OT - A intriguing "open lette"r on health care ...

"Lew Hodgett" <[email protected]> wrote in message
news:P%[email protected]...

>
> On first glance looks good, but when you dig deeper has a major flaw.
>
> When insurance covers regular services of a person's primary giver,
> illnesses are detected earlier and can be handled with the lowest cost
> service.
>
> When insurance does not covers regular services of a person's primary
> giver, illnesses are not detected as early as they should be often
> resulting in higher cost services to overcome the advanced problem.
>
> Health care insurance is a tad different than other insurance products.
>
> Lew
>
>

The very simple solution is that the insurance company requires the customer
to have regular scheduled check ups on his dime. Kinda like auto insurance
companies giving you better rates if you take defensive driving courses and
avoid tickets by obeying traffic laws.

"Doug Winterburn" wrote:

> Why would anyone buy an insurance policy with a 6 figure copay,
> deductible or a ceiling which would leave you that unprotected?

From what I was told, it was an accumulation of several events.

Lew

"Larry Blanchard" <[email protected]> wrote in message
news:[email protected]...
> On Sat, 30 May 2009 11:01:05 -0500, dpb wrote:
>
>>> But yet the SSA administers Social Security with an almost negligible
>>> amount of overhead. A government program can work efficently, but the
>>> devil is in the details.
>> ...
>>
>> Yeah, so efficiently they have thousands on the roles that have been
>> deceased, some for decades (GAO investigation I heard reported not long
>> ago)...
>
> I don't doubt there's some fraud going on, but unless you can cite the
> source I doubt it's in the thousands. And I mentioned low overhead which
> you didn't seem to question.

I doubt it too. I'd think it is probably in the tens of thousands. Really,
I do. Then the ones fraudulently collecting disability is probably triple
that number. Read the last line in this .

http://therecordlive.com/article/Beyond_the_County/Beyond_the_County/Brady_working_to_stop_Social_Security_disability_cheats/52994
U.S. Congressman Kevin Brady (R-The Woodlands) met today in Houston with
officials from the Social Security Administration ahead of a congressional
hearing next week to examine fraud in the federal disability program. Brady,
who requested the hearing of the House Ways & Means Subcommittee on Social
Security, says scammers may be draining up to $11 billion from the Social
Security Disability Insurance Trust Fund that helps more than seven million
disabled Americans.

"We have a responsibility to taxpayers and the truly disabled to make sure
these precious dollars are not lost to fraud and those trying to game the
system," said Brady, a member of the Social Security panel.

Brady met Monday with Patrick O'Carroll Jr., inspector general of the Social
Security Administration, and leaders of the Houston Co-operative Disability
Investigative (CDI) unit which includes team members from the Social
Security Administration, the Inspector General's office, the state
disability agency and Harris County law enforcement.

Since the Houston unit was formed in 2000, the team has successfully
terminated 1,003 cases, saving taxpayers nearly $90 million. The unit
investigates disability fraud in applicants faking impairments as well as
those concealing work payments or medical improvements while receiving
disability payments.

O'Carroll told the congressman that 14 tax dollars are saved for every
dollar Congress allots to investigate disability fraud allegations. The
Social Security Administration is required to conduct continuing disability
reviews on each case.

In one particularly egregious case from last year, a dead man was actually
put in a wheelchair and brought to a check-cashing store in New York so one
of his friends could cash his check (Source: Reuters 1/9/08).

On Jun 6, 2:18=A0pm, "Lew Hodgett" <[email protected]> wrote:
> "dpb" wrote:
> > immaterial to the point...
>
> No it is exactly the point.
>
> Health care costs esclate as the end of life approaches which is
> exactly why Medicare/Medicaid are in trouble and a solution must be
> found.
>
> Lew

Soylent Green?

J. Clarke wrote:
> Han wrote:
>> "HeyBub" <[email protected]> wrote in
>> news:[email protected]:
>>
>>> Tort damages consist of several pieces: recovery of economic loss,
>>> pain & suffering, loss of consortium, and so on. My plan is to
>>> divert ALL "punitive" damages to the state. Punitive damages are
>>> really "fines" to discourage future rascally behavior by the
>>> defendant, so why should the plaintiff benefit? In many cases,
>>> punitive damages dwarf all other awards and it is they that make
>>> the case worthwhile for the plaintiff bar.
>
> So now the state treats lawsuits as a source of revenue and does
> everything it can to encourage them.
>
> Can you say "unintended consequences"?
>

Ooh! Good point!

On Jun 10, 5:56=A0pm, "Upscale" <[email protected]> wrote:
> "Lew Hodgett" <[email protected]> wrote in message
> > Producing a healthier young population that requires fewer high cost
> > procedures later in life is the easiest way to reduce what are now a
> > totally runaway costs to a more manageable level while at the same
> > time improving over all health of the nation.
>
> Essentially, that's the same as saying the entire county population has t=
o
> undergo a complete lifestyle change. What are the chances of that happeni=
ng?
> Sounds good in theory and in practice, but it ain't going to happen in a
> dozen lifetimes.

The governments WANT people to die young, 70 tops. No pensions to pay,
no long-term care facilities. Keep the hospitals open for those who
can be put back to work so they can be milked for taxes. An aging
population, a sick population is bad for harvesting taxes.
So smoke'm if you got'm.

Tom Watson wrote:
> On Fri, 29 May 2009 18:03:59 -0500, Swingman <[email protected]> wrote:
>
>> Friend of mine, a doctor and fellow musician, came up with the
>> following, an intriguing plan to revamp the US health care system from a
>> practicing physician's perspective.
>>
>> Be sure to read the entire plan before making any judgments, it's tricky
>> in few spots.
>>
>> <Open Letter>
>
>
>> <snip>
>
>
> Why don't we just buy ourselves a doctor?
>
> Let's say you belong to a builder's association with one hundred
> members.
>
> Each of the members has been spending $1000.00 per month on family
> medical insurance.
>
> That creates a theoretical maximum pool of $1,200,000.00 per year.
>
> Let's say an internist earns an average of $200,000.00 per year.
>
> His salary would cost each member $2,000.00 per year.
>
> Since he only has a patient group of four hundred people, he can do
> his own damned paperwork and he doesn't need an office because with
> only four hundred patients everything would be a house call.
>
> Alright, if you're gonna bitch about medical equipment and other
> expenses, let's throw in $50,000.00 a year for that.
>
> So now we have a medical subcontractor at a total cost of $250,000.00
> per year divided by one hundred members for a cost of $2500.00 per
> year. That's $208.33 per month for primary medical care for a family
> of four.
>
> That leaves $791.67 per month to pay for catastrophic coverage.
>
> At a cost of $3500.00 per year for that coverage that would be another
> $291.67 per month.
>
> Total cost of primary and catastrophic coverage is about $500.00 per
> month.
>
>
> I haven't looked into the cost of buying an actual hospital yet but,
> what the hell, we're talking about a builder's group. I'm thinking
> $200.00 per square foot including the Chiwanese medical gear we'll get
> from Grizzly.
>
>
> I don't know why my son thinks that math isn't fun.
>
>

That's the best proposal in this thread. I also think that
the group participants ought to be able to pick the nurses
for their, um, non-medical attributes since these almost
certainly enhance healing ...

--
----------------------------------------------------------------------------
Tim Daneliuk [email protected]
PGP Key: http://www.tundraware.com/PGP/

"Lew Hodgett" <[email protected]> wrote in message
> Health care costs esclate as the end of life approaches which is
> exactly why Medicare/Medicaid are in trouble and a solution must be
> found.

Yeah. All this talk about escalating health care and the end of life makes
me think about the movie Soylent Green. Not exactly the same thing, it does
give one to thought.

"Leon" <[email protected]> wrote in message
> The very simple solution is that the insurance company requires the
customer
> to have regular scheduled check ups on his dime. Kinda like auto
insurance
> companies giving you better rates if you take defensive driving courses
and
> avoid tickets by obeying traffic laws.

Sorry, can't agree with that view. Some people who are not in perfect health
even though it may not be their fault, have to pay through the nose. You can
be smart, educated and do everything in your power to take care of yourself
and still be terribly ill.

Unlike your defensive driving courses where proper driving etiquette can be
learned, some people can't avoid the ill health the plagues them.

"Nova" <[email protected]> wrote in message
news:[email protected]...
> Leon wrote:
>> "Nova" <[email protected]> wrote in message
>> news:[email protected]...
>>
>>>
>>>I don't know that I'd always want my medical treatment to go to the
>>>lowest bidder.
>>
>>
>> Agreed and these guys are probably makin more off of the procedure than
>> those having to collect from an insurance company. Remember insurance
>> companines get deep deep discounts and often don't pay.
>
> It sound to me like the insurance companies are keeping the cost down.

Would you use an insurance company to hep you buy electricity, groceries,
clothing? They don't keep costs down, often they perpetuate the problem.

>
>
>> Basically HMO's and > insurance companies are more like agents for many
>> doctors. I think I would probably have more faith in a doctor that
> > does not rely on an insurance company to bring in it's patients.
>>
>
> The insurance companies rely on their participating doctors list to bring
> in the customers.

I have never heard of any one including myself choosing an insurance company
based on its doctors list. Most employees insurance is provided through
their employeer. The employeer decides which insurance company to go with
and you choose from the list of doctors.





>
>>>>There will probably still be insurance for catastrophic needs if you
>>>>feel that living an extra year or two is woth having insurance for.
>>>
>>>It doesn't take a catastrophe to end up with astronomical medical bills.
>>>I don't foresee any major reduction is the cost of medical care
>>>regardless of who foots the bill.
>>
>>
>> Don't for get the major point here, insuranc companies make more than the
>> health care system does and what overhead does an insurance company have
>> other than an office for record keeping?
>
> Medical insurance companies are gambling that the coverage premium they
> charge along with any returns on there investments made with your money
> will exceed the medical payments they make in your behalf. By them making
> a profit it shows that on the average they're right.

But dont be fooled into thinking that every claim is not scrutinized by the
insurance company. More often than not th winsurance company disallows
legitimate claims.

>
>> Take the insurance company out of petty coverage and every one saves,
>> except the insurance company.
>
> Your key word above is "petty". If you take the insurance company out of
> the picture you'd better hope that you're one of the customers that make
> their "average" profitable.

I do not want the insurance company completely removed, just remove them
from the petty, normal, illnesses by simply raising the deductible. I lower
my auto and home owners, and flood insurance by paying a higher deductible.
If the average person had a $2000 deductible I suspect the cost of primary
care would go down when the insurance claims became fewer in number.

Han wrote:
> $800/month may be doable for you, but there may be people for whom it is
> not. Example: 40-odd year-old couple (no kids, no more parents). Both
> lost full-time jobs. One of them can retain the job, but is only paid 50%
> as a part-time person. No benefits. Cobra costs over $1000/month.
>
> That can be tough in NY City.

Well, I lost my job in 1998 and my wife didn't work. It was still
easily doable because I planned ahead and invested 10% of my gross from
the time I started working. 10% is less than what you and your employer
contribute to SS, yet if invested wisely, it will provide much more
income and not be drained even over a lifetime. Compound
interest/earnings are wonderful things.

"dpb" <[email protected]> wrote in message news:[email protected]...
> Leon wrote:
>> "HeyBub" <[email protected]> wrote in message
>> news:[email protected]...
>>> This plan does not rely on "human nature" to reduce costs - it relies on
>>> government setting rules on how health care contracts should be
>>> negotiated and enforced. There is nothing that would prevent, today, a
>>> physician from demanding payment up front from the patient and refusing
>>> all third-party involvement.
>>>
>>
>>
>> Precisely, and that is the beauty. Once again competition between
>> doctors and their services would keep costs low. Already there are
>> groups of doctors, clinics, pharmacies, and hospitals that will not
>> accept insurance. You have to join their group for well under $100 per
>> month for your whole family but a typical office visit costs around $35.
>
> But what do you do for critical care wherein costs can easily run into the
> $100's of K numbers--a friend had heart valve replacement at roughly $300K
> recently.

