is inexcusable.



> and because it is an insurance model they have little incentive to understand what the costs of services really are because they don't have to deal with them.


  That's ridiculous.  How do you get "they don't have to deal with them?" 



> How do you fix it? It really isn't that hard.


On he contrary, it's extremely hard, because it's a complex issue and because there are billions at stake.  A drawback of the capitalistic system, I'm afraid (not that I advocate any other).



> Create a penalty system that makes it unthinkable to insurance companies to deny claims they know they should cover.


Sounds good but again you run into a vague/subjective issue of "claims they know they should cover."  



> Secondly, if the insurance industry is so awful maybe we should consider not depending on them so heavily.  Here's a crazy idea, how about you the consumer just pay for the services he provides you?


??  Because most people can't.  



> Thirdly, you can't argue with basic laws of economics. The more competiveness there is for a good or service the lower the cost of that good or service is going to be. That applies to both insurance plans and actual services.


Generally speaking, yes.  But again, this is a very complex issue. There are numerous insurance companies out there yet costs remain high.



> This is where deregulating various things comes in. Instead of mandating that employers above a certain size must provide a health care plan, take the money they would spend per individual on a plan and just give them the money instead and let them shop for the health care plan they want.


 ??  That already exists.  In fact I chose such an option with my last employer.  (PS side note:  "CORBA" is a joke; hideously expensive)



> Having choice is a key mechanism in keeping costs down to consumers. Look at all of the choice government has removed from the market.  They have removed the choice of how an employer wants to provide the health care benefit to its employees and they have removed coverage options of the insurer.


Where you are getting this data?  Or do things just work very differently in your field?  I had various options with most if not all of the policies my company "provided."


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## bill5 (Sep 10, 2011)

Bern80 said:


> The goal should not the ability of people to afford health care insurance. The goal needs to be the ability for people to afford health care.


That is a totally unrealistic and unworkable goal.  Price out a 1-week stay in the hospital sometime, or the cost of a CT scan or 3.


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## Bern80 (Sep 10, 2011)

bill5 said:


> Bern80 said:
> 
> 
> > The goal should not the ability of people to afford health care insurance. The goal needs to be the ability for people to afford health care.
> ...



It is the extreme narrow mindedness of people like yourself who think those variables are not changeable, that is holding health care reform back. Are you getting the central theme here? The consumer needs to start plugging in, in order to solve this problem. They have to be responsible for knowing what their plan covers and responsible for know what the real cost of services are. Yes there are lots of insurance companies and yes prices are still high. That is because consumers of the product are having to go out and actually shop for a plan. Despite the number of competitors the incentive still isn't there for them compete  directly for consumers via price. Start an HSA or something. I know care is expensive, better than most. It not an unrealistic goal and greater patient involvement is essential to bring down the cost things like you mention.


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## Valerie (Sep 10, 2011)

bill5 said:


> Bern80 said:
> 
> 
> > The goal should not the ability of people to afford health care insurance. The goal needs to be the ability for people to afford health care.
> ...





Ask yourself WHY it has come to cost so much...?  The natural fee-for-service scale has gone way off the charts because of unnatural market forces!  Health insurance has become a racket but don't worry we will have created soooo many new jobs with all the "overhead" reams of paperwork involved!


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## California Girl (Sep 10, 2011)

Bfgrn said:


> Bern80 said:
> 
> 
> > Very few people would disagree that our health care system needed to be reformed. But doing something.....anything is not always an improvement. The 'how' it is being reformed via Obamacare is the problem.
> ...



I don't give a fuck which party proposed it. It's a clusterfuck.


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## Greenbeard (Sep 10, 2011)

bill5 said:


> > Having choice is a key mechanism in keeping costs down to consumers. Look at all of the choice government has removed from the market.  They have removed the choice of how an employer wants to provide the health care benefit to its employees and they have removed coverage options of the insurer.
> 
> 
> Where you are getting this data?  Or do things just work very differently in your field?  I had various options with most if not all of the policies my company "provided."



This is the everything-but-the-kitchen-sink approach. Not so much about developing a coherent or consistent story but more about venting against all that irks you.

1) Benefit mandates are the problem. Except the reality is that most people with private insurance are in plans that aren't subject to state or federal benefit mandates.

2) Having insurance is the problem. Except, as noted above, the distribution of health expenditures makes an insurance model not only prudent but necessary.

3) No, insurance is fine but should be tailored to the low-spending tiers. If we let in the higher spending cohorts, just make them pull their weight. There's no reason the most expensive cohort shouldn't pay premiums 55 times what the least expensive cohort pays!

4) People need to better understand their insurance policies. But, of course, any effort to make health insurance policies more intelligible and choices in insurance markets more meaningful is condescending and anathema to truth, justice, and the American way.

5) The problem is that people are getting too many "oil changes" (which, apparently, refers to physicals?) or, alternatively, not finding a good enough deal on them. So insurance is fine but shouldn't contribute at all to oil changes. This is key, because a significant chunk of our two and a half trillions dollars in national health expenditures is on...physicals. The five percent of folks responsible for half of our national spending must be getting quite a few physicals!

This could go on but the primary difficulty I'm seeing here is a very large lack of appreciation for the links between payment and service delivery. In its place is a blind faith that certain misapplied maxims will produce good outcomes. Instead of pursing the current trend toward tightly-knit, integrated care with coordinated team-based approaches (the sort of approach that has simultaneously led to lower costs and some of the highest quality care in the United States where implemented), we're now faced with this push for fragmented, episodic care modeled after the approach to getting your Chevy serviced. Despite the evidence in favor of coordinated care and the importance of smooth care transitions, what we _really_ need is a more adversarial, territorial, and competitive relationship between practitioners--more MBA physicians might just be the missing piece of the puzzle.

The good thing is that everyone here seems to agreed that 1) consumers should have a meaningful choice of health insurance products and employers (particularly small businesses) should be flexibility in how they assist employees with finding coverage, and 2) value should be sought, identified, and paid for. Both of these are in the process of coming to fruition as they never have before--a happy circumstance.


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## Zander (Sep 10, 2011)

Government involvement in Health care caused the problem. Now the only solution is more government involvement? You people are permanently stuck on stupid.....


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## Bern80 (Sep 10, 2011)

Greenbeard said:


> bill5 said:
> 
> 
> > > Having choice is a key mechanism in keeping costs down to consumers. Look at all of the choice government has removed from the market.  They have removed the choice of how an employer wants to provide the health care benefit to its employees and they have removed coverage options of the insurer.
> ...



And with all your rambling greeny (including things I never actually said) you still can't answer why it's not possible to simplify this system. I didn't say people are getting too many physicals. I suggested that instead of using insurance to pay for everything in some form or other where health care is concerned it be used more akin to auto insurance which pays for major issues under certain circumstances and the consumer pay for the more routine health care issues. Routine physicals, some prescriptions, etc. The things I don't need or are inexpensive enough for most to pay for on their own don't need to be part of insurance plan. Those same things drive the cost of premiums up. Not every medical service costs an arm and a leg. Many generic prescription cost very little. For example, I'm on a generic thyroid medication. With my insurance it costs $8 and change per refill. Paying for it out of pocket it costs about $10. I think I can handle that.


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## bill5 (Sep 10, 2011)

Greenbeard said:


> bill5 said:
> 
> 
> > > Having choice is a key mechanism in keeping costs down to consumers. Look at all of the choice government has removed from the market.  They have removed the choice of how an employer wants to provide the health care benefit to its employees and they have removed coverage options of the insurer.
> ...


Was that supposed to make any sense whatsoever?  I was not "venting," and I have no idea what "developing a story" or your odd "everything-but-the-kitchen-sink approach" is even supposed to mean.  

As I started to read the rest of your post it sounded similarly nonsensical, so I didn't bother to read much further.


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## Bfgrn (Sep 10, 2011)

Zander said:


> Government involvement in Health care caused the problem. Now the only solution is more government involvement? You people are permanently stuck on stupid.....



And America's health care is at the bottom of all industrialized countries.

A recent study reported in the Journal of the Royal Society of Medicine compared the amounts of money spent by nineteen Western countries on health care relative to their respective gross domestic product (GDP). The authors, Professor Colin Pritchard of the Bournemouth University School of Health and Social Care, and Dr. Mark Wallace of the Latymer School of London, ranked countries by the average percentage of GDP spent on health care between 1979 and 2005. They then looked at mortality rates for all adults (15-74 years old) and for just the older population (55-74) to determine a cost-effective ratio, i.e., how much bang for the buck each country has been getting for the money spent. The conclusions are striking.

*Increasing Health Care Costs*

It will come as no surprise that health care costs have gone up everywhere. In 1980, Sweden spent nine percent of its GDP on health care. The USA came in second at 8.8%. Most countries averaged about 7.1% of GDP. In 2005, the picture had changed. The United States was far in front of all other countries, spending an average of 12.2% of its GDP for all public and private health care costs. Germany was a somewhat distant second at 9.7%, with the average for all countries standing at 7.4%. In other words, while average health care expenditures increased from 7% to 7.4%, Americas costs jumped from 8.8% to 12.2% of GDP over the same span of time.

*Mortality Rates*

The study then looked at trends in mortality rates for both the entire adult population (15-74) and for older people (55-74). Deaths per million population were looked at, and the authors found that mortality rates had declined in segments of this population in every country, an indication that medical science has indeed improved over the past few decades.

Utilizing standard statistical tools and analysis, the authors then ranked the same 19 countries according to their effectiveness in reducing the mortality rate for the elderly populace ages 55 to 74. Comparing the amount of money spent by each country on health care and the reduced mortality rates, the countries fell into the following ranking:

  1  Ireland
  2 United Kingdom
  3 New Zealand
  4 Austria
  5 Australia
  6 Italy
  7 Finland
  8 Japan
  9 Spain
  10 Sweden
  11 Canada
  12 Netherlands
  13 France
  14 Norway
  15 Greece
  16 Germany
*  17 USA*
  18 Portugal
  19 Switzerland
*
Conclusions*

Take a look. America outspends everyone else by far on health care, and has shown the least amount of improvement on mortality rates, with the exception of Portugal and Switzerland. Why does the United States do such a poor job?

The authors give several potential reasons, including regional disparities in health care availability in a country as large as the US, the much higher rate of firearms-related homicides here, and the higher number of un-insureds we have. The study is, however, consistent with other reports that show the USA is doing a poor job of health care for its citizens. A recent UNICEF report looked at well-being of children among major industrialized countries (e.g. material wealth, family relationships, health care), and found the United States ranking 23rd of 24 countries reviewed.
*
Universal vs. Private Health Insurance*

*There is one factor common to the top 15 countries on the above list. They all have strong state funding of single-payer universal health care, instead of insurance based health care tied to employment. The bottom four countries  Germany, USA, Portugal and Switzerland  all depend more heavily on profit-based, private health insurance provided primarily through the employer/employee relationship.*


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## Greenbeard (Sep 10, 2011)

bill5 said:


> Was that supposed to make any sense whatsoever?  I was not "venting," and I have no idea what "developing a story" or your odd "everything-but-the-kitchen-sink approach" is even supposed to mean.



Relax there, chief. I was referring to the post you were quoting in your response. It was the tail end of a litany of loosely related gripes from Bern.


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## bill5 (Sep 10, 2011)

Bern80 said:


> It is the extreme narrow mindedness of people like yourself who think those variables are not changeable, that is holding health care reform back.



It is the extreme silliness of comments like that that hold intelligent discussions back.

FYI hospitals are expensive.  CT machines are expensive.  And so on.  Those "variables" are not "changeable" ie they have been and will remain expensive, and understandably so.  This means the costs associated with provided such services to people will also be expensive - far too expensive for many to afford, hence the need for health insurance.  That said, I do not agree with forcing people to have insurance.  Just don't come crying to the gov't (or anyone else) if you choose not to have it and something happens requiring you to get care which you can't afford.



> The consumer needs to start plugging in, in order to solve this problem. They have to be responsible for knowing what their plan covers and responsible for know what the real cost of services are.


The consumer "plugging in" will not solve this problem.  As for "knowing the real cost of services," how are they supposed to do that?  And did you know some costs are not even fixed, eg CT scans?  The hospitals and insurances play this "negotiation" game.



> Yes there are lots of insurance companies and yes prices are still high. That is because consumers of the product are having to go out and actually shop for a plan.


 ??  Earlier you said "They have little incentive to understand their plan because they have little choice in plans."  Now you're saying they have to out and shop for them?  Which is it?


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## Zander (Sep 10, 2011)

Bfgrn said:


> Zander said:
> 
> 
> > Government involvement in Health care caused the problem. Now the only solution is more government involvement? You people are permanently stuck on stupid.....
> ...



Quite frankly, I don't give a damn.  Get the government out of our health care. You are responsible for your own life, your own health, and your own health care. Government is not your mommy.


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## Bfgrn (Sep 10, 2011)

Zander said:


> Bfgrn said:
> 
> 
> > Zander said:
> ...



Epic fail...Plus you are an ignorant fuck who is brainwashed.

Our wealth care system puts all our businesses at a competitive disadvantage in the international marketplace. The cost of health insurance adds $1500 to the cost of every vehicle domestic automakers produce. Japanese manufacturers spend $200 per vehicle because Japan has universal health care.







More money per person is spent on health care in the USA than in any other nation in the world, and a greater percentage of total income in the nation is spent on health care in the USA than in any United Nations member state except for East Timor. Although not all people are insured, the USA has the third highest public healthcare expenditure per capita, because of the high cost of medical care in the country. A 2001 study in five states found that medical debt contributed to 46.2% of all personal bankruptcies and in 2007, 62.1% of filers for bankruptcies claimed high medical expenses. Since then, health costs and the numbers of uninsured and underinsured have increased.