The only reason that the procedure cost that much is because insurance
companies probably only pay 30% of that cost. Eleminate the insurance
companines and you get the better pricing because every one is paying their
fare share and the medical industry does not need nearly as many on staff
whose only job is to "try" to collect what is owed them by the insurance
companies.

The "groups" that I referred to so surgery also at a dramatic reduction in
cost.





>
> The routine office visit is simple; the costs are in the high-dollar items
> that are less frequent, high liability (tort) costs and the costs for
> unreimbursed care that have to be picked up by those who do pay.
>
> The "competition" between physicians for expert medical care is a
> fallacy -- in general the consumer has insufficient expertise to judge
> quality or to know how to select alternate care options for the highest
> efficacy. When forced to make difficult decisions on perhaps
> life-or-death issues, in the end its not likely that the overriding
> concern will be the cost. Easy enough to hypothesize that's what the
> so-called rational consumer SHOULD do, but just as the markets are as much
> or more emotion-driven, health care choices are as well.
>
> --

"Lew Hodgett" <[email protected]> wrote in message
> Producing a healthier young population that requires fewer high cost
> procedures later in life is the easiest way to reduce what are now a
> totally runaway costs to a more manageable level while at the same
> time improving over all health of the nation.

Essentially, that's the same as saying the entire county population has to
undergo a complete lifestyle change. What are the chances of that happening?
Sounds good in theory and in practice, but it ain't going to happen in a
dozen lifetimes.

"dpb" wrote:

> But the sidebar was about LT care and not dumping oneself onto the
> gov't.

"Dumping".

Great choice of words, it says a lot.

What would you have a person do who has played by the rules, saved for
a "rainy day", provided insurance coverage, then as a result of an
unforeseen illness or accident, find themselves in debt in the 6
figure range and has to declare bankruptcy?

Hand them a gun?

The above is happening every day at an alarming rate.

The so called "Middle Class" is being eaten alive by out of control
medical costs which by and large are being driven by health care
insurance exceptions which then leave the policy holder holding the
bag.

It is just one of the signs of a broken health care system which is
not going to be fixed with advanced planning by an individual for an
individual.

Lew

On Sat, 30 May 2009 08:02:12 -0700, cm wrote:

> I agree that changes are needed in our current system, but it scares the
> heck out of me to think that the government would be more involved.
> These are the same democrats and republicans that have sent our economy
> into a tail spin.

But yet the SSA administers Social Security with an almost negligible
amount of overhead. A government program can work efficently, but the
devil is in the details.

For example, Medicare offers way too many opportunities for fraud just
because of the way it is structured and administered. And the fraud is
coming from the private sector part (i.e. patients, doctors, hospitals,
and insurance companies) not the government part.

--
Intelligence is an experiment that failed - G. B. Shaw

Han wrote:
>>
>> Once again, chew on it for a while before rushing to judgment.
>>
> Once upon a time I needed surgery to remove an excessive portion of my
> uvula (the thingy hanging down in the back from the roof of your
> mouth - it caused excessive snoring). The ENT said I needed Vioxx
> for pain relief (that's how long ago). I asked why not Celebrex, and
> he said Vioxx is better. End of discussion. Is that how you will be
> negotiating prices?

God! I first read you sentence as having a need to remove an excess vulva!

Anyway, if a doctor offered me Vioxx (or Celebrex) and declined my request
for Vicodin, (or if he insisted on Vicodin when I requested Morphine) I'd
ask for a referral to a more patient-friendly physician.

"Leon" <[email protected]> wrote in message
> My whole thought process is to prevent ER care for a sore throat because
the
> regular doctor is off for the weekend or doctor visits that are uncalled
> for.

That may be the unintended result up here in Canada. I don't know what
average waiting times are like in the USA, but emergency room visits with
triage actions in effect can easily stretch into hours upon hours of waiting
time to get treated. Anyone who has gone through it even once won't visit an
emergency room for a relatively minor complaint.

I remember once having an allergic reaction to something. (Never did find
out what it was) In any event, I had red spots all over me and the itching
everywhere was driving me crazy. Went down to the emergency room at 1:00 am
in the morning. 7:00 am, I'm still waiting for treatment and still itching
like crazy. I gave up and rolled over to another hospital about 20 minutes
away. I was treated within 30 minutes. I've been in pain before, but it just
doesn't compare to that itching episode.

"dpb" wrote:

> I don't follow that at all -- everything you've written up to this
> point seems to be supporting nationalizing all health care--now
> you're putting it into the individual's province where I've said it
> belonged all along and gotten ripped...I'm cornfoozed for sure now,
> good buddy.

I've stated and continue to say that the elephant in the room is "Mom
& Pop".

I am truly glad the decision(s) on how we as a society address this
issue is not mine.

In addition to the cold hard economic facts, there are the emotional
ones involving religion, personal values, etc.

I neither support or oppose "nationalizing all health care"; however,
I do support EVERYBODY having health care insurance.

My money is on some form of hybrid private/public program will come
out of Congress pretty quickly.

The politicians, if nothing else, astute at reading the tea leaves and
responding to what the public wants.

The majority of the public wants health care coverage for the total
population, and Congress is going to satisfy the public desire.

That's how they get re-elected.

Lew

dpb wrote:

> I'm not sure I've seen much in any really new ideas, unfortunately,
> particularly those that would actually help across the full spectrum of
> both abilities to pay and access to services.
>
> The one thing I'm pretty sure of is that the inclusion of large segments
> of currently under- or uninsured without a commensurate inclusion into
> the payment pool by some means is going to be another federal welfare
> program that will not be able to be funded w/o massive deficits or taxes
> of one form or another.
>

<snip>

Here's a few changes I'd like to see:

1. The federal government will set a maximum hourly billing rate for
doctors based on their classification (GP, FP, neurosurgeon, etc.). The
patient can be billed only for the actual time spent with the physician
in 15 minute increments.

2. If you have scheduled a doctors appointment and are kept waiting past
your appointed time the doctor pays you for your wasted time at his
billing rate in 15 minute increments.

3. If you see a doctor and all he does is refer you to a specialist the
referring doctor get a $15 administrative fee only.

4. The patient pays only for those medications that prove to be effective.

5.A doctor is allowed to have all the tests performed that he deems
necessary. The patient pays for the test that finds the problem. The
doctor pays for the rest of the tests.

6. All hospital charges, anesthesiologist fees, nursing staff, in
hospital supplies and medications, etc. will be considered part of the
doctor's overhead and will be paid for by the attending physician. This
should get rid of the $15 aspirins, $20 Band-Aids, etc.

7. A doctor receives no payment until all work is complete to the
patient's satisfaction.

8. A money back guarantee will be issued with all procedures performed.

I'm sure the group can think of others...

--
Jack Novak
Buffalo, NY - USA
[email protected]

On Fri, 29 May 2009 18:39:56 -0500, Larry Blanchard
<[email protected]> wrote:

>Make the HSAs mandatory, deducted from earnings, and the plan has a
>pretty good chance of working.

Analogous to Social Security/Medicare deductions? (No judgment implied
or intended)

Many employers now offer optional "before tax" deductions to medical
deposit accounts that are limited to payments for health care. The
only one I'm familiar with had a "Use it this year, or it's gone
forever" clause and too many "if, ands, and buts" about it to be very
attractive to me. It was primarily intended to cover deductibles and
other expenses beyond the group health insurance coverage.

Sounds like a revamping of plans such as those could come pretty close
to the "open letter" suggestion.


Tom Veatch
Wichita, KS
USA

"Leon" <[email protected]> wrote in message
news:[email protected]...
>
> "Larry Blanchard" <[email protected]> wrote in message
> news:[email protected]...
>> On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote:
>>
>>> They must be made aware that contribution yearly to the HSA must come
>>> before purchase of consumer goods, a new car, or a vacation, for
>>> example. There will be no free "safety net" other than the catastrophic
>>> coverage.....
>>
>> Someone has a lot of faith in people acting responsibly. It'll never
>> happen. And what happens to the health needs of children of
>> irresponsible parents?
>
>
> The "Right" thinks that the "Left" can learn this responsibility.

The "right" more often than not, is wrong.

"Swingman" wrote:

> You're totally ignoring what was quoted. I gave you my cite, let's
> see your's, not some guesstimate on your part.

Obviously, it ignores reality.

No guesstimate on my part.

I signed the checks as well as the forms for my mother.

Lew

"Lew Hodgett" <[email protected]> wrote in message
news:[email protected]...
> "Swingman" wrote:
>
> <snip Lawrence E. Mallette, MD, PhD, FACP, FACN plan>
>
> "This plan relies on human nature to reduce costs"
>
> There in lies the fallacy of the plan.
>
> Lew
>
>

I recall a company that wanted to reduce their expenses for sales and
service people with expense accounts. They had company credit cards and
cell phones.

They took away the company cards and phones and instead, had them use there
personal cards and phone, but also paid their entire phone bill, not just
the company portion, and gave them some extra on other expenses. Once the
people handled the money themselves, saw the bills, saw the waste, they
reduced the overall expenses considerably.

I may work.

"Upscale" <[email protected]> wrote in message
news:[email protected]...
>
> "Leon" <[email protected]> wrote in message
>> The very simple solution is that the insurance company requires the
> customer
>> to have regular scheduled check ups on his dime. Kinda like auto
> insurance
>> companies giving you better rates if you take defensive driving courses
> and
>> avoid tickets by obeying traffic laws.
>
> Sorry, can't agree with that view. Some people who are not in perfect
> health
> even though it may not be their fault, have to pay through the nose. You
> can
> be smart, educated and do everything in your power to take care of
> yourself
> and still be terribly ill.
>
> Unlike your defensive driving courses where proper driving etiquette can
> be
> learned, some people can't avoid the ill health the plagues them.


Totally agreed, and I was not suggesting to filter any one out. I was
simply suggesting that the insurance company require every one to have
regular "checkups" that they pay for them selves. That this could go a long
way in reducing a lot of doctor visits or more expensive treatments later
on.. For those that already have a condition the only requirement would be
that they also go to have the "regular check up". The fact that they have a
preexisting condition or happen to be come ill more often that the average
person would have no factor at all.
This would be more of a preventative program for those that do and or do not
appear to have symptoms.
My whole thought process is to prevent ER care for a sore throat because the
regular doctor is off for the weekend or doctor visits that are uncalled
for.

Lew Hodgett wrote:
> "Doug Winterburn" wrote:
>
>
>> I'm one of your "in the middle" people. I planned ahead - invested
>> 10%
>> of gross for 35 years and have insurance that I carefully shopped
>> for.
>> The wife had two major medical events in '05 and '06 and I had
>> surgery
>> for colon cancer in '05, all adding up to a large 6 figure billable
>> total. The insurance copays weren't overly burdensome. The
>> insurance
>> company didn't try to get out of anything and there are no max
>> coverage
>> issues. The insurance premiums run a little over $800/month which
>> is
>> easily doable if you plan ahead.
>
>
> Consider yourself lucky you had 35 straight years to build a nest egg.

"Luck is where preparation meets opportunity."

>
> In many cases a lengthily undisrupted period to build a nest egg was
> not a possibility for many reasons.
>
> For a family earning say $48K/annum or $4,000/month gross, an
> $800/month health care premium or 20% of gross is probably a real
> stretch to handle, especially if you throw in say 35% for ALL taxes,
> and 30% for housing.
>
> That leaves only about 15% or $600/month to cover all other living
> expenses.
>
> Highly unlikely that scenario is going to fly.
>
> BTW, the 6 figure unpaid bill referred to previously, was an
> accumulation of the remaining copay after the insurance company had
> paid.

Why would anyone buy an insurance policy with a 6 figure copay,
deductible or a ceiling which would leave you that unprotected? One
needs to examine the terms and conditions before selecting a policy.

>
> Lew
>
>

"Charlie Self" <[email protected]> wrote in message
> Soylent Green?

Great minds....

On Sat, 30 May 2009 22:32:34 GMT, Nova <[email protected]> wrote:

>dpb wrote:
>
>> I'm not sure I've seen much in any really new ideas, unfortunately,
>> particularly those that would actually help across the full spectrum of
>> both abilities to pay and access to services.
>>
>> The one thing I'm pretty sure of is that the inclusion of large segments
>> of currently under- or uninsured without a commensurate inclusion into
>> the payment pool by some means is going to be another federal welfare
>> program that will not be able to be funded w/o massive deficits or taxes
>> of one form or another.
>>
>
><snip>
>
>Here's a few changes I'd like to see:
>
>1. The federal government will set a maximum hourly billing rate for
>doctors based on their classification (GP, FP, neurosurgeon, etc.). The
>patient can be billed only for the actual time spent with the physician
>in 15 minute increments.

PErhaps you'd like a Washington Bureauscrat to set your hourly pay
too?

>2. If you have scheduled a doctors appointment and are kept waiting past
>your appointed time the doctor pays you for your wasted time at his
>billing rate in 15 minute increments.

He's going to do this without raising his rates, just to make you
happy? He has to schedule empty slots so emergencies don't upset the
cart?

>3. If you see a doctor and all he does is refer you to a specialist the
>referring doctor get a $15 administrative fee only.

His knowledge isn't worth anything?

>4. The patient pays only for those medications that prove to be effective.

There goes all experimental drugs and any treatment that isn't 100%
effective (are there any?).

>5.A doctor is allowed to have all the tests performed that he deems
>necessary. The patient pays for the test that finds the problem. The
>doctor pays for the rest of the tests.

No tests - no diagnosis. That's a good idea too.

>6. All hospital charges, anesthesiologist fees, nursing staff, in
>hospital supplies and medications, etc. will be considered part of the
>doctor's overhead and will be paid for by the attending physician. This
>should get rid of the $15 aspirins, $20 Band-Aids, etc.

Nonsense. It'll just add another level of bean counting. "$15
aspirins" are "$15" because a large slice of the population is
actually paying $0. For everything.

>7. A doctor receives no payment until all work is complete to the
>patient's satisfaction.

No mode oncologists. Forget hospice care. Nice plan you have going
there.

>8. A money back guarantee will be issued with all procedures performed.

See above.

>I'm sure the group can think of others...

I suppose any idiot can show his stuff on the Usenet.

"dpb" <[email protected]> wrote in message news:[email protected]...

>
> I didn't say anything about _which_ estimate you have to submit; only that
> they will only pay the amount of the lowest that is submitted that covers
> the required work.

That is not true, they indeed have to pay what ever price the shop charges
that you choose. Been there and done that for years on end.

>
> Most body shops I've dealt with will come to within a few $$ of any other;
> they all use one of a few software packages for estimating so their labor
> estimates are all within a few tenths of hours/task and they all use the
> same or nearly after-market parts markets as well. The biggest
> differences I've seen is finishing but the highest here will tell you when
> he makes the estimate it's higher than most other shops in town because of
> that and he'll knock it down when the insurance company balks (as they
> always do).

The insured calls the shots as to which repair shop does the work, the
repair shop may drop the price to play along.

>
> If it's a chromed piece I'll make it be OEM; otherwise anymore I can't see
> any significant difference in the aftermarket parts of significance. Just
> been thru it w/ Mr Buck that couldn't stay on the side of the road where
> he belonged... :(
>

Work around genuine and aftermarket and you will soon learn to tell the
difference. I bought and sold both for 15+ years. Basically you still get
better parts when you pay more. some times this will make a difference some
times not. After market sheet metal will dent easier and often rusts
sooner. Considering chrome, most often the repaired/rechromed bumper will
have a life time guarantee, the Body shop however will not often tell you
that.

Leon wrote:
> "Nova" <[email protected]> wrote in message
> news:[email protected]...
>
>>Leon wrote:
>>>
>>>Precisely, and that is the beauty. Once again competition between
>>>doctors and their services would keep costs low.
>>
>>Do you really think the medical profession would keep the cost low or
>>would they continue to keep jacking their price up to match the ones that
>>are charging the most?
>
>
> Competition drives down prices. With insurance paying for your care there
> is no competition.
>

The competition comes into play with the insurance providers. When I
choose my medical insurance plan one of the major considerations is
which doctors participated in each of the plans that are available.
The lower priced plans had fewer participating doctors and specialists.

<snip>

>
>>>You have to join their group for well under $100 per month for your whole
>>>family but a typical office visit costs around $35.
>>
>>How do they handle payment for the expensive things like surgeries, cancer
>>treatment, child births, hospital stays, etc.?
>
>
> A patient that is a member of one of the Houston area groups had a daughter
> than needed arthroscopic knee surgery. He shopped the price and got quotes
> in the $15,000 range. IIRC his group did the surgery for less than $3,000.

I don't know that I'd always want my medical treatment to go to the
lowest bidder.

>
> There will probably still be insurance for catastrophic needs if you feel
> that living an extra year or two is woth having insurance for.

It doesn't take a catastrophe to end up with astronomical medical bills.
I don't foresee any major reduction is the cost of medical care
regardless of who foots the bill.

As proposed in Swingman's original post:

"Each American citizen shall be able to exclude from taxation the amount
of $5000 per year (adjusted for inflation) for deposit in his or her
Health Savings Account, with catch up contributions allowed if the prior
year's expenses exceeded this amount. There shall be no limit to the
total amount of capital the citizen can accumulate in his or her HSA. .... "

How does this work for a hypothetical married couple with three young
children and one wage earner making minimum wage? Obviously they won't
be able to put $25,000 per year into their HSA.

Then there's:

"8. Citizens with income below the poverty level will be provided yearly
with a "tax rebate" from the Federal Government, deposited directly into
their HSA..... "

A "tax rebate" would indicate the citizen is paying federal tax. A
family of five earning $13,624 per year ($6.55 per hour x 40 hours x 52
weeks) does not pay federal income tax.

And there's:

"10. Citizens who become ill before they have accumulated sufficient
funds in their HSA to cover the "gap" (whose HSA balance falls below
zero in a given year) will be LOANED the needed funds by the Federal
government, to be repaid with interest in the future. This loan will
show up on their credit report and will influence their ability to
borrow for other purposes until it is repaid. .... "

Let's bury the hypothetical family in debt and take away all incentive
to work. Tim and I can cover all their expenses with out tax dollars.

--
Jack Novak
Buffalo, NY - USA
[email protected]

Han wrote:
>
>> What worries me is that the very real possibility of fucking-up
>> something that works properly for 250 million citizens in the hope
>> that a few under-served people will be helped.
>
> Yes, that is pssible. The reverse is much more likely.

Not as long as congress-critters hold to "static-scoring," that is, the
belief that addressing one problem won't affect other areas. For example,
suppose our betters say: "Look, there're 40 million uninsured in the
country. Let's simply require doctors to treat those without insurance and
send their bill to Medicaid. We can (barely) pay for that." Then the fools
look surprised when 260 million people suddenly cancel their existing
insurance.

Delaware dramatically upped taxes on millionaires two years ago. This year,
there are one-third fewer millionaires in the state. Delaware officials are
shocked that over 1,000 of their highest income people have pulled an Elvis.

Point is, people are not "static." They respond to government actions, often
in unexpected, but rational, ways.

>
>> Another issue - and I don't recall whether you mentioned it - is
>> physician liability. My state, Texas, instituted a severe tort reform
>> measure four years ago. Among other things, it capped non-economic
>> losses (pain & suffering, punitive damages) at $250,000. We've
>> stopped hemorrhaging physicians and, in fact, had a tremendous
>> increase in doctors moving here from less-enlightened places.
>
> Congratulations. That example should be followed everywhere. In
> addition, physicians who make bad decisions should get more than a
> friendly pat - some should be really punished, and it should NOT be
> covered by insurance.

I've got an even better fix.

Tort damages consist of several pieces: recovery of economic loss, pain &
suffering, loss of consortium, and so on. My plan is to divert ALL
"punitive" damages to the state. Punitive damages are really "fines" to
discourage future rascally behavior by the defendant, so why should the
plaintiff benefit? In many cases, punitive damages dwarf all other awards
and it is they that make the case worthwhile for the plaintiff bar.

As an aside, Walmart has a policy (I'm told) of NEVER settling a
"slip-and-fall" case - they will always take the case to trial. This costs
more up front, but it does guarantee that meritless claims don't get past
the letter-writing stage.

"Ed Edelenbos" <[email protected]> wrote in message
news:[email protected]...
>>
>>
>> The "Right" thinks that the "Left" can learn this responsibility.
>
> The "right" more often than not, is wrong.


Yeah, you are probably right, the left should be handled by the government
and the right should take care if it self with out having to help the
government take care of the left.

Leon wrote:
> "HeyBub" <[email protected]> wrote in message
> news:[email protected]...
>
>>This plan does not rely on "human nature" to reduce costs - it relies on
>>government setting rules on how health care contracts should be negotiated
>>and enforced. There is nothing that would prevent, today, a physician from
>>demanding payment up front from the patient and refusing all third-party
>>involvement.
>>
>
>
>
> Precisely, and that is the beauty. Once again competition between doctors
> and their services would keep costs low.

Do you really think the medical profession would keep the cost low or
would they continue to keep jacking their price up to match the ones
that are charging the most?

> Already there are groups of doctors, clinics, pharmacies, and hospitals
> that will not accept insurance.

That's because they feel the "usual and customary" charges, agreed to by
those practicing and accepting the payment amounts the insurance
companies have negotiated, are too little and they don't like being
questioned when they overcharge.

> You have to join their group for well under $100 per month for your whole
> family but a typical office visit costs around $35.

How do they handle payment for the expensive things like surgeries,
cancer treatment, child births, hospital stays, etc.?

--
Jack Novak
Buffalo, NY - USA
[email protected]

Somebody wrote:

> The one thing I'm pretty sure of is that the inclusion of large
> segments
> of currently under- or uninsured without a commensurate inclusion
> into
> the payment pool by some means is going to be another federal
> welfare
> program that will not be able to be funded w/o massive deficits or
> taxes
> of one form or another.

The problem is we are already paying the increased costs to cover the
under insured as hidden costs of doing business as a society.

As an example, emergency room visits that go unpaid which in many
cases requirement of a medical program that has advanced because
preventative medice was not available due to cost.

The E/R becomes the court of last result along with it high costs.

In the end it becomes a hidden cost we all pay which is higher than
necessary if all were insured.

It becomes a matter of "PAY me now or PAY me later"

Lew

On Sat, 30 May 2009 11:01:05 -0500, dpb wrote:

>> But yet the SSA administers Social Security with an almost negligible
>> amount of overhead. A government program can work efficently, but the
>> devil is in the details.
> ...
>
> Yeah, so efficiently they have thousands on the roles that have been
> deceased, some for decades (GAO investigation I heard reported not long
> ago)...

I don't doubt there's some fraud going on, but unless you can cite the
source I doubt it's in the thousands. And I mentioned low overhead which
you didn't seem to question.

I wonder if the costs of lowering the fraud rate would exceed the amount
that was saved?

--
Intelligence is an experiment that failed - G. B. Shaw

I agree that changes are needed in our current system, but it scares the
heck out of me to think that the government would be more involved. These
are the same democrats and republicans that have sent our economy into a
tail spin.

I have witnessed our own insurance company dictating the course of treatment
for my wife's breast cancer over the last three years. We have had to fight
to get the proper drugs and treatment over the cost saving path the
insurance company would prefer. We have also been subject to huge
co-payments on drugs. Three years ago we had a co-payment of $65 per pill
for Anzemet!