The USA pays twice as much yet lags behind other wealthy nations in such measures as infant mortality and life expectancy, though the relation between these statistics to the system itself is debated. Currently, the USA has a higher infant mortality rate than most of the world's industrialized nations. In the United States life expectancy is 42nd in the world, after some other industrialized nations, lagging the other nations of the G5 (Japan, France, Germany, UK, USA) and just after Chile (35th) and Cuba (37th).

Life expectancy in the USA is 42nd in the world, below most developed nations and some developing nations. It is below the average life expectancy for the European Union. The World Health Organization (WHO), in 2000, ranked the U.S. health care system as the highest in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study). The Commonwealth Fund ranked the United States last in the quality of health care among similar countries, and notes U.S. care costs the most.

The USA is the "only wealthy, industrialized nation that does not ensure that all citizens have coverage" (i.e., some kind of private or public health insurance). In 2004, the Institute of Medicine report observed "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States." while a 2009 Harvard study estimated that 44,800 excess deaths occurred annually due to lack of health insurance.
wiki


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## Zander (Sep 10, 2011)

Bfgrn said:


> Zander said:
> 
> 
> > Bfgrn said:
> ...


Your cut and paste posts do not impress me son.  Try writing your own thoughts. I know you're the type of person that needs government to save you and pay for your life, but please,  save the insults for your playground pals.  You have done nothing in this thread but cut and paste crap and sling insults.


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## Bfgrn (Sep 10, 2011)

Zander said:


> Bfgrn said:
> 
> 
> > Zander said:
> ...



And your ignorance does not impress me. I am probably older than you SON. 

Knowledge is learned. Try it sometime, maybe you can replace your dogma


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## Trajan (Sep 10, 2011)

Bfgrn said:


> Zander said:
> 
> 
> > Bfgrn said:
> ...



I have seen the argument that the huge costs spent on an education system that is failing , should lead to a revamp of the whole system but that doesn't get much play yet here you say same ala health care and the sky is falling.........selectivity- the last line of defense...


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## Care4all (Sep 11, 2011)

Bfgrn said:


> WHY did health care need reform? Because Wall Street took complete control of the health care industry. Profit driven incentives create REAL death panels for Americans. Insurance corporations are incentivized to deny patient coverage and push more and more of the costs onto consumers.
> 
> For anyone who wants an insider's knowledge of this, I recommend investing a half hour of your time to listen to what this man has to say...
> 
> ...


i don't need someone else to tell me it needs reform!

i pay 5 k a year for health insurance including dental through matt's job....from Aetna, I had the choice of only 2 policies, both aetna, one a cheaper version, I chose the more expensive one which still was crappy.

i just had pneumonia (for a month)  

NOT ONE of my doctor's bills or x-rays or breathing apparatus that they had me use, was paid by the insurance company...All $1100 of it was out of pocket by me....because the plan has a $1250 dollar deductible that i had to pay first....year is gonna end soon and starting january i start all over again, pay the insurance company 5 grand, then pay the first $1250 out of pocket!

the insurance company has a real racket going!


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## Bfgrn (Sep 11, 2011)

Trajan said:


> Bfgrn said:
> 
> 
> > Zander said:
> ...



Then start a thread on education...


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## Bern80 (Sep 11, 2011)

bill5 said:


> FYI hospitals are expensive.  CT machines are expensive.  And so on.  Those "variables" are not "changeable" ie they have been and will remain expensive, and understandably so.  This means the costs associated with provided such services to people will also be expensive - far too expensive for many to afford, hence the need for health insurance.  That said, I do not agree with forcing people to have insurance.  Just don't come crying to the gov't (or anyone else) if you choose not to have it and something happens requiring you to get care which you can't afford.
> 
> No shit hospitals negotiate the price of services with different insurance companies. Why is it so unfathomable to think they would not negotiate with YOU?
> 
> The consumer "plugging in" will not solve this problem.  As for "knowing the real cost of services," how are they supposed to do that?  And did you know some costs are not even fixed, eg CT scans?  The hospitals and insurances play this "negotiation" game.




You really believe a service costs the same or less when a third party is paying for service someone else received as opposed to the consumer paying for it directly?  When you pay a set premium per month and an actual procedure is covered 80% or completely by your insurance, do you really care how much the hospital charges for that service? All you car about is what the hospital says you owe AFTER insurance has paid their part. If there was no such thing as insurance you don't think people might ship around a bit more to find the best service at the best price?



bill5 said:


> ??  Earlier you said "They have little incentive to understand their plan because they have little choice in plans."  Now you're saying they have to out and shop for them?  Which is it?



Are NOT. My apologies.


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## bill5 (Sep 11, 2011)

Bern80 said:


> No shit hospitals negotiate the price of services with different insurance companies. Why is it so unfathomable to think they would not negotiate with YOU?


Basically, because they don't have to.  Insurance companies can get that done because they are experts in the field and have the resources/"muscle" to work with hospitals.  That cannot be said for I and 99%+ of all other consumers.



> You really believe a service costs the same or less when a third party is paying for service someone else received as opposed to the consumer paying for it directly?


 I don't "believe" it, I KNOW it.  In fact I have seen and lived it.  



> When you pay a set premium per month and an actual procedure is covered 80% or completely by your insurance, do you really care how much the hospital charges for that service?


No.  And that's relevant because....



> If there was no such thing as insurance you don't think people might ship around a bit more to find the best service at the best price?


 If there was no such thing as insurance it wouldn't always matter because people couldn't afford even the cheapest one.



> Are NOT. My apologies.


Thanks and no worries but I don't know what you mean by are not.


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## AnnieInMexico (Sep 11, 2011)

Bern80 said:


> You really believe a service costs the same or less when a third party is paying for service someone else received as opposed to the consumer paying for it directly?  When you pay a set premium per month and an actual procedure is covered 80% or completely by your insurance, do you really care how much the hospital charges for that service? All you car about is what the hospital says you owe AFTER insurance has paid their part. If there was no such thing as insurance you don't think people might ship around a bit more to find the best service at the best price?



I'm not sure I am understanding you.  Are you saying that  ins co's pay the same as a private individual paying cash for the same service?


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## Bern80 (Sep 12, 2011)

AnnieInMexico said:


> Bern80 said:
> 
> 
> > You really believe a service costs the same or less when a third party is paying for service someone else received as opposed to the consumer paying for it directly?  When you pay a set premium per month and an actual procedure is covered 80% or completely by your insurance, do you really care how much the hospital charges for that service? All you car about is what the hospital says you owe AFTER insurance has paid their part. If there was no such thing as insurance you don't think people might ship around a bit more to find the best service at the best price?
> ...



No. I'm saying in many cases the same sercive would actually cost LESS if you offered to pay for it yourself instead of having it billed through an insurance company,


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## Bfgrn (Sep 12, 2011)

Bern80 said:


> AnnieInMexico said:
> 
> 
> > Bern80 said:
> ...



FALSE!

Have you ever been on Cobra? Insurance companies pay much less for healthcare than individual patients


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## AnnieInMexico (Sep 12, 2011)

Bern80 said:


> No. I'm saying in many cases the same sercive would actually cost LESS if you offered to pay for it yourself instead of having it billed through an insurance company,



Hmmm... I was not aware of this.  Every case I have seen in my 25+ years of medicine shows that ins co's have contracted prices.  They get a deal based on quantity of people vs. an individual.

Think of it this way.  You go to the hospital and have your appendix removed.  The hospital will likely bill your ins co around $50K.  But after the ins co goes through the bill and their contract with that hospital it's typically around $12-$15K and the rest is written off.  Then the insured pays their deductable/co pays in line with what ins paid.  A self pay with no negotiations would pay $50K.  Cut a deal with the hospital (even after the fact, many times) and you pay what an average ins co will pay.

With that said, many people are not aware that due to these contracted prices with ins co's if they are self pay they can usually request a discount and more times than not, this is granted.

I work in this industry for a living.  I send people from Mexico to the US for (paid) medical care.  Sometimes they have great ins that covers US care as well as MX and sometimes they have a lot of money and are merely self pay.  I have ALWAYS been able to get my self pay people ins co contracted prices which is a fraction of what a self pay would usually be.

But, those  are merely my experiences.


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## Bern80 (Sep 12, 2011)

bill5 said:


> , because they don't have to.  Insurance companies can get that done because they are experts in the field and have the resources/"muscle" to work with hospitals.  That cannot be said for I and 99%+ of all other consumers.



Your trying to dodge around the obvious point bill, but being more specific, if health insurance was used less, more people would have to pay providers directly for certain services. Because the cost of service is now being felt directly by the consumer, human nature suggests the consumer is going to look for the best deal at the best price. That will create competition for customers by providers which would make services that cost one thing when billed through insurance cost less when billed directly to the customer. 



bill5 said:


> , I don't "believe" it, I KNOW it.  In fact I have seen and lived it.



How and when exactly. When has a provider charged less for service you received when charged to someone other than you as opposed to a service charged directly to you?




bill5 said:


> No.  And that's relevant because....



It is relevent because if you don't care you have no incentive to research costs. If you have no incentive to research costs, the provider has no incentive to make the information available to the public. If the public does not have the information they can not make informed decisions on quality or price thus there is no incentive to 'shop' for providers. If there is no incentive to 'shop' for providers there is no incentive for providers to compete directly for consumers by lowering prices.


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## Bern80 (Sep 12, 2011)

AnnieInMexico said:


> Bern80 said:
> 
> 
> > No. I'm saying in many cases the same sercive would actually cost LESS if you offered to pay for it yourself instead of having it billed through an insurance company,
> ...



I am looking at this from the perspective of what the hospital bills for a service. You mentioned 50k billed to insurance above. I have heard of several cases where if that same procedure were billed directly to the customer they would be charged less. It's not less than what they would be with insurance coverage but the point is more how much is charged for the service based on who is being charged.


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## Bern80 (Sep 12, 2011)

Bfgrn said:


> Bern80 said:
> 
> 
> > AnnieInMexico said:
> ...



Actually yes I have. I think you're misunderstanding what I'm saying.


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## AnnieInMexico (Sep 12, 2011)

Bern80 said:


> I am looking at this from the perspective of what the hospital bills for a service. You mentioned 50k billed to insurance above. I have heard of several cases where if that same procedure were billed directly to the customer they would be charged less. It's not less than what they would be with insurance coverage but the point is more how much is charged for the service based on who is being charged.



I don't know, I've been in medicine for a lot of years and I've not seen this once, not without prior (or post) negotiations.

Ins co's are not stupid.  They are not going to pay one more penny than they have to and you often times have to fight them to pay what they are supposed to pay.

I have a hunch the issues you have heard about are negotiated fees.  The computer doesn't care who is paying, they spit out the same fees regardless of the person.  AFTER ins pays then it is refigured with contractual limits.


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## bill5 (Sep 12, 2011)

Bern80 said:


> Your trying to dodge around the obvious point bill, but being more specific, if health insurance was used less, more people would have to pay providers directly for certain services. Because the cost of service is now being felt directly by the consumer, human nature suggests the consumer is going to look for the best deal at the best price. That will create competition for customers by providers which would make services that cost one thing when billed through insurance cost less when billed directly to the customer.


 My point is that your point, while logical sounding on the surface, is simply and patently incorrect.  Ask people in the biz if you don't believe me.

You also ignored my point that even if true, people often simply cannot afford health care on their own anyway, esp for anything serious, requiring hosp. stays etc etc.




> How and when exactly. When has a provider charged less for service you received when charged to someone other than you as opposed to a service charged directly to you?


Sorry I'm not in the habit of giving out personal data on myself.  Besides, how does that matter?  It happened.  It's fine if you don't believe me, was just letting you know I've experienced it first-hand.  Besides, how would you know I didn't just make it up?




bill5 said:


> It is relevent because if you don't care you have no incentive to research costs. If you have no incentive to research costs, the provider has no incentive to make the information available to the public.


 That makes no sense whatsoever.  The provider has no incentive to make the information available to the public, period.  And how are you going to "research the costs" without them giving you that data anyway?  



> If the public does not have the information they can not make informed decisions on quality or price thus there is no incentive to 'shop' for providers.


This also makes no sense but there's no incentive anyway because most people have insurance that covers most if not all costs.


----------



## Bern80 (Sep 12, 2011)

bill5 said:


> My point is that your point, while logical sounding on the surface, is simply and patently incorrect.  Ask people in the biz if you don't believe me.



No it isn't incorrect. What is patently false is the notion that health care is the one service that can somehow inexplicably react differently than any other good or service to basic economic laws. I have asked you repeatedly why it won't work and you refuse to answer.



bill5 said:


> You also ignored my point that even if true, people often simply cannot afford health care on their own anyway, esp for anything serious, requiring hosp. stays etc etc.



Who says they have to pay their bill all at once? I have worked out payment plans for my bills on numerous occasions.




bill5 said:


> Sorry I'm not in the habit of giving out personal data on myself.  Besides, how does that matter?  It happened.  It's fine if you don't believe me, was just letting you know I've experienced it first-hand.  Besides, how would you know I didn't just make it up?



I'm not asking for personal data. I think it would matter to most economists to know about transactions that violate fundamental theories of economics. I'm sure they would be quite interested to hear a scenario where a market group that was less price sensitive was charged less for the same service than a market group that is more price sensitive.




bill5 said:


> It is relevent because if you don't care you have no incentive to research costs. If you have no incentive to research costs, the provider has no incentive to make the information available to the public. That makes no sense whatsoever.  The provider has no incentive to make the information available to the public, period.  And how are you going to "research the costs" without them giving you that data anyway?
> 
> This also makes no sense but there's no incentive anyway because most people have insurance that covers most if not all costs.