I like the basis of the letter, but by the time our government gets through
haggling over it we may be fucked again.

cm


"Swingman" <[email protected]> wrote in message
news:[email protected]...
> Friend of mine, a doctor and fellow musician, came up with the following,
> an intriguing plan to revamp the US health care system from a practicing
> physician's perspective.
>
> Be sure to read the entire plan before making any judgments, it's tricky
> in few spots.
>
> <Open Letter>
>
> Dear Mr. President,
>
> Here are the basic principals upon which a sound, sustainable and ethical
> health care system can and should be built:....
>
> 1. It shall be illegal for physicians to contract with anyone other than
> their patient or patient's legal representative. There shall be no
> contracts with the government, with any "managed care" entity or insurance
> company, or with any other third party.....
>
> 2. It shall be illegal for physicians to receive payment directly from a
> third party "payor." Payment must come from the patient directly and shall
> be made at the time of service.....
>
> 3. It shall be illegal for third parties to request discounts from a
> physician for their clients. The price for various services is to be
> negotiated between patient and physician, as is the case with all other
> professions. ....
>
> 4. Each American citizen shall have a Health Savings Account established
> at birth. The HSA will be maintained with an investment firm or bank, the
> accounts being insured by the Federal government to the amount of
> $150,000, as are bank deposits. Increases in value on these accounts via
> interest, dividends or increases in investment value are not taxed, and
> these assets are protected from creditors, as with the usual IRA.
> (Regulations will need to be developed regarding the type of investment,
> allowing a certain low percentage to be invested in more volatile
> investments.) Funds in the HSA can be spent only for Health Care, but can
> be passed on to heirs over multiple generations, to be used for the heir's
> health care needs. ....
>
> 5. Each American citizen shall be able to exclude from taxation the amount
> of $5000 per year (adjusted for inflation) for deposit in his or her
> Health Savings Account, with catch up contributions allowed if the prior
> year's expenses exceeded this amount. There shall be no limit to the total
> amount of capital the citizen can accumulate in his or her HSA. ....
>
> 6. Businesses may no longer subtract from taxable income any payments to
> "insurance companies" for health insurance plans. They can, however,
> deposit money yearly into their employees' HSAs as a dedutible business
> expense, the yearly maximum contribution per employee to be determined
> after study by qualified economists. ....
>
> 7. Each American citizen shall have a catastrophic health insurance plan
> in place that covers yearly health care expenses over $20,000 (adjusted
> yearly for inflation). This plan will be sponsored and financed by the
> Federal Government. See below for Comments about administration of this
> plan.....
>
> 8. Citizens with income below the poverty level will be provided yearly
> with a "tax rebate" from the Federal Government, deposited directly into
> their HSA.....
>
> 9. The government will mandate that each state educate its citizen about
> this "self-reliant" system. Every citizen must realize the need for
> preventive health care and a healthy lifestyle. They must realize that
> prudent use of these funds and maintaining a healthy lifestyle are the
> surest route to security. They must be made aware that contribution yearly
> to the HSA must come before purchase of consumer goods, a new car, or a
> vacation, for example. There will be no free “safety net” other than the
> catastrophic coverage.....
>
> 10. Citizens who become ill before they have accumulated sufficient funds
> in their HSA to cover the "gap" (whose HSA balance falls below zero in a
> given year) will be LOANED the needed funds by the Federal government, to
> be repaid with interest in the future. This loan will show up on their
> credit report and will influence their ability to borrow for other
> purposes until it is repaid. ....
>
> Comments.....
>
> This plan relies on human nature to reduce costs. When payment is coming
> directly from funds controlled by the patient, the patient will make wiser
> choices. There will be less desire to obtain expensive tests that are
> marginally indicated for minor complaints or to obtain expensive tests
> when less expensive tests will do. Less expensive, but equally effective,
> medications will be demanded by the patient..... and so forth.
>
> With this system, the medical profession will be restored to an ethical
> status, it being unethical to allow outside influences to intrude on the
> physician-patient relationship (as contracts with third parties invariably
> do). ....
>
> The public will demand transparency in the pricing of services and will
> cease to tolerate overpriced services. ....
>
> The nation will then be pooling health risks that are in the catastrophic
> range, rather than simply using the "insurance industry" as a (leaky)
> conduit of money from employer to physician or hospital for everyday care.
> ....
>
> With prudent living and prudent saving, within five to six years each
> citizen will have in their HSA sufficient funds to cover the $20,000 "gap"
> in any one catastrophic year, and within ten or so years should have the
> funds to cover the gap for several years of catastrophic ill health. With
> good health and good planning, these funds can be passed from generation
> to generation, allowing those families with good health to become fully
> covered with only rare intervention by the government. ....
>
> The government can negotiate with the current managed care industry to
> obtain management of the catastrophic funds with minimal administrative
> expense, or can set up its own administrative agency (to replace the
> current CMS, for example) to manage and administer the catastrophic
> coverage program.....
>
> Physicians will now be free to concentrate on what they do best, care for
> patients and maintain their knowledge base, and will no longer have to
> waste time dealing with managed care contracts and meaningless requests
> from managed care companies. ....
>
> I urge you not to let the powers that be within the current managed care
> industry or within the established government agencies to bring pressure
> against the adoption of such a rational and beneficial plan.....
>
> Respectfully yours,
>
> Lawrence E. Mallette, MD, PhD, FACP, FACN
> April 2009
>
> </Open Letter>
>
> Once again, chew on it for a while before rushing to judgment.
>
> --
> www.e-woodshop.net
> Last update: 10/22/08
> KarlC@ (the obvious)

krw wrote:
> On Sat, 30 May 2009 22:32:34 GMT, Nova <[email protected]> wrote:
>
>
>>dpb wrote:
>>
>>
>>>I'm not sure I've seen much in any really new ideas, unfortunately,
>>>particularly those that would actually help across the full spectrum of
>>>both abilities to pay and access to services.
>>>
>>>The one thing I'm pretty sure of is that the inclusion of large segments
>>>of currently under- or uninsured without a commensurate inclusion into
>>>the payment pool by some means is going to be another federal welfare
>>>program that will not be able to be funded w/o massive deficits or taxes
>>>of one form or another.
>>>
>>
>><snip>
>>
>>Here's a few changes I'd like to see:
>>
>>1. The federal government will set a maximum hourly billing rate for
>>doctors based on their classification (GP, FP, neurosurgeon, etc.). The
>>patient can be billed only for the actual time spent with the physician
>>in 15 minute increments.
>
>
> PErhaps you'd like a Washington Bureauscrat to set your hourly pay
> too?

Actually I do think I'd prefer it. Government workers in my field are
getting higher pay.


>>2. If you have scheduled a doctors appointment and are kept waiting past
>>your appointed time the doctor pays you for your wasted time at his
>>billing rate in 15 minute increments.
>
>
> He's going to do this without raising his rates, just to make you
> happy? He has to schedule empty slots so emergencies don't upset the
> cart?

Waiting 30 to 60 minutes for every appointment tells me he makes it a
practice to over schedule.

>>3. If you see a doctor and all he does is refer you to a specialist the
>>referring doctor get a $15 administrative fee only.
>
>
> His knowledge isn't worth anything?

Sure, to refer me to a another doctor it would be worth $15. How much
are you willing to pay, say an air conditioning repairman, for a service
call who tells you you have to call a another repairman to fix the problem.

>>4. The patient pays only for those medications that prove to be effective.

> There goes all experimental drugs and any treatment that isn't 100%
> effective (are there any?).

When is the last time your doctor prescribed an experimental drug. I
believe mine only prescribes the FDA approved ones. I never mentioned
100%, just effective.


>>5.A doctor is allowed to have all the tests performed that he deems
>>necessary. The patient pays for the test that finds the problem. The
>>doctor pays for the rest of the tests.
>
>
> No tests - no diagnosis. That's a good idea too.

The doctor is free to run any test he wants. I think he'd pick the one
that would provide the most conclusive results the first time rather
than paying for three or four slightly less expensive tests that he
suspects has little chance of revealing the problem.


>>6. All hospital charges, anesthesiologist fees, nursing staff, in
>>hospital supplies and medications, etc. will be considered part of the
>>doctor's overhead and will be paid for by the attending physician. This
>>should get rid of the $15 aspirins, $20 Band-Aids, etc.
>
>
> Nonsense. It'll just add another level of bean counting. "$15
> aspirins" are "$15" because a large slice of the population is
> actually paying $0. For everything.

That could very well be. That's probably the reason my wife's family
got a $3000 hospital bill for services rendered to her mother where the
date of the services performed were three months after her burial.
Neither are right.

>>7. A doctor receives no payment until all work is complete to the
>>patient's satisfaction.
>
>
> No mode oncologists.

Why, my wife has been more than satisfied with her oncologist who has
treated her twice in the past.

Forget hospice care.

I agree.

Nice plan you have going there.

Thank you!

>>8. A money back guarantee will be issued with all procedures performed.

> See above.

>>I'm sure the group can think of others...

> I suppose any idiot can show his stuff on the Usenet.

I guess so.

--
Jack Novak
Buffalo, NY - USA
[email protected]

On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote:

> They must be made aware that contribution yearly to the HSA must come
> before purchase of consumer goods, a new car, or a vacation, for
> example. There will be no free “safety net” other than the catastrophic
> coverage.....

Someone has a lot of faith in people acting responsibly. It'll never
happen. And what happens to the health needs of children of
irresponsible parents?

Make the HSAs mandatory, deducted from earnings, and the plan has a
pretty good chance of working.

--
Intelligence is an experiment that failed - G. B. Shaw

"dpb" wrote:

> I still say one's viewpoint of costs when dealing w/ major health
> care isn't generally focussed on lowest bidder. For maintenance
> care such as long-term medications, etc., sure, but for (say) cancer
> are you going to the local GP or Hutchinson or Mayo or other
> specialty clinic?

It is the market forces at work regardless of the industry.

When the talent pool is limited and the demand high, price reflects
this whether you are dealing with show business talent, lawyers, or
the medical profession.

Quality, perceived or otherwise, has it's price.

Lew

"Lew Hodgett" <[email protected]> wrote in message
news:[email protected]...
> "Leon" wrote:
>
>
>> The very simple solution is that the insurance company requires the
>> customer to have regular scheduled check ups on his dime.
>
> You have just eliminated that portion of the population that can least
> afford to pay for health care in the first place which will definitely
> include the full time minimum wage worker.

Well you have to start some where and I would just have to call it tough
love. If you eleminate the insurance industry death grip on the family
practitioner the medical costs would be much more affordable. Paying the
way for non citizens is part of the big problem. It all snow balls.

There are many free clinics that could perform the check up.
For a normal check up a person does not need red carpet service if he cannot
afford to pay, especially if it lowers costs.

"Nova" <[email protected]> wrote in message
news:[email protected]...
> Leon wrote:
>> "HeyBub" <[email protected]> wrote in message
>> news:[email protected]...
>>
>>>This plan does not rely on "human nature" to reduce costs - it relies on
>>>government setting rules on how health care contracts should be
>>>negotiated and enforced. There is nothing that would prevent, today, a
>>>physician from demanding payment up front from the patient and refusing
>>>all third-party involvement.
>>>
>>
>>
>>
>> Precisely, and that is the beauty. Once again competition between
>> doctors and their services would keep costs low.
>
> Do you really think the medical profession would keep the cost low or
> would they continue to keep jacking their price up to match the ones that
> are charging the most?

Competition drives down prices. With insurance paying for your care there
is no competition.





>
>> Already there are groups of doctors, clinics, pharmacies, and hospitals
>> that will not accept insurance.
>
> That's because they feel the "usual and customary" charges, agreed to by
> those practicing and accepting the payment amounts the insurance companies
> have negotiated, are too little and they don't like being questioned when
> they overcharge.

I suspect it is because they make more money and have lower costs extcept
for the extensive advertising.


>
>> You have to join their group for well under $100 per month for your whole
>> family but a typical office visit costs around $35.
>
> How do they handle payment for the expensive things like surgeries, cancer
> treatment, child births, hospital stays, etc.?

A patient that is a member of one of the Houston area groups had a daughter
than needed arthroscopic knee surgery. He shopped the price and got quotes
in the $15,000 range. IIRC his group did the surgery for less than $3,000.

There will probably still be insurance for catastrophic needs if you feel
that living an extra year or two is woth having insurance for.

"dpb" wrote:

> But, unfortunately, easily verifiable as true regardless of whether
> one wishes to admit it or not.

Be my guest.

> W/O personal accountability which present systems tend to not have,
> there's no hope of ever changing the mindset of the dependent nor is
> there then any limit to the resources that can be absorbed.
> Remember Johnson's "war on poverty"????

And where is the lack of personal accountability?

> I don't believe that would actually turn out that way overall. I
> think the demand for increased services will far outstrip the
> benefits to be gained. Only time will tell for sure.

This campaign to revise the health care system is not being driven by
wanting to increase costs but rather the necessity too reduce them.

> Again, time will tell, but I would be _MOST_ surprised if it turns
> out to actually have any significant reduction in cost. Health care
> isn't turning out widgets on an assembly line so production can't
> really go up much just because there's a computer-generated record
> as compared to introducing robotics or other technologies in
> manufacturing. It's a flawed comparison.

The impact that the internet and digital technology is having on
information systems is such that the half life of anyones knowledge of
information systems is measured in months not years.

There will be growing pains to implement the technology; however,
there is no way to totally comprehend the benefits to be gained at
this point in time.

> I've yet to see any specific cost-avoidance that the implementation
> of computerized records is going to achieve documented. The folks
> keep repeating the promises, but don't ever say how.

See above.

> The insurance companies have to pay the medical costs w/ generated
> revenues. The discussion is to bring more people into the covered
> fold w/o additional identified sources of that revenue. How that is
> to reduce costs is somewhat of a mystery.

The name of the game is to implement a new model that is more
efficient, not stay with the status quo..

People are demanding more miles per gallon from their health care $,
and come hell or high water, it's going to happen.

> All I'm advocating is that somewhere there has to be a way to create
> the revenue stream and that imo it is the responsibility of the
> individual to be the contributor directly for their own welfare.

Once again, how does a health insurance program that covers the total
population eliminate the contribution requirement of all participants?

> I'm willing to share to a degree for the less fortunate, but not to
> the degree of simply continuing to carry the load for those who
> choose not to as is the present plan (and, as far as I can tell, the
> intent of this Congress is to make that even more so).

It may surprise you but I look at this rather selfishly.

By including everybody in the gene pool with no "cherry picking"
allowed, I fully expect my health care costs to be reduced.

Lew

On Thu, 04 Jun 2009 14:23:30 -0500, HeyBub wrote:

>> If that's correct, a single-payer federal system could waste 1/3 and
>> still break even.
>
> Assuming, arguendo, that the 1/3 number is correct: So what? One-third
> seems like a lot, but how does it compare to the alternatives?

We'll never know unless we try the alternative, will we?

--
Intelligence is an experiment that failed - G. B. Shaw

"dpb" wrote:

> That's what catastrophic policies are for...you don't have one???

And after it gets maxed out, then what?

Lew

"J. Clarke" <[email protected]> wrote in message
news:[email protected]...
>
> More to the point, even if the actual cost is only 100K and not 300K,
> that's
> still more than most people can afford out of pocket.
>
>

but a far greater amount of people can afford 100k vs. 300k. You are not
going to be able to please all the people all the time.

Leon wrote:
> "Nova" <[email protected]> wrote in message
> news:[email protected]...
>
>>
>>I don't know that I'd always want my medical treatment to go to the lowest
>>bidder.
>
>
> Agreed and these guys are probably makin more off of the procedure than
> those having to collect from an insurance company. Remember insurance
> companines get deep deep discounts and often don't pay.

It sound to me like the insurance companies are keeping the cost down.


> Basically HMO's and > insurance companies are more like agents for many
> doctors. I think I would probably have more faith in a doctor that
> does not rely on an insurance company to bring in it's patients.
>

The insurance companies rely on their participating doctors list to
bring in the customers.

>>>There will probably still be insurance for catastrophic needs if you feel
>>>that living an extra year or two is woth having insurance for.
>>
>>It doesn't take a catastrophe to end up with astronomical medical bills. I
>>don't foresee any major reduction is the cost of medical care regardless
>>of who foots the bill.
>
>
> Don't for get the major point here, insuranc companies make more than the
> health care system does and what overhead does an insurance company have
> other than an office for record keeping?

Medical insurance companies are gambling that the coverage premium they
charge along with any returns on there investments made with your money
will exceed the medical payments they make in your behalf. By them
making a profit it shows that on the average they're right.

> Take the insurance company out of petty coverage and every one saves, except
> the insurance company.

Your key word above is "petty". If you take the insurance company out
of the picture you'd better hope that you're one of the customers that
make their "average" profitable.

--
Jack Novak
Buffalo, NY - USA
[email protected]

"dpb" wrote:

> For the record, the "somebody" was actually me--
>
> Of course much of the high cost is the cost of the under/non-insured
> being paid by the responsible/insured. But, I fail to see how/why
> people seem to think that adding additional clientele who aren't
> payers to the system is somehow going to reduce the actual
> expenses--it's only going to raise demand and (at least everything
> I've seen proposed so far) take money from a government pocket to
> artificially reduce _apparent_ individual cost. Meanwhile,
> non-itemized expenses in the form of alternative and higher taxes
> (remember, the whole point of the proposed C cap&trade fiasco is to
> generate a multi-billion revenue stream to the federal government to
> pay for this) is going to skyrocket.
>
> Unless and until there's some technique to generate more actual
> revenue from those who are actually in the pool that aren't
> currently paying there's no relief. I've yet to see proposals that
> seem to be effective in doing that.
>
> My suggestions to open up the existing large insurance pools to the
> self-employed and for small businesses that currently can't afford
> any or at least very good programs for themselves and their
> employees would allow for a large population to actually contribute
> that currently aren't.
>
> In addition, I think it should be required that all salaried workers
> contribute something to a plan regardless of salary level--opting
> out unless demonstrate are covered under a spousal plan or
> independently (similar to showing proof of auto insurance for
> registration) would not be allowed.
>
> Also, the earlier point someone made upthread of raising
> contribution limits and relaxing restrictions on usage of the
> various health savings plans would allow for more people to be able
> to do better in becoming self-insured either fully if of high-enough
> income or partially if lesser. There would be far more
> participation in these if, for example, it wasn't "use it or lose
> it" on a yearly basis as the most obvious.
>
> More controversial, the inevitable cheats who don't have coverage at
> the minimum as outlined above get nothing but the most basic of
> services. There have to be consequences for bad behavior or there is
> no incentive for the irresponsible and as is currently the case the
> good will continue to carry the bad.

We are faced with a health care system with a cost structure that can
not be maintained and that fails to cover all its people.

A system put together as a patchwork of special interest programs with
more exceptions and loop holes than the federal income tax laws.

An underling thread in the above seems to be that somehow, just
because you are
poor, you will cheat the system and get benefits you are not entitled
to have.

Some how this baffles me.

All people, poor or not, want to improve their lot in life.

I've met very few that were unwilling to work to improve thier lot in
life.

The idea that somebody might get something free or at less cost than
somebody else borders on paranoia, if you ask me.

There is not doubt that including EVERYBODY in a health plan is going
to increase the initial cost of a medical plan; however, offsetting
cost savings are MANDATORY, if health care, 100% or otherwise is to
continue to be provided.

The status quo can NOT be sustained.

There is the obvious low hanging fruit such as records computerization
and allowing Medicare to negotiate competitive drug prices, and the
reduction of CYA tests used by doctors today, but that doesn't scratch
the surface.

Reorganization such that competitive bidding can be introduced will go
a long way; however, the health insurance lobby is/will fight that one
all the way.

I'm certainly not a health insurance expert; however, it doesn't
require much thought to realize serious changes must be made to the
existing system.

Lew

"dpb" wrote:

> Unfortunately, I don't really believe that is as much the actual
> underlying motive as it is the technique chosen to "sell" the idea.
> Many are more concerned w/ growing bureaucracy and expanding their
> political base than any real reduction in health care costs.

Including 100% of the gene pool to provide preventative health care
rather than provide more expensive treatment, usually via the E/R is
not what is or will drive higher health care costs.

The elephant in the room is Mom & Pop, IOW, are aging population.

Health care costs for the last few years of life are consuming health
care resources at an alarming rate, but what do you do?

Fortunately we have not yet come to the point where we allocate health
care resources based on rate of return.

(i.e. You are to old for that (Insert name) operation. You most likely
won't live long enough to make it worth the cost so we won't pay for
it).

I don't have the answer, but changes must be made, and ultimately it
will require a single payer system to get it done.

The politically conservative right wing will fight it to the death,
but they don't have the votes to stop health care reform this year.

Lew

"Nova" <[email protected]> wrote in message
news:u%[email protected]...
> Leon wrote:
>> "Nova" <[email protected]> wrote in message
>>>>Agreed and these guys are probably makin more off of the procedure than
>>>>those having to collect from an insurance company. Remember insurance
>>>>companines get deep deep discounts and often don't pay.
>>>
>>>It sound to me like the insurance companies are keeping the cost down.
>>
>>
>> Would you use an insurance company to hep you buy electricity, groceries,
>> clothing? They don't keep costs down, often they perpetuate the problem.
>
> Think of it as a co-op paying wholesale rather than retail.


That is exactly how I think of it. The insurance company is paying
wholesale to the doctor, I pay way above retail for that insurance.

>>>>Basically HMO's and > insurance companies are more like agents for many
>>>>doctors. I think I would probably have more faith in a doctor that
>>>>does not rely on an insurance company to bring in it's patients.
>>>>
>>>
>>>The insurance companies rely on their participating doctors list to bring
>>>in the customers.
>>
>>
>> I have never heard of any one including myself choosing an insurance
>> company based on its doctors list. Most employees insurance is provided
>> through their employeer. The employeer decides which insurance company
>> to go with and you choose from the list of doctors.
>
> The company I work for last year offered three different plans.
>
> The first plan was their "Basic Medical Plan". The company paid 100% of
> the premium. You had to designate a primary physician and the only way
> you could see a different doctor was through a referral by the primary.
> There was a $25 co-payment per office visit and very few doctors in my
> area accepted the plan. None of the doctors we've used for years accepted
> the plan.
>
> The second offering was an HMO where I paid a small portion of the premium
> and all medical treatment had to be done by the single designated
> facility. The office was about 20 miles from my home and I'd never heard
> of any of the doctors on the staff.
>
> The third plan required me to pay a much higher portion of the monthly
> premium. The out of pocket premium would cost me about $80 per month for
> myself and my wife. Any doctor I looked for in the list of participating
> doctors accepted the plan. I did not have to designate a primary
> physician and could see any doctor of my choice at any time. Office visits
> had a $10 co-payment.
>
> I chose the third plan.

And your share is a drop in the bucket compared to what the company cost
was. My wife works for the state of Texas and they get very favorable
rates, her insurance is similar to the one you chose and her share of the
premium is $0. For myself and our son our share of the premium is 1/2,
$380 per month.
Several years ago the average expense for a company was around $900 per
month to cover an employee with insurance.

"Leon" wrote:

> Exactly! I believe that insurance costs are sky high because of
> abuse. IMHO insurance should only be used of those events that you
> could no possibly afford, not normal trips to the doctor for the
> regular illness.

On first glance looks good, but when you dig deeper has a major flaw.

When insurance covers regular services of a person's primary giver,
illnesses are detected earlier and can be handled with the lowest cost
service.

When insurance does not covers regular services of a person's primary
giver, illnesses are not detected as early as they should be often
resulting in higher cost services to overcome the advanced problem.

Health care insurance is a tad different than other insurance
products.

Lew

Lew Hodgett wrote:
\
> The elephant in the room is Mom & Pop, IOW, are aging population.
>
> Health care costs for the last few years of life are consuming health
> care resources at an alarming rate, but what do you do?

Not true, sounds reasonable, but is unfortunately an urban myth, not
supported by research ... "the growing ranks of the elderly are
projected to account for just 0.4 percent of the future growth in health
care cost" - Center for Studying Health System Change.