If they want to compete directly for customers, yes they do have incentive to make them aware of the cost of doing business with them. If you can't research the costs of a service you need then you typically aren't going to do business with that company. If you you are choosing to buy a car and have a choice between dealerships are going to spend a lot of time with the dealership that won't even tell you how much the car is going to cost? Makes no sense? This is as common sense as it gets, bill. If you can't figure this out no wonder you don't have clue one how to fix this. If people are not doing business with a company that won't advertise their prices and are going somewhere else that will, That company will either die or react positively by doing what customer's want in order to get them back in the door. I don't get what doesn't make sense to you. If people have no incentive to shop because either insurance covers everything thus providers have no incentive to make consumers aware of the cost of services, then you give consumers an incentive to shop so providers have the incentive to lower prices. What that means as far as medicine is the consumer taking a greater role in paying for services directly and using insurance for fewer things.


----------



## Bern80 (Sep 12, 2011)

AnnieInMexico said:


> Bern80 said:
> 
> 
> > I am looking at this from the perspective of what the hospital bills for a service. You mentioned 50k billed to insurance above. I have heard of several cases where if that same procedure were billed directly to the customer they would be charged less. It's not less than what they would be with insurance coverage but the point is more how much is charged for the service based on who is being charged.
> ...



So fees are negotiated. So what? That's kind of the idea here. That consumers negotiate directly with providers for the best price.


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## bill5 (Sep 13, 2011)

Bern80 said:


> No it isn't incorrect. What is patently false is the notion that health care is the one service that can somehow inexplicably react differently than any other good or service to basic economic laws. I have asked you repeatedly why it won't work and you refuse to answer.


It is not "inexplicable" and I have not refused to answer.  It has been explained to you above by me and others, but you continue to ignore it.  If you don't want to accept those answers, fine; do some research, talk to those in the biz, etc and you will find out for yourself.

And you again ignore my other points eg that health care is and would often remains too expensive for people to afford without insurance.  We NEED health care insurance.  The idea of doing away with it and people paying as they go is utterly unworkable.



> Who says they have to pay their bill all at once.


?  The hospitals, doctors, etc.  They aren't about to suddenly start accepting "payment plans."  



> If they want to compete directly for customers, yes they do have incentive to make them aware of the cost of doing business with them.


 Really?  Then why don't they? 



> If you you are choosing to buy a car and have a choice between dealerships are going to spend a lot of time with the dealership that won't even tell you how much the car is going to cost? Makes no sense? This is as common sense as it gets, bill.


...in regards to buying a car, yes.  Not health care.  That is not common sense.  That is apples and oranges.  You are taking an overly simplistic view here without looking at all the factors in play (granted not hard to do regarding something this complex).



> If you can't figure this out no wonder you don't have clue one how to fix this.


I don't.  Nor do you.  The diff is I admit it and don't suggest unworkable plans to do so.

PS:  I wish things worked how you suggest.  Boy do I wish that were true.  Unfortunately, they simply do not.


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## bill5 (Sep 13, 2011)

Bern80 said:


> So fees are negotiated. So what? That's kind of the idea here. That consumers negotiate directly with providers for the best price.


So you again missed the point, that's so what.  Fees are negotiated BY THE INSURANCE COMPANIES.  Who are able to do so - unlike consumers - for reasons already explained.


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## Greenbeard (Sep 13, 2011)

I hate to interrupt a great discussion, but it's worth posting a recent news story pertinent to the original post. Now that healthcare.gov is collecting information on insurer denial rates we can get a good look at how many people get turned away. Though it varies widely from market to market, more than one in five people get denied in the individual market at present.



> The federal website contains denial rates in all 50 states, the District of Columbia and U.S. territories, and is updated periodically. The most current information is for the first three months of 2011. The data show that denial rates routinely exceed 20 percent and often are much higher, according to a KHN review of 20 of the most populous states and the District of Columbia. The data reflect applications that are turned down for any reason.


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## Bern80 (Sep 13, 2011)

Greenbeard said:


> I hate to interrupt a great discussion, but it's worth posting a recent news story pertinent to the original post. Now that healthcare.gov is collecting information on insurer denial rates we can get a good look at how many people get turned away. Though it varies widely from market to market, more than one in five people get denied in the individual market at present.
> 
> 
> 
> > The federal website contains denial rates in all 50 states, the District of Columbia and U.S. territories, and is updated periodically. The most current information is for the first three months of 2011. The data show that denial rates routinely exceed 20 percent and often are much higher, according to a KHN review of 20 of the most populous states and the District of Columbia. The data reflect applications that are turned down for any reason.



That is important, but also important is WHY they are being denied. Again I think part of the issue is because people tend to not take a lot of time to actually understand what their plan covers, they think an insurance plan basically covers everything. And again, that simply isn't so. It says the insurance company will cover x costs under x conditions. If your issue does not fall under those parameters you really have no business griping to the insurance company about not covering something they aren't obligated to cover in the first place and you can't tell that at least some of those 20% of denials aren't things insurance companies have no obligation to cover.

On the opposite side if they are denying things they really ought to be covering perhaps some more regulation would be in order in strictly enforcing these contracts.


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## Bern80 (Sep 13, 2011)

bill5 said:


> Bern80 said:
> 
> 
> > So fees are negotiated. So what? That's kind of the idea here. That consumers negotiate directly with providers for the best price.
> ...



I am aware fees are negotiated by insurance companies. I'm not missing anything bill. You are. What you apparently missed is econ class in high school. And no you never did explain why it is simply not possible for a person to negotiate the cost of treating a broken arm rather than an insurance company or why it simply isn't possible for an individual to shop for the best quality of care at the best price for said injury. You get more bazar by the minute bill. You have a problem with an insurance model but are basically advocating FOR them, by totally rulling out any other type of model that involves accountability on the part of the consumer.


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## AnnieInMexico (Sep 13, 2011)

Bern80 said:


> I am aware fees are negotiated by insurance companies. I'm not missing anything bill. You are. What you apparently missed is econ class in high school. And no you never did explain why it is simply not possible for a person to negotiate the cost of treating a broken arm rather than an insurance company or why it simply isn't possible for an individual to shop for the best quality of care at the best price for said injury. You get more bazar by the minute bill. You have a problem with an insurance model but are basically advocating FOR them, by totally rulling out any other type of model that involves accountability on the part of the consumer.



But it is possible to negotiate the cost of medical care when paid for by a private citizen.  I do it for a living on behalf of  my patients.  If it involves ins then no, you are correct.  We cannot negotiate and over ride a contract between a medical provider and the ins co.


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## bill5 (Sep 13, 2011)

Greenbeard said:


> The data show that denial rates routinely exceed 20 percent and often are much higher,


They are actually all over the map depending on a variety of circumstances/locations, which is what the article ends up actually saying more than anything.




Bern80 said:


> That is important, but also important is WHY they are being denied. Again I think part of the issue is because people tend to not take a lot of time to actually understand what their plan covers, they think an insurance plan basically covers everything. And again, that simply isn't so. It says the insurance company will cover x costs under x conditions. If your issue does not fall under those parameters you really have no business griping to the insurance company about not covering something they aren't obligated to cover in the first place and you can't tell that at least some of those 20% of denials aren't things insurance companies have no obligation to cover.
> 
> On the opposite side if they are denying things they really ought to be covering perhaps some more regulation would be in order in strictly enforcing these contracts.


All good points, but you misunderstood:  the article discusses people denied coverage at all, ie 20% getting denied a policy, not 20% of their claims being denied.


----------



## Bern80 (Sep 13, 2011)

bill5 said:


> Bern80 said:
> 
> 
> > It is not "inexplicable" and I have not refused to answer.  It has been explained to you above by me and others, but you continue to ignore it.  If you don't want to accept those answers, fine; do some research, talk to those in the biz, etc and you will find out for yourself.
> ...


----------



## Bern80 (Sep 13, 2011)

AnnieInMexico said:


> Bern80 said:
> 
> 
> > I am aware fees are negotiated by insurance companies. I'm not missing anything bill. You are. What you apparently missed is econ class in high school. And no you never did explain why it is simply not possible for a person to negotiate the cost of treating a broken arm rather than an insurance company or why it simply isn't possible for an individual to shop for the best quality of care at the best price for said injury. You get more bazar by the minute bill. You have a problem with an insurance model but are basically advocating FOR them, by totally rulling out any other type of model that involves accountability on the part of the consumer.
> ...



Then here is the million dollar final question. Can an individual negotiate a better price with a provider than an insurance company for the same service?


----------



## AnnieInMexico (Sep 13, 2011)

Bern80 said:


> Then here is the million dollar final question. Can an individual negotiate a better price with a provider than an insurance company for the same service?



I'm not sure.  I know they can negotiate for the same price as an ins co, I guess for the sake of TODAY (vs. future) one thing they can do is see what Aetna pays for a broken arm, that might be 10% more than what BC/BS pays for the same services, contractually speaking.

I rarely get fees negotiated down below what ins pays and when I do it is for highly specialized drugs or treatments that even ins won't pay for.

Example, I used to work for the county hospital in Phoenix.  There are 'designer' chemo drugs that cost 10s of thousands of dollars per dose.  Medicaid doesn't cover them, private ins doesn't cover them.  The two groups of people that can afford them are wealthy who will self pay and quite frankly, illegals.  There is a list of drugs an ins co will pay for and each ins co has a different list of drugs they will honor.  Illegals have no formulary, they have no limits.

This means your kid could be in the hospital with an illegal kid and they both have some horrific form of cancer.  Your kid has ins that denies the claim for 'x' drug.  The illegal kid has no insurance so they are covered and get the drug.

In rare cases such as this I can get negotiated fees because so few people can afford the drug it often times expires before it's used and wasted.  The hospital would prefer to take less money for the drug and get something out of it vs. returning it to the manufacturer to be destroyed.  BTW, county hospitals gets these designer drugs for free from the manufacturer.  Doesn't cost them a penny.  Should they take $1K for it vs. the $10K they are charging ins co's?  Or just pitch the thousand and return the drug?

In cases like that you can negotiate for less than the ins co but other than that, I personally haven't seen this scenario happen.


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## bill5 (Sep 13, 2011)

Bern80 said:


> I am aware fees are negotiated by insurance companies. I'm not missing anything bill.


Yes, actually, you are:  reality.  For the last time:  economic theory does not equate to reality and you ignore other factors in play.



> What you apparently missed is econ class in high school.


 This is not econ class.  Again, this is reality.  Life and the business world make their own rules and don't necessarily give a flip about following textbooks FYI.



> And no you never did explain why it is simply not possible for a person to negotiate the cost of treating a broken arm rather than an insurance company or why it simply isn't possible for an individual to shop for the best quality of care at the best price for said injury.




Give that a try and let us know how it works out.  There may be instances where it's feasible, but I assure you they are in the extreme minority.



> You get more bazar by the minute bill.


"bizarre" is the word I think you were reaching for, but it still doesn't apply or even make sense.  Disagreeing with you does not equate to being bizarre; sorry.



> You have a problem with an insurance model


Define "have a problem with an insurance model."  If by that you mean I think it is flawed, certainly.  If you mean I think it should or can be scrapped (or something close to it) as you have, I have been saying quite the opposite.


----------



## Bern80 (Sep 13, 2011)

bill5 said:


> Greenbeard said:
> 
> 
> > The data show that denial rates routinely exceed 20 percent and often are much higher,
> ...



I agree that is harder one to solve. But it somewhat relates to my idea to fix social security. I think the social services we do have should go to those that really need them. Meaning I would modify social security and medicare such that instead of automatically getting them at a certain age (let's face it, Bill Gates, Warren Buffett, etc. don't really need to collect SS) you need to show a need for them. That would ensure that those that need it get the service and should also lower everyone elses tax burden. So if 20% of the population can't get insurance anywhere maybe we need to consider expanding medicare to those people.


----------



## bill5 (Sep 13, 2011)

Bern80 said:


> Then you will have to spell it out for me.


 I and others have already tried; frankly you have shown that to be pointless.



> I haven't ignored anything and have actually answered this several times myself. I never said there is no need for insurance at all.


Then pardon my misinterpretation.  When you said "how about you the consumer just pay for the services he provides you" initially, ie a blanket proposal, that's what it sounded like to me.



> If you grasp the bigger theme I'm talking about here I'm saying it's overused, which is causing services to cost more than they should be. It is not unworkable. Take a second. Forget what you think you know and humor me.


It is quite unworkable, again for reasons explained (multiple times).  As for humouring you, sorry, I've had enough of that.



> In the words of one wiser than me. 'NO, it is no different. Only different in your mind".


 It is different in this thing we call the real world.  Cars are not people and health care is not buying auto parts or services, in a wide variety of ways.


----------



## Bern80 (Sep 13, 2011)

bill5 said:


> Give that a try and let us know how it works out.  There may be instances where it's feasible, but I assure you they are in the extreme minority.



Now you're just being difficult. You're really going to try and pretend that is not possible for me to call a hospital, tell them my arm is broken and want to pay for all of it out of pocket and ask them what it will cost, then call another hospital and another and ask them what it will cost? And you're going to insist it's not possible for me to find someone who would give recommendations for good physicians at some of these hospitals?

EVERY good or service responds to beasic economic forces. Health care is not immune to it. The reason it doesn't react the same way is not because of some anomoly of the servce of health care. If some good or service doesn't react as economic theory suggests it is because some other variable is present overriding that economic principle.


----------



## Bern80 (Sep 13, 2011)

bill5 said:


> Bern80 said:
> 
> 
> > Then you will have to spell it out for me.
> ...



Then for love of god explain why. Because believe me I want to solve this as much as the next guy. But you can't keep saying it's so and keep insisting you've told us all how health care services react differently to market factors than any other good or service out there, when the fact is NO WHERE in this thread have you done that. If you have, copy and paste it.


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## Greenbeard (Sep 13, 2011)

Bern80 said:


> That is important, but also important is WHY they are being denied. Again I think part of the issue is because people tend to not take a lot of time to actually understand what their plan covers, they think an insurance plan basically covers everything.



These are not _claims_ denials, in which an insured person's payer rejects a claim from a provider. These are coverage denials, in which someone seeks to buy insurance and is turned down.


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## Bern80 (Sep 13, 2011)

bill5 said:


> I and others have already tried; frankly you have shown that to be pointless.



That is a lie. You have explained the way things are. You have not explained why prices won't go down using the solutions I've suggested.



bill5 said:


> It is different in this thing we call the real world.  Cars are not people and health care is not buying auto parts or services, in a wide variety of ways.



Theory is used to explain the real world, bill. Not answering farily simple questions speaks volumes about your credibility. You went so far as to imply a person can't call a hospital and ask how much a service costs if they want to pay for it themselves.


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## Care4all (Sep 14, 2011)

your car seat gets ripped, you price a new seat and it is too much money for you to replace it...so you live with the old ripped seat....

you crush and break your arm...you price what it is going to take to fix it and the break....it's too expensive and you can not afford it.....

do you just deal with the crushed and broken arm on your own or do ya go to a doc and get it fixed, regardless of cost?

health care is not a widget.


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## bill5 (Sep 14, 2011)

Bern80 said:


> Theory is used to explain the real world, bill.


No it isn't, but I'm hardly surprised you think so.  

I am not going in circles with you any more.  Think whatever you want.




Care4all said:


> your car seat gets ripped, you price a new seat and it is too much money for you to replace it...so you live with the old ripped seat....
> 
> you crush and break your arm...you price what it is going to take to fix it and the break....it's too expensive and you can not afford it.....
> 
> ...


Thanks for the example.  I wasn't about to waste the keystrokes.


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## Bfgrn (Sep 14, 2011)

Care4all said:


> your car seat gets ripped, you price a new seat and it is too much money for you to replace it...so you live with the old ripped seat....
> 
> you crush and break your arm...you price what it is going to take to fix it and the break....it's too expensive and you can not afford it.....
> 
> ...



Sure it is a 'widget'...anyone who is denied coverage for a serious illness can take their business elsewhere.................................IN ANOTHER LIFE!!!


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## Bern80 (Sep 15, 2011)

Care4all said:


> your car seat gets ripped, you price a new seat and it is too much money for you to replace it...so you live with the old ripped seat....
> 
> you crush and break your arm...you price what it is going to take to fix it and the break....it's too expensive and you can not afford it.....
> 
> ...



I have repeatedly stated I am not propsing we completely do away with insurance. If your financial siutation dictates that you can't really afford to pay for much anything then you probably should have some type of comprehensive insurance coverage. Or as I have suggest before, perhaps we should modify medicare such that only those with a financial need can be on it. If you don't have insurance, try negotiating payments with the hospital if it is too expensive to pay all at once. I have done this several times. Or, believe it or not, there are some people who actually do just let it go. They sling or splint the break and let it heal. The point is there are all kinds of different methods and models that can be used for one to pay for the health care they need that would help bring prices down. Competition in every other good or service contributes to driving down the cost of like items between those competitors. No one yet has been able to explain to me why that basic economic principle simply can not be applied to health care. No one can explain to me why it isn't possible for a person to call a few different hospitals to find out what a service would cost them. Or do some research as to quality of care comparison between facilities.

This is starting to border on childish with some of you. We have a common goal; get people the health care they need afforably. But for who knows what reason you are adamant in rejecting any type of policy that puts more responsibility on the consumer. You seem to be adamant in not applying any type of economic principle to this industry that works everywhere else to bring costs down.


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## Brutus (Sep 17, 2011)

Bfgrn said:


> WHY did health care need reform?



Simple, liberals took the capitalism out of our health care system and so it developed a soviet level of efficiency. A liberal will lack the IQ to understand capitalism so will not be able to talk intelligently about this issue.


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## Brutus (Sep 17, 2011)

Bern80 said:


> You seem to be adamant in not applying any type of economic principle to this industry that works everywhere else to bring costs down.



this is because a liberal will lack the IQ to understand capitalism.


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## Brutus (Sep 17, 2011)

Care4all said:


> health care is not a widget.



true enough, it is far more important and far more complex. This is all the more reason to have it strictly and precisely regulated by capitalism rather than a few cancerous liberals in Washington.


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## bill5 (Sep 17, 2011)

You're right!  It's all the liberals' fault!  They are responsible for the defecit, the war, El Nino, cancer, world hunger, and bad breath!  Dammit if only we only got rid of all liberals the world would be perfect!!

   If you're much past the age of 12, your posts are laughably idiotic.

PS and oh btw: I am pretty conservative, overall.  Unlike you, however, I possess a functioning brain, which means I know neither "side" is always right or wrong, to say the least.


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## Brutus (Sep 17, 2011)

Ok then  why be so afraid to tell us a substantive conservative position that is mistaken???


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## bill5 (Sep 18, 2011)

If anyone can trasnslate I'd appreciate it.


----------



## Bfgrn (Sep 18, 2011)

bill5 said:


> If anyone can trasnslate I'd appreciate it.



It is an attempt by a child to use adult words.


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## Brutus (Sep 18, 2011)

bill5 said:


> your posts are laughably idiotic.



if so why be so afraid to present your best example for the whole world to see?????


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## bill5 (Sep 18, 2011)

Bfgrn said:


> bill5 said:
> 
> 
> > If anyone can trasnslate I'd appreciate it.
> ...


Thank you.


----------



## Bern80 (Sep 19, 2011)

Brutus said:


> bill5 said:
> 
> 
> > your posts are laughably idiotic.
> ...



No, no he claims he alraady explained why free market principles won't work.......except there is no post in this thread that actually provides such an explanation......


----------



## Bfgrn (Sep 19, 2011)

Bern80 said:


> Brutus said:
> 
> 
> > bill5 said:
> ...



It's pretty simple Bern. It is something that any person with an adult mind should be able to not only understand, but figure out on his own.

The whole basis of a 'free market' is the buyer has leverage, i.e. he/she can take his/her business elsewhere. That works perfectly fine when the stakes are things (cars or TV sets etc). But a person's health is not a 'thing', and the consumer's stake is their very life. An unhappy consumer can go buys a different car or TV. If a person has a life threatening illness and is denied coverage for treatment, WHAT leverage does that person have...take their business elsewhere IN ANOTHER LIFE?


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## bill5 (Sep 19, 2011)

I applaud your determination, but it should be clear by now that attempts to get through are pointless.


----------



## Bern80 (Sep 19, 2011)

bill5 said:


> I applaud your determination, but it should be clear by now that attempts to get through are pointless.



Naw. He's actually making an effort. he actually managed to form a semblance of a counter argument... a place to actually begin a debate. Far more than I can say for you. If I didn't know better, given your obtuseness, weaseling, lying and general lack of maturity I'd say this is Jake Starkey's new account.


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## Bern80 (Sep 19, 2011)

Bfgrn said:


> Bern80 said:
> 
> 
> > Brutus said:
> ...



I guess if your serious about looking at the above scenario we'd have to look at some details. First off, why is coverage being denied? Is it because the plan doesn't cover the needed treatment or because the insurance company is being shady? Or do we just want to assume there is no possible chance any insurance provider is going to pay the cost of treatment?


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## bill5 (Sep 19, 2011)

Bern80 said:


> bill5 said:
> 
> 
> > I applaud your determination, but it should be clear by now that attempts to get through are pointless.
> ...


  First idiocy, now childish attacks and the pot/kettle thing.  What a surprise.  

I made the effort.  You ignored what I and others said.  Now you're surprised I don't re-re-repeat myself?  Whatever.


----------



## Bfgrn (Sep 19, 2011)

Bern80 said:


> Bfgrn said:
> 
> 
> > Bern80 said:
> ...



You really need to watch the half hour interview with Wendell Potter in the OP.


----------



## Bern80 (Sep 19, 2011)

bill5 said:


> Bern80 said:
> 
> 
> > bill5 said:
> ...



No bill. You did not. You never answered the question even once. There aren't many posts in this thread to go through and no where did I see an answer to the question I asked, which was essentially why free market principles won't help to bring the cost of health care down. If you did, feel free to simply copy and paste. Any other response to this is simply proof that you're a liar.


----------



## Bern80 (Sep 19, 2011)

Bfgrn said:


> Bern80 said:
> 
> 
> > Bfgrn said:
> ...



I did watch it. What it has to do with a person's options once denied coverage I have no idea. We can't even go that far because you won't answer why, in this hypothetical scenario, the person was denied. That would require you to acknowledge that just having insurance doesn't mean any and all health care costs are going to be covered by your plan.


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## Brutus (Sep 19, 2011)

Bfgrn said:


> If a person has a life threatening illness and is denied coverage for treatment, WHAT leverage does that person have...take their business elsewhere IN ANOTHER LIFE?



that would be the rare exception of course. Capitalism makes it possible for people to afford critical things like food, clothing, and shelter whereas under socialism people starved to death in the 10's of millions . In a truly capitalist system very few would need to be subsidized.

A liberal is a liberal because he lacks the IQ to understand capitalism.


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## bill5 (Sep 19, 2011)

Or English, apparently.


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## saveliberty (Sep 19, 2011)

Healthcare was not reformed, it was hijacked by Democratic terrorists.


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## bill5 (Sep 19, 2011)

Well it's about time.  Finally someone comes along to digress yet another thread here into a wingnut cat fight!  YAAAAAAAAAYYYY   The left sucks!  No wait the right sucks!  Bush!  Obama!  Tea Party!  There's my opinion and the wrong one!  My side is always right!  Yours is always wrong!  blah! etc! blah!


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## saveliberty (Sep 19, 2011)

A reform would have addressed accessibility across state lines for coverage and tort reform.  This bill simply applied accounting tricks and lead time on a plan doomed from the start.  Then violating our Constitutional right to choose if we buy a product.  Pardon my shorthand.


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## Bfgrn (Sep 20, 2011)

Bern80 said:


> Bfgrn said:
> 
> 
> > Bern80 said:
> ...



I can believe anyone could watch that interview and not see that the for profit insurance cartels are the root of our problems.

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

BILL MOYERS: So, the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

WENDELL POTTER: That's right. Exactly right.

BILL MOYERS: So they want to reverse that. They don't want my premium to go for my health care, right?

WENDELL POTTER: Exactly right. They--

BILL MOYERS: Where does it go?

WENDELL POTTER: Well, a big chunk of it goes into shareholders' pockets. It's returned to them as part of the investment to them. It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses. So a lot of it goes to pay those kinds of administrative functions. Overhead.


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## Bern80 (Sep 20, 2011)

Bfgrn said:


> Bern80 said:
> 
> 
> > Bfgrn said:
> ...




I'm in no way defending the insurance companies, Bf. In fact if you read back you will see where I addressed the actual conversation above and the beneficial steps that some insurance companies are taking.  I can give you a perfect example of how when financies directly impact the actual consumer costs go down and quality goes up. Our employer provided insurace plan is providing not just free health screenings at our offices for the next couple weeks they are actually giving people $100 to attend them.  How many people do you suppose started taking a real interest in their overall health for a moment? Why do suppose an insurance company would offer something like that? Perhaps to improve that medical loss ratio Potter talks about? Now I agree that not all insurance companies are saints, but fact that we agree insurance companies are part of the problem make it all the more bewildering that we disagree on the solution. We need some type of system other than we have now, but you immediately rule out any type of solution that is free market based (principles that have shown to reduce costs wherever else tried) and you are anti any solution that gives the consumer of the service any more control/responsibility over their health care decisions and finances.

Getting back to our hypothetical it is again important to know why the person was denied coverage. Again there is no health insurance plan that covers everything. Believe it or not some claims are legitimately denied and if your complaint is the isurance companies should never deny anything and that everything ought to be covered, that is a bit of a different conversation. Insurance claims can legitimately be denied Bf. To believe that your insurance plan is supposed to cover any and every medical expense is to live in a fairy tale land.  Getting back to reality you need to stop being  consumer with the 'evil' insurance companies and start tackling this issue from purely a financial perspective. There will always be cases where sometimes the financia responsibility of some health care service will fall to the consumer. Maybe their denied coverage for certain treatment, maybe there insurance has run out, who knows. The real question is what should a person and/or we as a society do when health care costs exceed what a person can reasonably expect to pay. Isn't that the real question here?


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## Greenbeard (Sep 20, 2011)

Bern80 said:


> That fact that we agree insurance companies are part of the problem make it all the more bewildering that we disagree on the solution. We need some type of system other than we have now, but you immediately rule out any type of solution that is free market based (principles that have shown to reduce costs wherever else tried) and you are anti any solution that gives the consumer of the service any more control/responsibility over their health care decisions and finances.



Haven't you simply been advocating for insurance plans with higher deductibles on average?


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## Bfgrn (Sep 20, 2011)

Bern80 said:


> Bfgrn said:
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The problem with insurance cartels is much greater and much more anti-patient outcome than you either realize or acknowledge.

Wall Street investors whose ONLY concern is profit margins should not be controlling that industry.