Actually, the practice of "fee-for-service" is the real reason for your
"alarming rate" increase.

--
www.e-woodshop.net
Last update: 10/22/08
KarlC@ (the obvious)

"Lew Hodgett" <[email protected]> wrote in message
news:[email protected]...
>
> "Leon" wrote:
>
>> Competition drives down prices. With insurance paying for your care
>> there is no competition.
>
> Reading the above brings a question to mind about another industry.
>
> How much competition is there among auto body shops for insured accident
> repair?

When I was in the business, there was basically no competition, in Houston
or Corpus Christi, in the 70's, 80's, and 90's. Because 99% of the cars
being repaired were covered by an insurance company. Basically we never
had to worry about a customer turning down an estimate.
Additionally we did not accept payment from insurance companies unless it
was MIC insurance sold by GM. We charged every one the same price whether
the insurance company was involve or not. When we had to accept MIC
insurance we had to discount parts $30% and give a hefty discount on labor.
We stayed busy.

"Upscale" wrote:
> And, what you say does make sense, but
> why are they not receiving adequate preventative health care? Is it
> solely a
> financial reason?

In the end, yes.

You are talking about a segment of the population that is at the
bottom of the economic scale.

Lack of formal education also comes into play.

Also what gets included is sex education (i.e. birth control) now that
Bush is gone.

Unrelated but it helps to illustrate the point that a little money
spent at the right time, can save a whole lot later.

Malaria is a serious problem in parts of Africa, primarily transmitted
by mosquitoes.

Bill Gates has brought in some mosquito netting and given it to
people.

The reduction in malaria cases has been dramatic.

As usual, things get down to timing.

Lew

"dpb" wrote:

> Nor ime is it likely to make any real difference in EOL outcomes as
> technology continues to improve to extend life and the expectation
> is that everyone is entitled to receive every possible treatment to
> extend life as long as possible irregardless of eventual outcome (in
> the near term sense, obviously). With that increasing technology
> and the use of it are inherent higher costs.

As I said earlier, it is the real elephant in the room.

It is THE issue that society must face.

When do you say, "Enough is enough"?

Do we require everybody to have a "Living will"?

At least then, the desires of the person most affected are known.

Do we nationally adopt the procedures that are in place in Oregon?

Do we empower the government to make these decisions?

I think NOT.

What part does a persons religion have in this process?

Tough questions, but it now is the time to face up to what are not
only tough, but uncomfortable questions to answer.

Lew

"HeyBub" <[email protected]> wrote in message
news:[email protected]...
>
> This plan does not rely on "human nature" to reduce costs - it relies on
> government setting rules on how health care contracts should be negotiated
> and enforced. There is nothing that would prevent, today, a physician from
> demanding payment up front from the patient and refusing all third-party
> involvement.
>


Precisely, and that is the beauty. Once again competition between doctors
and their services would keep costs low. Already there are groups of
doctors, clinics, pharmacies, and hospitals that will not accept insurance.
You have to join their group for well under $100 per month for your whole
family but a typical office visit costs around $35.

"Ed Pawlowski" wrote:


> From what I've seen, there will be benefits not only in cost, but
> better patient care. The HMO that we belong to is on of the largest
> in MA, They went to a computerized system a bit over a year ago.
> My wife has a heart condition that started in 2001. Her file was
> about 6" thick and was carried from the central office to any of the
> half dozen doctors in four different facilities. Now, nothing is
> moved and everything is on the computer.
>
> An X Ray would be taken at the hospital. Two weeks later she'd see a
> different doctor about it so we'd have to call for the x ray, pick
> it up and carry it to the next doctor and he'd have to send it back
> when done. No more, it is available at any of the computers in any
> exam room or doctor's office.
>
> Prescriptions? A couple of mouse clicks and it is ready to pick up
> at our pharmacy in our town 30 miles away.
>
> I had some knee problems. My x rays and MRI results are right there,
> in seconds, for the doctor to see.
>
> I'm not so sure the government should be paying for the change, but
> I can see the benefits anytime either one of us goes to the doctor,
> and that can be very frequent.

What you are describing` is just the low hanging fruit.

Who knows what benefits lie ahead?

It is hard to tell which is progressing more rapidly, medicine or
electronics, but when driven to feed off each other, look out for that
rocket ship.

Lew

Larry Blanchard wrote:
> On Thu, 04 Jun 2009 14:23:30 -0500, HeyBub wrote:
>
>>> If that's correct, a single-payer federal system could waste 1/3 and
>>> still break even.
>>
>> Assuming, arguendo, that the 1/3 number is correct: So what?
>> One-third seems like a lot, but how does it compare to the
>> alternatives?
>
> We'll never know unless we try the alternative, will we?

We have tried it. Both Medicare and Medicaid are both, essentially,
single-payer.

On Thu, 04 Jun 2009 07:47:28 -0500, HeyBub wrote:

> That said, what does your experience say about who will do a better job
> of eliminating waste and duplication - insurance companies or the
> federal civil servants?

I think a couple of quotes from today's newspaper might apply - one
directly, one indirectly. First the direct one:

"One-third of every health care dollar pours into industry profit,
administrative redundancy, congressional campaign funding, marketing, and
lobbying."

If that's correct, a single-payer federal system could waste 1/3 and
still break even.

And since most of the opposition to single payer comes from the right
wing of American politics, herewith the indirect quote:

"It has long been a problem for the GOP that some of the party's most
cherished positions are embraced most enthusiastically by people whose
grip on reality is sometimes tenuous."

Sorry, the devil made me do it :-). And I expect at least one response
that takes the previous sentence as the "gospel" truth :-).

Oh yes, as far as competition lowering costs. A study from some group at
Harvard found that the more medical professionals there were in a given
area, the more expensive the care was without any corresponding increase
in positive results. IOW, since each doctor was getting a smaller slice
of the pie, he or she raised fees to compensate. So much for
competition. BTW, I recall several earlier studies that found the same
results.

--
Intelligence is an experiment that failed - G. B. Shaw

"dpb" wrote:

> Glittering generalities... :)

Doesn't fit the definition as I was taught in high school civics
class.

> There are great promises made in phrases much like the sentence you
> wrote above, but never any actual details of what costs are avoided
> that are greater than the cost of implementing/maintaining and
> operating the new computerized system.

They haven't been released yet; however, as someone who has required
medical service recently, much of the medical industry is in the stone
age when it comes to record keeping.

Reminds me of "the book" my parents had at the local grocery store
that got settled every other week when Dad got paid.

> W/O a credible analysis of that, I'm unwilling to accept a general
> statement that it will somehow just turn out that way. I compare it
> to the implementation of word processing in business--we know turn
> out reams of gorgeous paper spending hours in formatting, adding
> clip art and so on, printing on color laser printers the same raw
> data that formerly went on IBM selectrics. It isn't at all clear
> most of this new technology does anything other than create busywork
> and the _impression_ of progress rather than anything actually real.

As the sign says, "Get in, sit down, buckle up, shut up and enjoy the
ride".

MRI's are on disc these days, so are X-Rays.

That's a long way from word processing.

My guess is that the medical community is going to create a demand for
memory capacity that is going to keep the memory people busy for quite
awhile.

> These folks should have consequences of that irresponsibility come
> back on them to provide incentives to contribute before they become
> direct drains on the system.

And you were never young and stupid?

> As for "cheats", I routinely even in this very small community see a
> number of people cashing in on food stamps that could purchase every
> bit of required foodstuffs they would need simply by having a car
> payment half of that they obviously have.

That's not your decision to make.

> Until there becomes a way in which bad decisions have negative
> repercussions there is no incentive for those people to change their
> behavior and under those conditions people will continue to take
> whatever is offered. Hence, the conundrum that there is essentially
> no limit to the amount of resources that _can_ be poured into any
> program--"demand" will always continue to grow no matter how much is
> spent.

Scrooge still lives.

It's almost as if you are jealous that you didn't try to avail
yourself of some of these schemes.

I still remember my mother's words, "Never yet saw a U-Haul following
a hearse".

Lew

"HeyBub" <[email protected]> wrote in message
news:[email protected]...

>
> This plan does not rely on "human nature" to reduce costs - it relies on
> government setting rules on how health care contracts should be negotiated
> and enforced. There is nothing that would prevent, today, a physician from
> demanding payment up front from the patient and refusing all third-party
> involvement.
>


I know of at least on who does just that. You get to negotiate with your
health insurance company and wait for them to pay.

dpb wrote:
> Lew Hodgett wrote:
> ...
>> Had a guy tell me it cost him over $65,000 the previous year to keep
>> his wife in the same nursing home my mother was in for almost 2 years.
> ...
> If he had been responsible and bought the long-term care policy, he
> would have been in far better shape.
>
> With mother the combination of her SS widows benefits paid daily cost of
> the assisted living facility until forced to nursing home. The
> combination of the care policy and SS covered virtually all of that cost.
>
> The point is, folks need to plan for their futures and take steps before
> they reach a crisis, not be like TheDoofus.
>
> At least then, there would be some possible chance of aiding some of
> those who actually need it rather than all who abrogate their
> responsibilities to the State.

A f*ckingmen, Bubba!!

IOW, do what "RESPONSIBLE" people have been doing since Adam and Eve ...
taking care of their elderly ***themselves***!!

Instead of conveniently warehousing them in a nursing home and/or paying
somone else to wipe their butts ... because the inconvenience to the
family of that single, symbolic act, and similar distasteful ones, is
realistically the driving force behind a cottage industry that does
indeed require big, but unnecessary, bucks.

And don't tell me it doesn't work ... we, as a family, are fresh from
taking turns taking care of my FIL in the last two years of his life, no
nursing home, no nursing care ... we wiped his ass ourselves instead of
paying someone the $5K/month required to do just that.

And we, collectively as a family, are doing the same for my parents. My
father, still relatively vigorous at 85, feels a RESPONSIBILITY to his
now demented wife of 67 years to NOT warehouse her, as convenient as it
would be, while the rest of the family pitches in, knowing he is next,
followed by us sooner or later.

Again, don't tell me it doesn't work ... we are living these words ...
it's a god damned shame that this culture won't raise a hand to take
care of their elderly, instead expecting the government, insurance
company's, and nursing homes to do the dirty work.

SHAME on you selfish sons of bitches who think otherwise out of
"convenience" or it not being "practical"!

--
www.e-woodshop.net
Last update: 10/22/08
KarlC@ (the obvious)

"dpb" <[email protected]> wrote in message news:[email protected]...
> ...
>
> Do they do the difficult surgeries or are they like the private heart
> clinics and others I'm aware of that "cherry-pick" the routine cases w/
> high probability of success and low probability of complications and leave
> the rest to the others thus driving up average costs drastically. Again,
> _there's_ where the rub is.

I have heard nothing to make me think that they would not. It would be as
ignorant to assume that they would not as it would be to believe that they
would with out checking the details. Same goes for AMU insurance company or
HMO.

>
> I'd wager it's the latter--every one of those groups I've ever seen have
> very selective membership criteria.

Have you seen them all?


>
> I don't understand the 30% example--typically insurance carriers are
> covering 80% or "standard and normal" for any particular procedure.

I see my medical bills and what portion that is actually paid by the
insurance companies. Often the insurance companies cut up to 90% off and
often will not cover a procedure. The doctor writes that off, I don't get
billed for the difference.


>
> I'll agree there is some overhead in processing claims but I'm yet to be
> convinced it is a preponderant fraction of costs--rate it compared to
> liability cost and uninsured/uncompensated care costs and I'd wager it's
> the tail of the dog. Just as I'm totally unconvinced electronic records
> will have any discernible effect on actual costs--it may help in some
> cases w/ precision, add errors in coding in others and every large
> data-processing implemented I've ever seen simply transferred one group of
> overhead costs to a different set to implement/maintain/operate the
> system.

"Tim Daneliuk" <[email protected]> wrote in message
news:[email protected]...

> That's the best proposal in this thread. I also think that
> the group participants ought to be able to pick the nurses
> for their, um, non-medical attributes since these almost
> certainly enhance healing ...
> ----------------------------------------------------------------------------

How "Dr. Strangelove" of you.