*Coverage Denied: How the Current Health Insurance System Leaves Millions Behind*

*Pre-Existing Conditions Affect Millions of Americans*

*A large proportion of Americans have health conditions that insurance companies can qualify as pre-existing conditions.
*
A pre-existing condition is a medical condition that existed before someone applies for or enrolls in a new health insurance policy. It can be something as prevalent as heart disease  which affects one in three adults1  or something as life-changing as cancer, which affects 11 million Americans.2

But a pre-existing condition does not have to be a serious disease like cancer or heart disease. Even relatively minor conditions like hay fever, asthma, or previous sports injuries can trigger high premiums or denials of coverage.3

*Unattainable Health Coverage*

*Insurance discrimination based on pre-existing conditions makes adequate health insurance unavailable to millions of Americans.*

In 45 states across the country, insurance companies can discriminate against people based on their pre-existing conditions when they try to purchase health insurance directly from insurance companies in the individual insurance market.4 Insurers can deny them coverage, charge higher premiums, and/or refuse to cover that particular medical condition.

A recent national survey estimated that 12.6 million non-elderly adults5  36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market  were in fact discriminated against because of a pre-existing condition in the previous three years.6

In another survey, one in 10 people with cancer said they could not obtain health coverage, and six percent said they lost their coverage, because of being diagnosed with the disease.7

It is still legal in nine states for insurers to reject applicants who are survivors of domestic violence, citing the history of domestic violence as a pre-existing condition.8

Even when offering coverage, insurers can exclude whole categories of illnesses related to a pre-existing condition. For example, someone with a pre-existing condition of hay fever could have any respiratory system disease  such as bronchitis or pneumonia  excluded from coverage.9

*Losing Coverage When You Need It Most*

*Thousands of Americans also lose health insurance each year through a practice called rescission.*

When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire. In most states individual insurance market, insurance companies can retroactively cancel the entire policy if any condition was missed  even if the medical condition is unrelated, and even if the person was not aware of the condition at the time. Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition.10

A recent Congressional investigation into this practice found nearly 20,000 rescissions from three large insurers over five years, saving them $300 million in medical claims11  $300 million that instead had to come out of the pockets of people who thought they were insured, or became bad debt for health care providers.

At least one insurance company has been found to evaluate employee performance based in part on the amount of money an employee saved the company through rescissions.12 Simply put, these insurance company employees are encouraged to revoke sick peoples health coverage.

More


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## dblack (Sep 20, 2011)

Greenbeard said:


> Bern80 said:
> 
> 
> > That fact that we agree insurance companies are part of the problem make it all the more bewildering that we disagree on the solution. We need some type of system other than we have now, but you immediately rule out any type of solution that is free market based (principles that have shown to reduce costs wherever else tried) and you are anti any solution that gives the consumer of the service any more control/responsibility over their health care decisions and finances.
> ...



No. It's an one _example_ of the kinds of alternatives people might explore. We're advocating for the freedom to make those kinds of choices without asking the government (or the regulators, or the vested interests in the health insurance industry) for permission.


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## Greenbeard (Sep 20, 2011)

dblack said:


> Greenbeard said:
> 
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> > Bern80 said:
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You don't need to ask permission for a high-deductible plan.

What are the other alternatives on the agenda?


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## dblack (Sep 20, 2011)

Bfgrn said:


> The problem with insurance cartels is much greater and much more anti-patient outcome than you either realize or acknowledge. ...



The cartelization of the insurance industry IS the problem. The health insurance cartel is built on government regulation. Which is why it's so painful to watch our leaders selling people on the idea that the solution is even more.


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## dblack (Sep 20, 2011)

Greenbeard said:


> You don't need to ask permission for a high-deductible plan.
> 
> What are the other alternatives on the agenda?



They're infinite. That's the point. From what I've read, catastrophic plans will not count as sufficient coverage - but it's all up to the regulators and their lobbyists eh? The point is, what we're arguing for isn't a specific plan of action, it's the freedom to find our own solutions rather than have the vested interests choose them for us.


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## Bern80 (Sep 20, 2011)

Greenbeard said:


> Bern80 said:
> 
> 
> > That fact that we agree insurance companies are part of the problem make it all the more bewildering that we disagree on the solution. We need some type of system other than we have now, but you immediately rule out any type of solution that is free market based (principles that have shown to reduce costs wherever else tried) and you are anti any solution that gives the consumer of the service any more control/responsibility over their health care decisions and finances.
> ...



Hadn't thought of it like that, but that would be one way of introducing such concepts.


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## Bfgrn (Sep 20, 2011)

dblack said:


> Bfgrn said:
> 
> 
> > The problem with insurance cartels is much greater and much more anti-patient outcome than you either realize or acknowledge. ...
> ...



Please provide the government 'regulations' that have cartelization of the insurance industry.

Are you saying that if the government just leaves the cartels alone, they will will become good actors and no longer put profits before patients?


The first thing to understand is the difference between the natural person and the fictitious person called a corporation. They differ in the purpose for which they are created, in the strength which they possess, and in the restraints under which they act. Man is the handiwork of God and was placed upon earth to carry out a Divine purpose; the corporation is the handiwork of man and created to carry out a money-making policy. There is comparatively little difference in the strength of men; a corporation may be one hundred, one thousand, or even one million times stronger than the average man. Man acts under the restraints of conscience, and is influenced also by a belief in a future life. A corporation has no soul and cares nothing about the hereafter.
William Jennings Bryan, 1912 Ohio Constitutional Convention


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## Bern80 (Sep 20, 2011)

Bfgrn said:


> Bern80 said:
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The above is why we can't solve the problem, Bf. You are so consumed with some rage at insurance companies you can't see the real problem, much less how to solve it. You have to stop looking at the issue from the perspective that having an insurance plan is the only way to deal with medical expenses.


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## Bfgrn (Sep 20, 2011)

Bern80 said:


> Bfgrn said:
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I have a perfect solution. It is what our founding fathers did. They pulled the corporate charter and shut down any corporation that caused harm to We, the People. And they held the owners and stockholders personally liable for that harm.

America&#8217;s Health Care System at the Bottom of the Heap

Mortality Rates

Mortality rates for both the entire adult population (15-74) and for older people (55-74).

Utilizing standard statistical tools and analysis, the study ranked the same 19 countries according to their effectiveness in reducing the mortality rate for the elderly populace ages 55 to 74. Comparing the amount of money spent by each country on health care and the reduced mortality rates, the countries fell into the following ranking:

    Ireland
    United Kingdom
    New Zealand
    Austria
    Australia
    Italy
    Finland
    Japan
    Spain
    Sweden
    Canada
    Netherlands
    France
    Norway
    Greece
    Germany
*    USA*
    Portugal
    Switzerland

Conclusions

Take a look. America outspends everyone else by far on health care, and has shown the least amount of improvement on mortality rates, with the exception of Portugal and Switzerland. Why does the United States do such a poor job?

The authors give several potential reasons, including regional disparities in health care availability in a country as large as the US, the much higher rate of firearms-related homicides here, and the higher number of un-insureds we have. The study is, however, consistent with other reports that show the USA is doing a poor job of health care for its citizens. A recent UNICEF report looked at &#8220;well-being&#8221; of children among major industrialized countries (e.g. material wealth, family relationships, health care), and found the United States ranking 23rd of 24 countries reviewed.

Universal vs. Private Health Insurance

*There is one factor common to the top 15 countries on the above list. They all have strong state funding of single-payer universal health care, instead of insurance based health care tied to employment. The bottom four countries &#8211; Germany, USA, Portugal and Switzerland &#8211; all depend more heavily on profit-based, private health insurance provided primarily through the employer/employee relationship.*


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## saveliberty (Sep 20, 2011)

Why was healthcare reform needed?  Because Democrats want another area of life to control people.  It is all about grabbing power.  The resulting law clearly demonstrates healthcare is no better, but there is more control.


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## Bfgrn (Sep 20, 2011)

saveliberty said:


> Why was healthcare reform needed?  Because Democrats want another area of life to control people.  It is all about grabbing power.  The resulting law clearly demonstrates healthcare is no better, but there is more control.



The Cost of Doing Nothing
*Why the Cost of Failing to Fix Our Health System Is Greater than the Cost of Reform*

2008

The U.S. health care system is in crisis. Health care costs too much; we often get too little in exchange for our health care dollar; and tens of millions of Americans are uninsured.

Our economy loses hundreds of billions of dollars every year because of the diminished health and shorter lifespan of the uninsured. Rising health care costs undermine the ability of U.S. firms to compete internationally, threaten the stability of American jobs, and place increasing strain on local, state, and federal budgets. As health care costs continue to rise faster than wages, health insurance becomes more and more unaffordable for more and more American families every day.

Yet, the recent financial services meltdown has led some people to suggest that we cannot afford health reform and that fixing our broken health care system will have to wait once again. But waiting comes with a price. The crisis worsens every day that we do not act. Premiums will continue to rise; Americans will continue to pay more for less-generous health coverage; and fewer employers will offer health insurance to their workers.

We must reform our struggling health system not in spite of our economic crisis, but rather because of the impact health care has on the American economy. The economic and social impact of inaction is high and it will only rise over time.

*Economic Cost*

The economic cost of failing to fix our broken health care system is greater than the upfront expense of comprehensive health reform. In 2006, our economy lost as much as $200 billion because of the poor health and shorter lifespan of the uninsured. This is by most estimates as much as, if not greater than, the public costs of ensuring all Americans have quality, affordable, health coverage. The economies in California, Texas, and Florida suffer most from productivity loses stemming from the uninsured. Yet, Delawares economy loses more per uninsured person -- over $6,800 per uninsured resident.

*Affordability*

As health care costs continue to grow faster than wages, health insurance will become more and more unaffordable for more and more American families every day. The financial burdens associated with health care and health insurance will only get worse over time without action.The cost of the average employer-sponsored health insurance plan (ESI) for a family will reach $24,000 in 2016. This represents an 84 percent increase over 2008 premium levels. *Under this scenario, we estimate that at least half of American households will need to spend more than 45 percent of their income to buy health insurance.*

More


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## saveliberty (Sep 20, 2011)

I see your resorting to the same incorrect thinking that is applied to Obama's jobs and economic recovery plans.  It would have been so much worse, if Obama hadn't done this ir that. Well it will come as a shock to you, but healthcare costs are STILL RISING at a high level.  He didn't do a thing with healthcare.  It DID cause uncertainty in the business community though.  That slowed job recovery.


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## Bern80 (Sep 20, 2011)

Bfgrn said:


> dblack said:
> 
> 
> > Bfgrn said:
> ...



And here is another reason we can't solve this problem. It essentially amounts to the 'evil corporate america' excuse. Is GM a bad actor in your opinon? How about Microsoft? Are those companies worse or better actors than the 'evil' health insurance companies? Oh by the way, which of those three is the most heavily regulated?


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## Bfgrn (Sep 20, 2011)

saveliberty said:


> I see your resorting to the same incorrect thinking that is applied to Obama's jobs and economic recovery plans.  It would have been so much worse, if Obama hadn't done this ir that. Well it will come as a shock to you, but healthcare costs are STILL RISING at a high level.  He didn't do a thing with healthcare.  It DID cause uncertainty in the business community though.  That slowed job recovery.



Don't worry, Republicans are busy working for Wall Street investors and against the people.

GOP Backs Insurance Industry-Friendly, Anti-Consumer Bills

House Republicans, unable to repeal President Obama's health care reform law outright, have decided to go after it piece by piece. If they are successful, what's likely to remain is the kind of reform the insurance industry dreamed of, but never really thought could be the law of the land.

Although the Republican-controlled House passed legislation to repeal the Affordable Care Act several months ago, the Senate, controlled by Democrats, rejected it. Bills are now being considered in the House that would strip some of the most important consumer protections from the new law. If the bills' sponsors are successful, health insurers would be free to spend as little of our premium dollars on our health care as they want, and they would be able to continue setting lifetime limits on policies and cancel our coverage at the time we need it most -- when we get sick. Other important benefits to consumers would also disappear.

One of the bills would eliminate a provision of the reform law that requires insurers to spend at least 80 percent of what we pay in premiums on actual medical care. The insurance industry tried, without success, to keep that provision out of the final bill, so they are solidly behind the effort to do away with it.

As I am explaining to the lawmakers, there is a single-minded focus among the big for-profit insurers on being able to show Wall Street and investors two things every three months: that the companies made more money during the most recent three months than during the same period a year earlier, and that the portion of each policyholder's premium devoted to covering medical expenses was less than it was the previous year.

When insurers release their quarterly earnings reports, investors and analysts look for two key figures: earnings per share, which is common to all companies; and the medical loss-ratio (MLR), which is unique to the health insurance industry. The MLR is the ratio between what an insurer actually pays out in claims and what it has left over to cover executive pay, underwriting, lobbying, sales, marketing, public relations, other administrative expenses, and, of course, profits.

More...

Wendell Potter is former Vice President of corporate communications at CIGNA, one of the United States' largest health insurance companies. In June 2009, he testified against the HMO industry in the U.S. Senate.


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## saveliberty (Sep 20, 2011)

Careful Bfgrn, you might start asking nonHuffo approved questions.  Stick to the script.


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## Bern80 (Sep 20, 2011)

Bfgrn said:


> Bern80 said:
> 
> 
> > Bfgrn said:
> ...



I wouldn't be terribly opposed to something like that to be honest. If two parties have an agreement over services, (i.e. an insurance company agrees to cover x expenses under x conditions in exchange for premiums from the insured) and the insurance company breaks said agreement then, yes, it should be the role of government to hold the insurance company responsible in some way for that breach of contract. But your last paragraph also reveals yet another reason we can't solve this problem. You can't be honest about what you want. All you really seem to care about is making it dirt cheap for consumer. Yeah technically we can do that if you just say 'here gov't, take my money and deal with it', just know you aren't going to address the issues really causing the problem and will likely get worse.