--
Dave in Houston

A Proposal:

Nobody, including me, wants anymore gov't involvement in our lives
than me.

The exception being when the scope of the task is such that only
government has the necessary resources to handle the task.

Reorganization of the health care systems is IMHO, one of those tasks;
HOWEVER, is does not require the government taking over the health
care system such as has been done in other countries.

Rather is will require the government to develop a set of laws that
will govern the way private enterprise operates in the health care
market.

One of those ways is for the government to form the John Q Citizen
division of the federal employees health care system and offer
coverage to anybody who wants to participate at competitive rates.

You don't have to buy the government insurance, but you DO have to buy
health insurance from somebody.

There will be a segment of the population which will require some form
of subsidy, and I leave that to others to resolve.

The whole purpose is to provide health care for everybody so that we
can transition from sickness treatment to preventative health care at
lower cost per transaction.

A benefit of such a program is that it will force the private sector
to offer competitive health insurance rather than the "Cherry Picking"
products now offered.

Open up the drug purchasing programs to competitive bidding, and I
don't want to hear any bull shit from the drug companies about
research costs.

They all ready spend more on advertising than they do on research.

The above still does not address the ballooning costs of health care
for the elderly, but it is a start, and it would not surprise me if
much of the above is where things are headed based on some of Obama's
comments.

"dpb" <[email protected]> wrote in message news:[email protected]...
> Lew Hodgett wrote:

> Quite a lot here, actually, anyway. All insurance companies I've dealt
> with pay only the lowest bid w/ confirmation work is required either by
> own inspection for really high-$$ jobs or simply photographic submittals
> for lesser amounts.

The insurance company "wants" to only pay the lowest bid. Read your
policy, there is generally no mention of where you have to get the car
repaired. If you choose to have the car repaired at a more expensive place
the insurance so is liable to pay for the repairs up to the value of the
car. Basically the lowest bid could still be thousands higher than the next
guy down the street. It is a game that the insurance companies play. They
try to make you and are very often successful at getting you to shop for
cheap repairs.

Swingman <[email protected]> wrote in
news:[email protected]:

> Friend of mine, a doctor and fellow musician, came up with the
> following, an intriguing plan to revamp the US health care system from
> a practicing physician's perspective.
>
> Be sure to read the entire plan before making any judgments, it's
> tricky in few spots.
>
> <Open Letter>
>
> Dear Mr. President,
>
> Here are the basic principals upon which a sound, sustainable and
> ethical health care system can and should be built:....
>
> 1. It shall be illegal for physicians to contract with anyone other
> than their patient or patient's legal representative. There shall be
> no contracts with the government, with any "managed care" entity or
> insurance company, or with any other third party.....
>
> 2. It shall be illegal for physicians to receive payment directly from
> a third party "payor." Payment must come from the patient directly and
> shall be made at the time of service.....
>
> 3. It shall be illegal for third parties to request discounts from a
> physician for their clients. The price for various services is to be
> negotiated between patient and physician, as is the case with all
> other professions. ....
>
> 4. Each American citizen shall have a Health Savings Account
> established at birth. The HSA will be maintained with an investment
> firm or bank, the accounts being insured by the Federal government to
> the amount of $150,000, as are bank deposits. Increases in value on
> these accounts via interest, dividends or increases in investment
> value are not taxed, and these assets are protected from creditors, as
> with the usual IRA. (Regulations will need to be developed regarding
> the type of investment, allowing a certain low percentage to be
> invested in more volatile investments.) Funds in the HSA can be spent
> only for Health Care, but can be passed on to heirs over multiple
> generations, to be used for the heir's health care needs. ....
>
> 5. Each American citizen shall be able to exclude from taxation the
> amount of $5000 per year (adjusted for inflation) for deposit in his
> or her Health Savings Account, with catch up contributions allowed if
> the prior year's expenses exceeded this amount. There shall be no
> limit to the total amount of capital the citizen can accumulate in his
> or her HSA. ....
>
> 6. Businesses may no longer subtract from taxable income any payments
> to "insurance companies" for health insurance plans. They can,
> however, deposit money yearly into their employees' HSAs as a
> dedutible business expense, the yearly maximum contribution per
> employee to be determined after study by qualified economists. ....
>
> 7. Each American citizen shall have a catastrophic health insurance
> plan in place that covers yearly health care expenses over $20,000
> (adjusted yearly for inflation). This plan will be sponsored and
> financed by the Federal Government. See below for Comments about
> administration of this plan.....
>
> 8. Citizens with income below the poverty level will be provided
> yearly with a "tax rebate" from the Federal Government, deposited
> directly into their HSA.....
>
> 9. The government will mandate that each state educate its citizen
> about this "self-reliant" system. Every citizen must realize the need
> for preventive health care and a healthy lifestyle. They must realize
> that prudent use of these funds and maintaining a healthy lifestyle
> are the surest route to security. They must be made aware that
> contribution yearly to the HSA must come before purchase of consumer
> goods, a new car, or a vacation, for example. There will be no free
> “safety net” other than the catastrophic coverage.....
>
> 10. Citizens who become ill before they have accumulated sufficient
> funds in their HSA to cover the "gap" (whose HSA balance falls below
> zero in a given year) will be LOANED the needed funds by the Federal
> government, to be repaid with interest in the future. This loan will
> show up on their credit report and will influence their ability to
> borrow for other purposes until it is repaid. ....
>
> Comments.....
>
> This plan relies on human nature to reduce costs. When payment is
> coming directly from funds controlled by the patient, the patient will
> make wiser choices. There will be less desire to obtain expensive
> tests that are marginally indicated for minor complaints or to obtain
> expensive tests when less expensive tests will do. Less expensive, but
> equally effective, medications will be demanded by the patient.....
> and so forth.
>
> With this system, the medical profession will be restored to an
> ethical status, it being unethical to allow outside influences to
> intrude on the physician-patient relationship (as contracts with third
> parties invariably do). ....
>
> The public will demand transparency in the pricing of services and
> will cease to tolerate overpriced services. ....
>
> The nation will then be pooling health risks that are in the
> catastrophic range, rather than simply using the "insurance industry"
> as a (leaky) conduit of money from employer to physician or hospital
> for everyday care. ....
>
> With prudent living and prudent saving, within five to six years each
> citizen will have in their HSA sufficient funds to cover the $20,000
> "gap" in any one catastrophic year, and within ten or so years should
> have the funds to cover the gap for several years of catastrophic ill
> health. With good health and good planning, these funds can be passed
> from generation to generation, allowing those families with good
> health to become fully covered with only rare intervention by the
> government. ....
>
> The government can negotiate with the current managed care industry to
> obtain management of the catastrophic funds with minimal
> administrative expense, or can set up its own administrative agency
> (to replace the current CMS, for example) to manage and administer the
> catastrophic coverage program.....
>
> Physicians will now be free to concentrate on what they do best, care
> for patients and maintain their knowledge base, and will no longer
> have to waste time dealing with managed care contracts and meaningless
> requests from managed care companies. ....
>
> I urge you not to let the powers that be within the current managed
> care industry or within the established government agencies to bring
> pressure against the adoption of such a rational and beneficial
> plan.....
>
> Respectfully yours,
>
> Lawrence E. Mallette, MD, PhD, FACP, FACN
> April 2009
>
> </Open Letter>
>
> Once again, chew on it for a while before rushing to judgment.
>
Once upon a time I needed surgery to remove an excessive portion of my
uvula (the thingy hanging down in the back from the roof of your mouth -
it caused excessive snoring). The ENT said I needed Vioxx for pain
relief (that's how long ago). I asked why not Celebrex, and he said
Vioxx is better. End of discussion. Is that how you will be negotiating
prices?


--
Best regards
Han
email address is invalid

"HeyBub" <[email protected]> wrote in
news:[email protected]:

> Han wrote:
>>>
>>> Once again, chew on it for a while before rushing to judgment.
>>>
>> Once upon a time I needed surgery to remove an excessive portion of
>> my uvula (the thingy hanging down in the back from the roof of your
>> mouth - it caused excessive snoring). The ENT said I needed Vioxx
>> for pain relief (that's how long ago). I asked why not Celebrex, and
>> he said Vioxx is better. End of discussion. Is that how you will be
>> negotiating prices?
>
> God! I first read you sentence as having a need to remove an excess
> vulva!
>
> Anyway, if a doctor offered me Vioxx (or Celebrex) and declined my
> request for Vicodin, (or if he insisted on Vicodin when I requested
> Morphine) I'd ask for a referral to a more patient-friendly physician.

For reasons unknown to me he is not at the hospital anymore. That's all
I can say. The procedure worked as advertised - something like 5 days of
pain, but tolerable under the medications provided. I ate a lot of soft
food (Singapore Mai Fung(spelling??)) which provided beneficial capsacain
(hot pepper). Snoring was almost eliminated, but after 5 or more years
is returning somewhat. In my professional opinion there should not have
been much difference between the 2 COX-2 inhibitors, but I am not a
physician.


--
Best regards
Han
email address is invalid

"cm" <[email protected]> wrote in
news:[email protected]:

> I have witnessed our own insurance company dictating the course of
> treatment for my wife's breast cancer over the last three years. We
> have had to fight to get the proper drugs and treatment over the cost
> saving path the insurance company would prefer. We have also been
> subject to huge co-payments on drugs. Three years ago we had a
> co-payment of $65 per pill for Anzemet!
>
I have to comiserate with you for the reasons for the drug Anzemet. I just
priced it for my insurance plan through US Healthcare (Medco administered).
Anzemet would cost me $100 for a 90 day supply. I am not familiar with the
drug (lucky me), so I don't know more.

I guess I am lucky to have a good coverage plan ...

--
Best regards
Han
email address is invalid

"HeyBub" <[email protected]> wrote in
news:[email protected]:

> dpb wrote:
>>
>> The "competition" between physicians for expert medical care is a
>> fallacy -- in general the consumer has insufficient expertise to
>> judge quality or to know how to select alternate care options for the
>> highest efficacy. When forced to make difficult decisions on perhaps
>> life-or-death issues, in the end its not likely that the overriding
>> concern will be the cost. Easy enough to hypothesize that's what the
>> so-called rational consumer SHOULD do, but just as the markets are as
>> much or more emotion-driven, health care choices are as well.
>
> I can't answer all your concerns, but quality can be judged by those
> competent to make the call; in this case, your family physician. If he
> refers you to a specialist that's not quite appropriate, some of the
> blame will trickle down to him and he'll (usually) adjust his
> referrals accordingly.

That's indeed the ideal situation. I wish it were true for more people,
including me, and I work in hospitals, albeit as a bench-type researcher.

> My internist has referred me to three different specialists
> (opthamologist, plastic surgeon, and orthopedic physician). Upon my
> return to him, the internist inquired as to whether I was treated
> properly by the referral.
>
> The health-care delivery system in the U.S. is not perfect by any
> measure. It is, however, like democracy, better than any other system
> available. While there are problems, the vast majority of Americans
> are satisfied with their options.

I'm not sure the majority is, and maybe some who are shouldn't be. That
goes vice versa as well. Some patients are just not taking the care they
should. Things as simple as the correct answer to have you recently
taken aspirin or other similar medications are not answered correctly (I
can prove this in my work).

> What worries me is that the very real possibility of fucking-up
> something that works properly for 250 million citizens in the hope
> that a few under-served people will be helped.

Yes, that is pssible. The reverse is much more likely.

> Another issue - and I don't recall whether you mentioned it - is
> physician liability. My state, Texas, instituted a severe tort reform
> measure four years ago. Among other things, it capped non-economic
> losses (pain & suffering, punitive damages) at $250,000. We've stopped
> hemorrhaging physicians and, in fact, had a tremendous increase in
> doctors moving here from less-enlightened places.

Congratulations. That example should be followed everywhere. In
addition, physicians who make bad decisions should get more than a
friendly pat - some should be really punished, and it should NOT be
covered by insurance.