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## saveliberty (Sep 20, 2011)

Obama is the one who bailed out Wall Street Bfgrn.  Facts can hurt huh?


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## Bfgrn (Sep 20, 2011)

Bern80 said:


> Bfgrn said:
> 
> 
> > dblack said:
> ...



Corporations are not 'evil', they are amoral. They don't have the same aspirations for America that you and I do. A corporation does not want democracy. It does not want free markets, it wants profits. Corporations are externalizing machines. They're constantly figuring out ways to get somebody else to pay their costs of production. That's their nature.

They should NOT be allowed to run our health care...


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## Bfgrn (Sep 20, 2011)

saveliberty said:


> Obama is the one who bailed out Wall Street Bfgrn.  Facts can hurt huh?



TARP

Troubled Asset Relief Program

The Troubled Asset Relief Program (TARP) is a program of the United States government to purchase assets and equity from financial institutions to strengthen its financial sector that *was signed into law by U.S. President George W. Bush on October 3, 2008.*


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## OldUSAFSniper (Sep 20, 2011)

Oh hell, did I accidentally go to Salon.com or the HuffingtonPost.com again?  I am reading these posts from Bfgrn and obviously they were written by someone from the Obama administration.  Talking poiints straight from the mouth of an administration parrot.

2,600 pages that almost NOBODY read.  No one knows what it is going to do to businesses and no one knows what is going to happen when its fully implemented.  You want to know why small business is sitting on it's capital.  Look to this monstrosity sitting out there like King Kong and no one knows how its going to affect them.

It's a crap sandwich and hopefully it will get to the Supreme Court soon so we won't have to take a bite.


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## bill5 (Sep 20, 2011)

dblack said:


> The cartelization of the insurance industry IS the problem. The health insurance cartel is built on government regulation.


I doubt it, since I seriously doubt any such thing exists.  Insurance companies are independent of each other and very much in competition ie effectively opposed to each other.  There is no "cartel."




saveliberty said:


> I see your resorting to the same incorrect thinking that is applied to Obama's jobs and economic recovery plans.  It would have been so much worse, if Obama hadn't done this ir that. Well it will come as a shock to you, but healthcare costs are STILL RISING at a high level.  He didn't do a thing with healthcare.  It DID cause uncertainty in the business community though.  That slowed job recovery.



YAAAAAAAAAYYYY FINALLY!  Someone finally got back to what this site is all about:  digressing all threads into a wingnut cat fight!  The left sucks!  No wait the right sucks!  Bush!  Obama!  Tea Party!  It's all the other side's fault!  blah! etc! blah!


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## bill5 (Sep 20, 2011)

Bfgrn said:


> Corporations are not 'evil', they are amoral. They don't have the same aspirations for America that you and I do. A corporation does not want democracy. It does not want free markets, it wants profits. Corporations are externalizing machines. They're constantly figuring out ways to get somebody else to pay their costs of production. That's their nature.
> 
> They should NOT be allowed to run our health care...


Ultimately it's not much of a choice is it?  

Private/corporate driven health care means soul-sucking, anything-to-save-a-buck health care that screws those paying into it at every opportunity, by its very nature.  

Gov't driven health care means gross inefficiency and ultimately lower quality, also by its very nature, to say nothing of a severe additional tax burden.  

sigh


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## Skull Pilot (Sep 20, 2011)

The fatal flaw of logic in the OP is the assumption that health care and insurance are the same thing.


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## saveliberty (Sep 20, 2011)

Bfgrn said:


> Corporations are not 'evil', they are amoral. They don't have the same aspirations for America that you and I do. A corporation does not want democracy. It does not want free markets, it wants profits. Corporations are externalizing machines. They're constantly figuring out ways to get somebody else to pay their costs of production. That's their nature.
> 
> They should NOT be allowed to run our health care...



Corporations are a shell.  It is the people running that give it a moral or immoral leaning.  A corporation WANTS a democratic REPUBLIC.  It is the best environment to pursue a profit.  A corporation wants a free market when they are starting to compete, maybe not so much when they produce a new product or are well established.  Corporations seek to reduce production costs, but not necessarily by passing costs on to a third party.  Of course, reductions in production costs can be passed on to consumers in many cases.

More healthcare producers can lower costs.  Removing innovation and research by these corporations will slow the progress of medicine.  In this regard corporations have been moral.  Removing the profit incentive, which seems to be your goal, has negative consequences too.


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## Bfgrn (Sep 20, 2011)

OldUSAFSniper said:


> Oh hell, did I accidentally go to Salon.com or the HuffingtonPost.com again?  I am reading these posts from Bfgrn and obviously they were written by someone from the Obama administration.  Talking poiints straight from the mouth of an administration parrot.
> 
> 2,600 pages that almost NOBODY read.  No one knows what it is going to do to businesses and no one knows what is going to happen when its fully implemented.  You want to know why small business is sitting on it's capital.  Look to this monstrosity sitting out there like King Kong and no one knows how its going to affect them.
> 
> It's a crap sandwich and hopefully it will get to the Supreme Court soon so we won't have to take a bite.



Oh hell, did I accidentally go to Faux News or the Drudge Report again? I am reading these posts from USAFSniper and obviously they were written by someone from the corporate owned right wing echo chamber. Talking points straight from the mouth of Frank Luntz, the modern day Goebbels.


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## Bfgrn (Sep 20, 2011)

saveliberty said:


> Bfgrn said:
> 
> 
> > Corporations are not 'evil', they are amoral. They don't have the same aspirations for America that you and I do. A corporation does not want democracy. It does not want free markets, it wants profits. Corporations are externalizing machines. They're constantly figuring out ways to get somebody else to pay their costs of production. That's their nature.
> ...



A corporation wants profits...period. AND, if the corporation does anything that lowers profits, they can be sued by their shareholders.


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## Bern80 (Sep 20, 2011)

Bfgrn said:


> Corporations are not 'evil', they are amoral. They don't have the same aspirations for America that you and I do. A corporation does not want democracy. It does not want free markets, it wants profits. Corporations are externalizing machines. They're constantly figuring out ways to get somebody else to pay their costs of production. That's their nature.



They are whatever their customers demand them to be. Yes, they are profit driven. Again you make it sound as if that is an evil thing. Profits are what allow a business to provide jobs, and continue to provide a service to their customers. Of course they want profits, and the truly successful corporations, the one's that stand the test of time, know and have shown that the best way to be profitable is to DO WHAT YOUR CUSTOMERS WANT. This industry your griping about, the health insurance industry. They can't do that. They are regulated to the hilt such that what customers want has no bearing on their business. That is the issue Bf. The insurance cartel has no incentive to change how they do things beased on what their customers want because what they want doesn't matter. The demands and actions of the insured have no positive or negative impact on them. THAT is what has to change.




Bfgrn said:


> They should NOT be allowed to run our health care...



So I was right. We really can't address the issue because we're not even on the same page. You don't want to problem solve how we improve affordability and access. You are blinded by your hate of corproatism and all you want is for government to take it over and are stupid enough to believe that's gonna make everything all better.


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## saveliberty (Sep 20, 2011)

Bfgrn said:


> saveliberty said:
> 
> 
> > Bfgrn said:
> ...



Hmmm...and what about nonprofit corporations?

I own an S corporation.  I want my labor paid.  I also want the company to continue beyond the short term, so I am willing to reduce profits to do that.  What about green companies?  They in it purely for the profit?


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## Bern80 (Sep 20, 2011)

Skull Pilot said:


> The fatal flaw of logic in the OP is the assumption that health care and insurance are the same thing.



Correct. They can't seem to separate the two. To them no insurance = death.


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## Bfgrn (Sep 20, 2011)

Here is a well written article. Maybe some of you will 'get it'

Insurance Company Savings

We understand completely the idea of incentives in the workplace. If an employee does his job particularly well, we think a reward system of some kind makes perfect sense. Such a system is good for both the employee and the employer, as it encourages the employee to work harder while the employer reaps the benefits of those labors.

Performance based initiatives are great if you happen to be selling cars, or making donuts or tires. But we have a real problem with the idea of rewarding employees for denying crucial and needed services. And this is exactly what is happening with health care in California, and possibly all over the country.

A recent article in the Los Angeles Times details the inner workings of Blue Cross of California, in which employees are rewarded not for providing medical care, but rather for denying it.

The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

Bear in mind that this employee was not rewarded for selling more policies, or cutting delays of payment, or even having a sunny disposition with customers. This employee was rewarded for cutting policyholders who might have actually cost Blue Cross money. This employee was rewarded for denying insurance claims. This employee was rewarded for leaving sick people in serious financial trouble.

This is the inherent flaw in a for-profit health care system. In any business, profits are maximized by improving efficiency and cutting costs. In the health insurance business, the only way to cut costs is to cut the health care itself. This means that sick people are culled from the rosters of insurance companies, as their illnesses might actually end up costing the insurers money. They do this by systematically targeting anyone with breast cancer, leukemia, and up to 1,400 other illnesses. They also scour medical and pharmacy records to see if there are any discrepancies between what they have been told by the policy holder and what these records could tell them. For instance, if a policyholder gets cancer, and the insurance company finds out that five years ago the policyholder got a prescription for an anti-smoking drug, the insurance company could then drop the policyholder for not telling them about the smoking.  And if that doesnt work, insurers can simply partially deny claims, often using the excuse that a certain test or procedure was medically unnecessary or voluntary on the part of the patient, even if it wasnt.

It is the job of thinking people not to be on the side of the executioners.
Albert Camus


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## Bern80 (Sep 20, 2011)

Bfgrn said:


> Here is a well written article. Maybe some of you will 'get it'
> 
> Insurance Company Savings
> 
> ...



I get it. Have gotten and will continue to get it. It isn't that I don't get it. I understand what IS going on. WHY it is and how to change it is what YOU don't get and you continue to ignore my responses and questions. You complain about giving these corrupt corporations money yet are at the same time advocating that we give our money to an even more corrupt organization (the government) and let them take care of it.


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## Bfgrn (Sep 20, 2011)

Bern80 said:


> Bfgrn said:
> 
> 
> > Here is a well written article. Maybe some of you will 'get it'
> ...



Is corruption 'evil' Bern? Because you are guilty of exactly what you accuse me of. The truth: America's health care is the most expensive on the planet, yet we are ranked 37th in patient outcomes. Our system under-performs all other industrialized nations...and what do we know about ALL those nations who out perform us: 

"There is one factor common to the top 15 countries on the above list. They all have strong state funding of single-payer universal health care, instead of insurance based health care tied to employment. The bottom four countries  Germany, USA, Portugal and Switzerland  all depend more heavily on profit-based, private health insurance provided primarily through the employer/employee relationship."

http://www.usmessageboard.com/4165416-post109.html


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## Bern80 (Sep 20, 2011)

Bfgrn said:


> Bern80 said:
> 
> 
> > Bfgrn said:
> ...




Now you're gonna cite that WHO report? A report that heavily weights what people pay in defining our rank. I have been over that report with a fine tooth comb. if you actually dig into it you would see that they essentialy grade the individual paying little for health care as a 'good' thing which contributes to a higher rank. The reality of that report is that in terms out comes, research, quality of facilities, we are nearly the best in the world, but because it's expensive and our health habits are relatively UNhealty, we are ranked lower.

Grow a set and admit it, Bf. You would rather have government just babysit your healthcare needs for you instead of YOU having to take any responsibility for them. No fucking wonder this conversation isn't going anywhere. You STILL can't admit what it is you want. Which is why we can't even beging to discuss how to get there.


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## Bfgrn (Sep 20, 2011)

Bern80 said:


> Bfgrn said:
> 
> 
> > Bern80 said:
> ...



The 37 ranking is from the WHO, but our ranking against other industrial nations comes from the Journal of the Royal Society of Medicine.

Then there is the Commonwealth Fund study...

U.S. scores dead last again in healthcare study

So Bern, I guess that leaves you to parrot Frank Luntz talking point LIES like Republicans during the health care debate...

Say it Bern:

Government takeover of health care...
Death Panels...
Pulling the plug on grandma...


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## saveliberty (Sep 20, 2011)

Bfgrn said:


> Here is a well written article. Maybe some of you will 'get it'
> 
> Insurance Company Savings
> 
> ...



Your argument makes absolutely no sense for several reasons:

1.  Health care is so expensive because too many tests are run in an effort to CYA.
2.  Every health care professional I have ever met wants to help people.
3.  Critical care is not withheld from ANY patient in the US.
4.  Why would you give too much care to one person and not enough or none to another?
5.  What is wrong with premiums based on actual risks presented by the customer?

This just fails on so many levels.


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## Bern80 (Sep 20, 2011)

Bfgrn said:


> So Bern, I guess that leaves you to parrot Frank Luntz talking point LIES like Republicans during the health care debate...
> 
> Say it Bern:
> 
> ...



I don't know who you're referring to, but I don't know who Frank Lutz is and I certainly haven't been quoting him. I dont have to parrot it. It's what YOU said YOU wanted. You said 'for profit corporations should not be running health care'. Well that just leaves government doesn't it? This is why I keep asking what is your goal? Mine is improve quality and access to it. Government running the show is not going to achieve those ends. It's the solution to 'I would just rather not have to deal with the costs of my health care'. You are either really after the later, or are too stupid to see it won't accomplish the former. Pick one.


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## Bfgrn (Sep 20, 2011)

Bern80 said:


> Bfgrn said:
> 
> 
> > So Bern, I guess that leaves you to parrot Frank Luntz talking point LIES like Republicans during the health care debate...
> ...



Well Bern, you say you don't know who Frank Luntz is, BUT, you claim you watched the interview with Wendell Potter...

My personal choice is Medicare for all. If anyone under the age of 65 wants to buy Medicare, they should be able to. Everything is in place, it has been an extremely sucessful program, it is more cost effective than private insurance, and it would take care of many of our problems. Medicare could even add a small percentage to the premium to help cover the costs the baby boomers will add.


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## dblack (Sep 20, 2011)

Bfgrn said:


> dblack said:
> 
> 
> > The cartelization of the insurance industry IS the problem. The health insurance cartel is built on government regulation. Which is why it's so painful to watch our leaders selling people on the idea that the solution is even more.
> ...



No, I'm saying that the cartels are _built_ on government regulation. It's how they limit competition and achieve effective collusion. Those who have thrived in the regulated environment are those that have learned to control it. That's why health care reform turned out the way it did. This is a point Wendell Potter makes repeatedly.

The ACA is designed from the outset as a bailout of the insurance industry. Its a deliberate ploy on the part of the established interests to set themselves up as, essentially, 'public utilities'. The insurance industry has known for some time that their business model is defunct which is why they finally acquiesced on 'reform'. They're now using their control over regulation to ensure that the product they're selling is, quite literally, our only choice.


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## bill5 (Sep 20, 2011)

Bfgrn said:


> Here is a well written article. Maybe some of you will 'get it'


Some of us do.  Already did.  But guess who that doesn't include  

"You are so stupid blah blah blah"


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## Bern80 (Sep 20, 2011)

Bfgrn said:


> Bern80 said:
> 
> 
> > Bfgrn said:
> ...



And I don't think you do a country any long term good by disincentivizing personal responsibility. And medicare successful? By what measure? Would it survive in the world world as a business if government weren't propping it up? You have pretty bizarre narrow definition of the word successful. As noted before apparently successful to you means cheap for the consumer and nevermind the inefficiencies of the organization running things or whether it's fiscally sound. As long as at the end of the day it doesn't cost the person that needs care anything, that's all that really matters to you it seems.

That said I don't have a problem expanding medicare to people under 65. My only caveat would be that it be used for those that can show a financial need or an inability to obtain coverage elsewhere. There isn't any reason that if capable you should not be responsible for financially planning for your health care needs. You can not expect to achieve the outcome of healthier country while at the same time absolving them of the responsibility of maintaining and planning for their health care.


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## dcbl (Sep 20, 2011)

> WHY health care needed reform



Because the gub-mint does such a good job with everything else they've been entrusted with? Why not turn it over to them!


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## Brutus (Sep 20, 2011)

Bfgrn said:


> My personal choice is Medicare for all....  it has been an extremely sucessful program, it is more cost effective than private insurance, .



liberals lack the IQ to understand capitalism; in fact that is the definition of a liberal. Medicare is not successful for those who pay for it, obviously. How could it be successful when people are not shopping with their own money?

Would you want the liberals to supply us cars that way too??

See how far a little thinking will get you?


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## Brutus (Sep 20, 2011)

dcbl said:


> > WHY health care needed reform
> 
> 
> 
> Because the gub-mint does such a good job with everything else they've been entrusted with? Why not turn it over to them!



Yes, exactly!! We have more government involvement in health care than anywhere and, surprise, it is our least efficient industry. 

Insanely, the liberal solution is more government involvement.


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## saveliberty (Sep 20, 2011)

Brutus said:


> dcbl said:
> 
> 
> > > WHY health care needed reform
> ...



Education is a close second.  Government has pretty much made that an overly expensive and under achieving industry.


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## bill5 (Sep 20, 2011)

Brutus said:


> Bfgrn said:
> 
> 
> > My personal choice is Medicare for all....  it has been an extremely sucessful program, it is more cost effective than private insurance, .
> ...



Clearly that's not on your agenda.

About time we got back to trying to digress yet another thread here into a wingnut cat fight!  YAAAAAAAAAYYYY   The left sucks!  No wait the right sucks!  Bush!  Obama!  Tea Party!  There's my opinion and the wrong one!  My side is always right!  Yours is always wrong!  blah! etc! blah!


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## Brutus (Sep 20, 2011)

saveliberty said:


> Brutus said:
> 
> 
> > dcbl said:
> ...



Yes the liberal unions have made our kids the dumbest in the industrialized world. Competition made our universities the best in the world, but the liberal unions care about their jobs most so they block all reform while our nation declines.


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## saveliberty (Sep 20, 2011)

Is your position that there is no right or wrong approach bill5?  A middle ground approach is nothing more than half wrong.


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## Brutus (Sep 20, 2011)

bill5 said:


> Brutus said:
> 
> 
> > Bfgrn said:
> ...



why change the subject? What are you afraid of? Why not try to put into words what you have against capitalism and freedom in health care? HOw will you learn if you are afraid to try?


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## Brutus (Sep 20, 2011)

bill5 said:


> to digress yet another thread here into a wingnut cat fight!



I hate to inform you, but the voting booth offers a simple choice: freedom and capitalism or liberalism, not a cat fight as you call democracy. Why not get in the game and decide where you stand?
I'm here to help you.


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## dblack (Sep 20, 2011)

Brutus said:


> bill5 said:
> 
> 
> > to digress yet another thread here into a wingnut cat fight!
> ...



You forgot the Republicans!


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## Brutus (Sep 20, 2011)

dblack said:


> Brutus said:
> 
> 
> > bill5 said:
> ...



how so???????????/


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## dblack (Sep 20, 2011)

Brutus said:


> dblack said:
> 
> 
> > Brutus said:
> ...



Well, you said it's a choice between the Libertarians and the Democrats. I wouldn't rule out the Republican's just yet.


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## Brutus (Sep 20, 2011)

dblack said:


> Brutus said:
> 
> 
> > dblack said:
> ...



actually Republicans are Libertarians who compromise in order to hold office in a centrist country. If they did not compromise they would merely be impotent libertarians. Not so hard to understand is it?


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## dblack (Sep 20, 2011)

Brutus said:


> actually Republicans are Libertarians who compromise in order to hold office in a centrist country. If they did not compromise they would merely be impotent libertarians. Not so hard to understand is it?



heh... seriously?


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## Greenbeard (Sep 20, 2011)

dblack said:


> They're infinite. That's the point. From what I've read, catastrophic plans will not count as sufficient coverage - but it's all up to the regulators and their lobbyists eh? The point is, what we're arguing for isn't a specific plan of action, it's the freedom to find our own solutions rather than have the vested interests choose them for us.



The most common type of catastrophic coverage--the high-deductible health plan, a plan that can be coupled to an HSA--is the benchmark used by the ACA. Its contours have been used in the ACA to define the landscape.

As for the freedom you're now denied: what is it? What do you want? An abstract "you know...stuff" won't do it.



Bern80 said:


> Hadn't thought of it like that, but that would be one way of introducing such concepts.



What were you suggesting when you said we should "Allow that 90% to purchase plans that maybe only cover catastrophic illness"?



saveliberty said:


> I see your resorting to the same incorrect thinking that is applied to Obama's jobs and economic recovery plans.  It would have been so much worse, if Obama hadn't done this ir that. Well it will come as a shock to you, but healthcare costs are STILL RISING at a high level.  He didn't do a thing with healthcare.  It DID cause uncertainty in the business community though.  That slowed job recovery.



Peer into the future. And still further.



OldUSAFSniper said:


> 2,600 pages that almost NOBODY read.



More like 950 pages. Not bad for a major reform of Medicare, Medicaid, and private insurance.



			
				Bern80 said:
			
		

> And medicare successful? By what measure?



Aside from its obvious successes in insuring the elderly and disabled, Medicare has done better than the private sector with regard to cost control: see today on the Incidental Economist, Private vs Public Health Care Cost Control FAQ. And as I've pointed out, the ACA's brakes on health spending via delivery system reform seem be felt by Medicare first.


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## dblack (Sep 20, 2011)

Greenbeard said:


> As for the freedom you're now denied: what is it? What do you want? An abstract "you know...stuff" won't do it.



Hmm... thought I'd covered that:



dblack said:


> ... the freedom to find our own solutions rather than have the vested interests choose them for us.



But you seem to be looking for something more concrete. How about the freedom to buy insurance other than that selected for me by the state? How about the freedom to not buy insurance at all? The point is that freedom isn't a matter of permission to do specific things. It's about judging for yourself what's best for you, and acting on your judgment without undo hindrance from government. Regulatory campaigns are sold as efforts to get control of industry run amok. But all too often the effort is turned inside out ands end up regulating customers more than business.


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## Bern80 (Sep 21, 2011)

Greenbeard said:


> What were you suggesting when you said we should "Allow that 90% to purchase plans that maybe only cover catastrophic illness"?



No. The high deductibles I'm familiar with are really only different in that one respect to 'regular' deductible plans. For example, at my work you essentially have two choices for insurance coverage; the low deductible plan or the high deductible plan. That's the only difference, what is covered is exactly the same between the two. 




Greenbeard said:


> Aside from its obvious successes in insuring the elderly and disabled, Medicare has done better than the private sector with regard to cost control: see today on the Incidental Economist, Private vs Public Health Care Cost Control FAQ. And as I've pointed out, the ACA's brakes on health spending via delivery system reform seem be felt by Medicare first.



Simply delivering a service is not a measure of success (if even THAT were true). You might be able to sell widgets at $5 to anyone that wants them on demand, but you are not going to be succussful if it costs you $10 to make one. And medicare is not controlling costs so much as they are dictating them. You have to start taking a broader view of the situation Green. Medicare can control costs the way it does because it is insulated from having to work in the free market. Again I ask, do you suppose the program would survive if it were a privately run company? Hospitals and physicians don't get to negotiate with medicare for reimbursements. Medicare simply tells them, this is what we'll pay. Take it or leave it. Medicare doesn't really care if their reimbursement covers the providers expenses in delivering the service. Consequently the rate at which providers have been turning away medicare patients has been escalating. http://www.usatoday.com/news/washington/2010-06-20-medicare_N.htm So no, not even your preliminary measure of success is accurate because many on medicare are not getting the care the need because they are being turned away from providers....because the government doesn't seem to care about the economics of the providers. 

The notion that medicare is successful is simply false. What would need to happen for it to be successfull which I would define as any and all medicare recipients receiving the care they need AND providers actually being able to live with their reimbursement rates, is that medicare funding would have to go up pretty significantly. And guess who would be on the hook for that.


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## saveliberty (Sep 21, 2011)

In Michigan, the largest carrier of health insurance is Blu Cross Blue Shield.  It is a nonprofit corporation.  Two things are sure.  One, it is not returning profits to its shareholders.  Two, its mission is not profit.


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## bill5 (Sep 21, 2011)

The things you are "sure" about are wrong.


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## saveliberty (Sep 21, 2011)

bill5 said:


> The things you are "sure" about are wrong.



Nope, I clearly saw nonprofit in the TV ad today.  My two points are sure.  You fail.


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## Brutus (Sep 21, 2011)

dblack said:


> Brutus said:
> 
> 
> > actually Republicans are Libertarians who compromise in order to hold office in a centrist country. If they did not compromise they would merely be impotent libertarians. Not so hard to understand is it?
> ...



if you disagree please try to say why or admit you can't. Thanks


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## bill5 (Sep 21, 2011)

saveliberty said:


> bill5 said:
> 
> 
> > The things you are "sure" about are wrong.
> ...



You clearly saw an extremely old ad or need glasses.  Google the topic if you don't believe me.  

I have no idea what "you fail" means, unless you're just riding that trendy and hideously over-used "fail" phrase. I "succeeded" in pointing out your error.  If you refuse to believe it, that's your right.  Enjoy.


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## saveliberty (Sep 21, 2011)

bill5 said:


> saveliberty said:
> 
> 
> > bill5 said:
> ...



Here you go idiot:

Blue Cross Blue Shield of Michigan is a *nonprofit corporation *and an independent licensee of the Blue Cross and Blue Shield Association.

https://secure.bcbsm.com/pr/pr_02-18-2010_85116.shtml

Blue Cross Blue Shield of Michigan (BCBSMI) 


In the backyard of the Michigan Wolverines, Blue Cross Blue Shield of Michigan is growing their own fans. This *nonprofit company *has been working with Michigan residents for more than sixty years.

Blue Cross Blue Shield of Michigan (BCBS in MI)

*BCBSM is committed to remain a private, nonprofit company that provides quality, affordable health care to our customers and members*. The reason is simple. Once a company becomes for-profit, the top priorities are no longer the customers, members or the people of Michigan. The top priority becomes the shareholders. As part of our commitment to nonprofit health care, *BCBSM is a founding member of the Alliance For Advancing Nonprofit Health Care*.

Blue Cross Blue Shield of Michigan - Nonprofit Health Care Advocacy

Sucks to be you.


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## Flopper (Sep 21, 2011)

Valerie said:


> bill5 said:
> 
> 
> > Bern80 said:
> ...


Until we do something about our fee for service system of delivering healthcare, cost will keep rising.  The fee for service system has too much overhead.  I don't know the answer but what we are doing now is not working.  I visited my doctor two days ago.  He spent 15 mins with me and billed my insurance company over $200.


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## lehr (Sep 25, 2011)

Bfgrn said:


> WHY did health care need reform? Because Wall Street took complete control of the health care industry. Profit driven incentives create REAL death panels for Americans. Insurance corporations are incentivized to deny patient coverage and push more and more of the costs onto consumers.
> 
> For anyone who wants an insider's knowledge of this, I recommend investing a half hour of your time to listen to what this man has to say...
> 
> ...



yea - we needed (reform) but national healthcare means throwing out the baby with the bath water - they r replacing the health private sector with government - EVERY THING GOVT. TOUCHES IT DESTROYS !


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## bill5 (Sep 25, 2011)

saveliberty said:


> Blue Cross Blue Shield of Michigan is a *nonprofit corporation *and an independent licensee of the Blue Cross and Blue Shield Association.


I thought you mean BC/BS in general, not simply Michigan.  My bad.

So what's your point?  Michigan sucks?  Wow big news flash there.


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## saveliberty (Sep 25, 2011)

bill5 said:


> saveliberty said:
> 
> 
> > Blue Cross Blue Shield of Michigan is a *nonprofit corporation *and an independent licensee of the Blue Cross and Blue Shield Association.
> ...



You would be correct on BC/BS at the national and most state levels.  I was specific to Michigan.

What sort of issues are you compensating for with the put downs?  Michigan was hampered by a Democrat governor for too long.  We are making good progress.


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## bill5 (Sep 25, 2011)

eh it was too easy a shot.    And an irrelevant sidetrack besides.  Back to the topic....


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## saveliberty (Sep 25, 2011)

Okay, so we have a local hospital that delivers quality health care at a low cost compared to other hospitals in the state.  Without this facility, we have to travel 20 miles away for services.  Dangerous, expensive and burdensome.  Know what one of our big problems is?  Medicare reimbursement.

Yep, Medicare pays bigger city hospitals MORE for the same services.  Basicly rewarding them for being less efficient and more expensive.  This lower rate keeps the possibility of closure a constant threat.

We also have to request a certificate of need for every new bed or major piece of equipment from the federal government.  Wonderful system where they know what you need more than us.  It also takes a long time to get an answer.  Takes a lot of adminstrative time and money to send in the paperwork too.


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## Flopper (Sep 26, 2011)

bill5 said:


> saveliberty said:
> 
> 
> > Blue Cross Blue Shield of Michigan is a *nonprofit corporation *and an independent licensee of the Blue Cross and Blue Shield Association.
> ...


Only 18% of our hospitals are for profit.  Half the major clinics are nonprofit and third of the nursing homes are nonprofit.  Compared to most industries, there is no profit motive in the healthcare which is the way it should be.  Insurance companies are still mostly for profit.


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## PeteEU (Sep 26, 2011)

Flopper said:


> Insurance companies are still mostly for profit.



Bingo.. and in here you have one of the major problems. Also these insurance companies live in a market with very little competition if at all and legislation that only has one goal.. to line the pockets of the insurance companies and hurt the people they serve. Another major problem is that most insurance is employer based, putting huge costs on American business and leaving many people who dont have a job without insurance.


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## editec (Sep 26, 2011)

Health care needs to change because our society is changing.

It's really that simple.

There was a time when practically everybody who wanted could find a job that paid a living wage and also offered health care benefits.

Those days are done.


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## bill5 (Sep 26, 2011)

Flopper said:


> Only 18% of our hospitals are for profit.  Half the major clinics are nonprofit and third of the nursing homes are nonprofit.  Compared to most industries, there is no profit motive in the healthcare which is the way it should be.  Insurance companies are still mostly for profit.


The thing is it's easy to play the "nonproft" game and yet profit.  For example:

Dan Loepp's total compensation as Blue Cross CEO jumped to $2.75 million in 2010 | Crain's Detroit Business

Quite a bit of money for someone leading a "nonprofit" organization, don't you think?  Yeah the company doesn't profit, just the people working there do


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## Bern80 (Sep 26, 2011)

bill5 said:


> Flopper said:
> 
> 
> > Only 18% of our hospitals are for profit.  Half the major clinics are nonprofit and third of the nursing homes are nonprofit.  Compared to most industries, there is no profit motive in the healthcare which is the way it should be.  Insurance companies are still mostly for profit.
> ...



No. The issue seems to be that people like you think, no profit = small salaries. That simply isn't the case.


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## Brutus (Sep 26, 2011)

Bern80 said:


> bill5 said:
> 
> 
> > Flopper said:
> ...



A liberal will lack the IQ to understand profit. Why would anyone invest money in a hospital for example if there was no profit from it. More importantly, how would you now if it was a competitive hospital if you could not measure the results in terms of profits. How would you know whether to invest more or less in that hospital.

Now you see why we are sure a liberal will have a low IQ. Sorry

The Red Chinese tried letting liberal bureaucrats figure out where to invest, 50 million slowly starved to death, then they switched to Republican capitalism and 50 million could suddenly afford automobiles.


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## bill5 (Sep 26, 2011)

lol - thank goodness, the wingnut cat fight begins (again)  

The left sucks!  No wait the right sucks!  Bush!  Obama!  Tea Party!  There's my opinion and the wrong one!  My side is always right!  Yours is always wrong!  blah! etc! blah!


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## Brutus (Sep 26, 2011)

bill5 said:


> lol - thank goodness, the wingnut cat fight begins (again)
> 
> The left sucks!  No wait the right sucks!  Bush!  Obama!  Tea Party!  There's my opinion and the wrong one!  My side is always right!  Yours is always wrong!  blah! etc! blah!



democracy is debate. If you're not intelligent enough to form a point of view and defend it then you don't belong in a democracy. Why not try Cuba?


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## Flopper (Sep 26, 2011)

bill5 said:


> Flopper said:
> 
> 
> > Only 18% of our hospitals are for profit.  Half the major clinics are nonprofit and third of the nursing homes are nonprofit.  Compared to most industries, there is no profit motive in the healthcare which is the way it should be.  Insurance companies are still mostly for profit.
> ...


Technically there is no profit.  Salaries can be high, but that's not the norm.  United Healthcare which is for profit pays their CEO over 100 million.

IMHO, most medical care should be in the same category as other life saving services such as fire, rescue, police, and 911.  Our lives and safety depend all these services. 911 doesn't ask for a credit card before dispatching life saving services and neither should the emergency room or the hospital.


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## bill5 (Sep 26, 2011)

Your said it yourself - _technically_ there is no profit.  But that's all it is, a technicality and legal-eze BS.  That's my point.


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## bill5 (Sep 26, 2011)

Brutus said:


> democracy is debate.


But it is not the topic.  If you're not intelligent enough to grasp a topic and reply with anything more than mindless inflammatory dribblings most 10 year olds would roll their eyes at, why not try remedial kindergarten?


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## Flopper (Sep 27, 2011)

bill5 said:


> Your said it yourself - _technically_ there is no profit.  But that's all it is, a technicality and legal-eze BS.  That's my point.


What would normally be called profit, the difference between revenue and expenses is called a surplus.  A surplus can be used for salaries, expansion, or retained to for preservation of the organization.  Ownership is a usually a trust, foundation, or nonprofit corporation.  There is no stock and no dividends.  Where a board of directions in for-profit corporation will push management to maximize profits, the Board of a nononprofit is likely to push management to maximize service.  In other words the goal of a nonprofit is service not profits.


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## Brutus (Sep 28, 2011)

Flopper said:


> the Board of a nononprofit is likely to push management to maximize service.  In other words the goal of a nonprofit is service not profits.




actually you can't maximize service without tons of profit. How could MacDonalds, for example, service billions of people all over the world without tons and tones of profits to open up all those restaurants and hire all those people?

See why we are positive a liberal will have a low IQ? Sorry but what other conclusion is possible? Should we have a non-profit economy so people will be service oriented rather than evil Republican profit seekers!!


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## Flopper (Sep 28, 2011)

Brutus said:


> Flopper said:
> 
> 
> > the Board of a nononprofit is likely to push management to maximize service.  In other words the goal of a nonprofit is service not profits.
> ...


I totally disagree for two reasons.  First a nonprofit can not produce a profit by definition.  Secondly, a nonprofit health provider such as a hospital may add services with no expectation of increasing revenue.  Our local hospital installed a half million dollars in air handling filtration to help prevent the spread of air borne diseases.  I seriously doubt that it will add a dimes worth of revenue, but it will make the hospital a little safer for the patients.  That's the difference in a for profit and nonprofit.  The motive of a for- profit is to increase profits which may or may not increase service. The opposite is true for nonprofit.


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## Bern80 (Sep 29, 2011)

Flopper said:


> Brutus said:
> 
> 
> > Flopper said:
> ...



Just because a business calls itself a non-profit doesn't mean it can prevent itself from making more than it expends. You really think every non-profit organization takes a loss every year or figures happens to have it work out that they break exactly even every year?


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## Flopper (Sep 30, 2011)

Bern80 said:


> Flopper said:
> 
> 
> > Brutus said:
> ...


Of course not.  Most non profits have revenues that exceed their expenses and thus have a surplus.  That surplus can not returned to owners.  It must be used to improve, expand the service or retained.  Since the owners which are usually a not for profit corporation or a trust do not receive dividends or any capital gains, their is no pressure from owners to increase profits because there are none.  The purpose  of the nonprofit is to maximize service and minimize cost which may or not increase surplus.


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## Brutus (Sep 30, 2011)

Flopper said:


> I totally disagree for two reasons.  First a nonprofit can not produce a profit by definition.



if they want to open a new McDonalds they need money whether you call it profit or not!!




Flopper said:


> Secondly, a nonprofit health provider such as a hospital may add services with no expectation of increasing revenue.



idiotic, a restaurant can be forced to add a grease trap, or paint their building for example, but neither increases revenue directly!!



Flopper said:


> Our local hospital installed a half million dollars in air handling filtration to help prevent the spread of air borne diseases.  I seriously doubt that it will add a dimes worth of revenue, but it will make the hospital a little safer for the patients.  That's the difference in a for profit and nonprofit.  The motive of a for- profit is to increase profits which may or may not increase service. The opposite is true for nonprofit.



now does the silly liberal understand???????????


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## saveliberty (Sep 30, 2011)

Flopper said:


> Of course not.  Most non profits have revenues that exceed their expenses and thus have a surplus.  That surplus can not returned to owners.  It must be used to improve, expand the service or retained.  Since the owners which are usually a not for profit corporation or a trust do not receive dividends or any capital gains, their is no pressure from owners to increase profits because there are none.  The purpose  of the nonprofit is to maximize service and minimize cost which may or not increase surplus.



Doesn't hold true for Medicare or Medicaid.  It doesn't necessarily follow for the Red Cross, a public hospital or nonprofit insurance carrier either.


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## Brutus (Sep 30, 2011)

Flopper said:


> The purpose  of the nonprofit is to maximize service and minimize cost which may or not increase surplus.



of course no one knows what it means to maximize service  unless competition tells you through the profits generated. The USSR and Red China failed because they were liberals like you who imagined they knew what was needed better than millions of consumers voting every day for what they need with their own hard earned money!

Before capitalism maximized service in Red China 50 million slowly starved to death, when they switched to capitalism 20 million immediately could afford cars!! See what we mean about a low IQ? No other conclusion is possible. Sorry


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## Flopper (Sep 30, 2011)

Brutus said:


> Flopper said:
> 
> 
> > I totally disagree for two reasons.  First a nonprofit can not produce a profit by definition.
> ...


A typical restaurant is in business to make a profit.  That is why it exists.  A nonprofit hospital exists to provide a service, not make a profit.  A profit in a restaurant can be returned to the owners.  A surplus in a nonprofit cannot. If you dont understand this, further discussion is pointless.


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## Flopper (Sep 30, 2011)

saveliberty said:


> Flopper said:
> 
> 
> > Of course not.  Most non profits have revenues that exceed their expenses and thus have a surplus.  That surplus can not returned to owners.  It must be used to improve, expand the service or retained.  Since the owners which are usually a not for profit corporation or a trust do not receive dividends or any capital gains, their is no pressure from owners to increase profits because there are none.  The purpose  of the nonprofit is to maximize service and minimize cost which may or not increase surplus.
> ...


Most governments and government agencies are not considered NPOs.

Yes, you are correct charitable nonprofits will typical spend what of what they collect so they do not build up a surplus.  Actually Red Cross does build a surplus for emergencies.  Most nonprofit hospitals do build surpluses that are used for expansion and improving service.


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## Flopper (Sep 30, 2011)

Brutus said:


> Flopper said:
> 
> 
> > The purpose  of the nonprofit is to maximize service and minimize cost which may or not increase surplus.
> ...


You seem to be equating nonprofit organizations with socialism.  Because the goal of a business is not build profits does not mean it's socialistic.


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## saveliberty (Sep 30, 2011)

Flopper said:


> Most governments and government agencies are not considered NPOs.
> 
> Yes, you are correct charitable nonprofits will typical spend what of what they collect so they do not build up a surplus.  Actually Red Cross does build a surplus for emergencies.  Most nonprofit hospitals do build surpluses that are used for expansion and improving service.



...and since medical advancements are continuous and frequent, the pressure to generate a surplus is equal to a profit company's need for profit/capital.


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## Bfgrn (Sep 30, 2011)

Brutus said:


> Flopper said:
> 
> 
> > The purpose  of the nonprofit is to maximize service and minimize cost which may or not increase surplus.
> ...



While not all conservatives are authoritarians; all highly authoritarian personalities are political conservatives.
Robert Altmeyer - The Authoritarians

*What Mao Zedong said about liberalism*

"Liberalism is extremely harmful in a revolutionary collective. It is a corrosive which eats away unity, undermines cohesion, causes apathy and creates dissension.

It robs the revolutionary ranks of compact organization and strict discipline, prevents policies from being carried through and alienates the Party organizations from the masses which the Party leads. It is an extremely bad tendency."
Combat Liberalism - Selected Works of Mao Tse-tung


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## Flopper (Oct 1, 2011)

saveliberty said:


> Flopper said:
> 
> 
> > Most governments and government agencies are not considered NPOs.
> ...


All hospitals, nonprofit or for-profit are under pressure to raise the financial resources to meet the needs of patients, however a for-profit is under additional pressure of producing a profit for it's owners.


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