--
Best regards
Han
email address is invalid

"HeyBub" <[email protected]> wrote in
news:[email protected]:

> Tort damages consist of several pieces: recovery of economic loss,
> pain & suffering, loss of consortium, and so on. My plan is to divert
> ALL "punitive" damages to the state. Punitive damages are really
> "fines" to discourage future rascally behavior by the defendant, so
> why should the plaintiff benefit? In many cases, punitive damages
> dwarf all other awards and it is they that make the case worthwhile
> for the plaintiff bar.
>
> As an aside, Walmart has a policy (I'm told) of NEVER settling a
> "slip-and-fall" case - they will always take the case to trial. This
> costs more up front, but it does guarantee that meritless claims don't
> get past the letter-writing stage.
>
Fine, but now the lawyers take 1/3 of all awards. I think the person who
is "damaged" should get all his losses (including reasonable lawyers'
fees) reimbursed. The "loser" should pay all lawyers fees, and indeed
punitive "rewards" should go to the state.

The Walmart thing is possibly just cases going after deep pockets, IMNSHO
that is not to be permitted. However, someone or some organization
should have been punished for the "thing" that happened to the person(s)
trampled to death during the Black Friday opening of a store in Valley
Stream Long Island. It does not seem logical that providing insufficient
security should go unpunished. Plus the mob there should have been
punished somehow. Just my opinion.


--
Best regards
Han
email address is invalid

"HeyBub" <[email protected]> wrote in news:17-
[email protected]:

> J. Clarke wrote:
>> Han wrote:
>>> "HeyBub" <[email protected]> wrote in
>>> news:[email protected]:
>>>
>>>> Tort damages consist of several pieces: recovery of economic loss,
>>>> pain & suffering, loss of consortium, and so on. My plan is to
>>>> divert ALL "punitive" damages to the state. Punitive damages are
>>>> really "fines" to discourage future rascally behavior by the
>>>> defendant, so why should the plaintiff benefit? In many cases,
>>>> punitive damages dwarf all other awards and it is they that make
>>>> the case worthwhile for the plaintiff bar.
>>
>> So now the state treats lawsuits as a source of revenue and does
>> everything it can to encourage them.
>>
>> Can you say "unintended consequences"?
>>
>
> Ooh! Good point!

Yes, indeed.

--
Best regards
Han
email address is invalid

$800/month may be doable for you, but there may be people for whom it is
not. Example: 40-odd year-old couple (no kids, no more parents). Both
lost full-time jobs. One of them can retain the job, but is only paid 50%
as a part-time person. No benefits. Cobra costs over $1000/month.

That can be tough in NY City.
--
Best regards
Han
email address is invalid

dpb wrote:
>
> The "competition" between physicians for expert medical care is a
> fallacy -- in general the consumer has insufficient expertise to judge
> quality or to know how to select alternate care options for the
> highest efficacy. When forced to make difficult decisions on perhaps
> life-or-death issues, in the end its not likely that the overriding
> concern will be the cost. Easy enough to hypothesize that's what the
> so-called rational consumer SHOULD do, but just as the markets are as
> much or more emotion-driven, health care choices are as well.

I can't answer all your concerns, but quality can be judged by those
competent to make the call; in this case, your family physician. If he
refers you to a specialist that's not quite appropriate, some of the blame
will trickle down to him and he'll (usually) adjust his referrals
accordingly.

My internist has referred me to three different specialists (opthamologist,
plastic surgeon, and orthopedic physician). Upon my return to him, the
internist inquired as to whether I was treated properly by the referral.

The health-care delivery system in the U.S. is not perfect by any measure.
It is, however, like democracy, better than any other system available.
While there are problems, the vast majority of Americans are satisfied with
their options.

What worries me is that the very real possibility of fucking-up something
that works properly for 250 million citizens in the hope that a few
under-served people will be helped.

Another issue - and I don't recall whether you mentioned it - is physician
liability. My state, Texas, instituted a severe tort reform measure four
years ago. Among other things, it capped non-economic losses (pain &
suffering, punitive damages) at $250,000. We've stopped hemorrhaging
physicians and, in fact, had a tremendous increase in doctors moving here
from less-enlightened places.

"dpb" wrote:

> Call Uncle Barak, I guess. Seems your answer to everything else;
> ask somebody else to take care your responsibilities.

I'm not sure what the answer is, but the system is broken.

If you are wealthy you can afford to pay for health care.

If you are poor, then the government provides you with health care.

However, if are in the middle, you are SCREWED.

You get to purchase health care insurance that may or may not cover
your particular problem when you need it most or have such a large
copay that coverage becomes impossible to use.

An unfortunate situation such as an accident or a disease such as
cancer, and the next thing you know, it's bankruptcy time, even with
the best laid plans of financial advance planning.

There are lots of middle class families that planned ahead, but ended
up with copay debt in the 6 figure class and bankruptcy, the only way
out.

Allowing the private sector to be the fox guarding the hen house has
developed a hodge podge safety net with far too many holes in it to be
considered safe.

I'm not in favor of having the government being in the health
insurance business, but I am in favor of government being the
oversight business which probably does include having government
provide "super high catastrophe" coverage and basic low end coverage.

That leaves a lot of room for the private sector to operate; however,
some retooling of how they operate will be required.

Lew

Lew Hodgett wrote:
> "Swingman" wrote:
>
>> Not true, sounds reasonable, but is unfortunately an urban myth, not
>> supported by research ... "the growing ranks of the elderly are
>> projected to account for just 0.4 percent of the future growth in
>> health care cost" - Center for Studying Health System Change.
>
> Sounds like you and/or your source haven't been in a nursing home
> lately.
>
> The scenario goes something like this:
>
> Nursing home cost is in the $160-$180/day range.
>
> Medicare covers either 90 or 120 days (I forgot which), then the
> patient covers the cost until their total assets are less than
> $1,500.00 then Medicaid kicks in.
>
> Patient is allowed to keep $40/month from their monthly S/S payment
> and signs over the rest to Medicaid which now covers all expenses.
>
> At a minimum, your are looking at $4,800-$5,400 per month plus medical
> costs such as doctors and drugs which can easily add $1,000-$1,500 to
> the monthly total.
>
> Had a guy tell me it cost him over $65,000 the previous year to keep
> his wife in the same nursing home my mother was in for almost 2 years.
>
> Go to a nursing home with 200-300 patients and your looking at some
> serious money.
>
> I'm sure Robert (NailShooter) is looking at a similar cost structure
> for his parents right now.
>
> It's not pretty, but it is reality and something MUST be done while we
> still can.
>
> Sounds like your source needs to do a little more research.

You're totally ignoring what was quoted. I gave you my cite, let's see
your's, not some guesstimate on your part.


--
www.e-woodshop.net
Last update: 10/22/08
KarlC@ (the obvious)

Douglas Johnson wrote:
> dpb <[email protected]> wrote:
>
>> I don't understand the 30% example--typically insurance carriers are
>> covering 80% or "standard and normal" for any particular procedure.
>
> My wife has had two serious hospitalizations. The billed rate was
> $110,000 for the first and $60,000 for the second. The hospital
> accepted $60,000 for the first and $28,000 for the second from the
> insurance company as payment in full. The first cost us $800 out of
> pocket and the second $100.
>
> The insurance company paid rates negotiated with the hospitals. And
> this is part of the problem. Uninsured people, the ones who can
> least afford it, pay the highest rates. I'm no socialist, but that
> just ain't fair.
>

Fair? What's UN-fair about a willing buyer and a willing seller?

If you bought a $110,000 product or service from me every couple of days,
I'd probably be willing to cut you a 45% discount, too.

"dpb" wrote:

> Thus I don't think competition is particularly effective in holding
> down health care costs because I don't believe it's the driving
> force in most decisions.

As long as private enterprise is involved in health care and are
allowed to limit the "gene pool" as a means of controlling their risk,
the problem will not be solved.

Some how, 100% of the population, no exceptions, must be covered, then
move forward to address and control the cost issues.

Limiting the "gene pool" is not a workable solution.

Lew

"Swingman" wrote:

<snip Lawrence E. Mallette, MD, PhD, FACP, FACN plan>

"This plan relies on human nature to reduce costs"

There in lies the fallacy of the plan.

Lew

Same goes for ANY insurance company or
> HMO.

"Leon" wrote:


> The very simple solution is that the insurance company requires the
> customer to have regular scheduled check ups on his dime.

You have just eliminated that portion of the population that can least
afford to pay for health care in the first place which will definitely
include the full time minimum wage worker.

Providing health care to those who can least afford to pay for it is
just another way of subsidizing the hidden costs of the minimum wage.

"Pay me now or pay me later" applies.

Lew

"dpb" <[email protected]> wrote in message news:[email protected]...
> Lew Hodgett wrote:
>> "dpb" wrote:
> ...
>>> I don't for a moment believe this saw of computerized records will cut
>>> anything at all in actual costs--it will simply shift one
>>> level/group/type of recordkeeping costs from one form to another.
> ...
>> Even if the cost difference is a wash, other benefits not even considered
>> at this point will produce added economies.
> ...
>
> Glittering generalities... :)
>
> That's the problem in everything I've yet heard/read on the subject.
>
> There are great promises made in phrases much like the sentence you wrote
> above, but never any actual details of what costs are avoided that are
> greater than the cost of implementing/maintaining and operating the new
> computerized system.

From what I've seen, there will be benefits not only in cost, but better
patient care. The HMO that we belong to is on of the largest in MA, They
went to a computerized system a bit over a year ago. My wife has a heart
condition that started in 2001. Her file was about 6" thick and was carried
from the central office to any of the half dozen doctors in four different
facilities. Now, nothing is moved and everything is on the computer.

An X Ray would be taken at the hospital. Two weeks later she'd see a
different doctor about it so we'd have to call for the x ray, pick it up and
carry it to the next doctor and he'd have to send it back when done. No
more, it is available at any of the computers in any exam room or doctor's
office.

Prescriptions? A couple of mouse clicks and it is ready to pick up at our
pharmacy in our town 30 miles away.

I had some knee problems. My x rays and MRI results are right there, in
seconds, for the doctor to see.

I'm not so sure the government should be paying for the change, but I can
see the benefits anytime either one of us goes to the doctor, and that can
be very frequent.

"Leon" wrote:
> There are many free clinics that could perform the check up.

Who funds the "Free" clinics?

I will submit that more often than not, the E/R becomes the "Free
Clinic".

Lew

You know, even though you did not have a strength of materials course,
you still seem to be a clear thinker.


I particularly admire the blending of the language from the AIA
shortform with the requisites for the proposed changes.







On Sat, 30 May 2009 22:32:34 GMT, Nova <[email protected]> wrote:

>dpb wrote:
>
>> I'm not sure I've seen much in any really new ideas, unfortunately,
>> particularly those that would actually help across the full spectrum of
>> both abilities to pay and access to services.
>>
>> The one thing I'm pretty sure of is that the inclusion of large segments
>> of currently under- or uninsured without a commensurate inclusion into
>> the payment pool by some means is going to be another federal welfare
>> program that will not be able to be funded w/o massive deficits or taxes
>> of one form or another.
>>
>
><snip>
>
>Here's a few changes I'd like to see:
>
>1. The federal government will set a maximum hourly billing rate for
>doctors based on their classification (GP, FP, neurosurgeon, etc.). The
>patient can be billed only for the actual time spent with the physician
>in 15 minute increments.
>
>2. If you have scheduled a doctors appointment and are kept waiting past
>your appointed time the doctor pays you for your wasted time at his
>billing rate in 15 minute increments.
>
>3. If you see a doctor and all he does is refer you to a specialist the
>referring doctor get a $15 administrative fee only.
>
>4. The patient pays only for those medications that prove to be effective.
>
>5.A doctor is allowed to have all the tests performed that he deems
>necessary. The patient pays for the test that finds the problem. The
>doctor pays for the rest of the tests.
>
>6. All hospital charges, anesthesiologist fees, nursing staff, in
>hospital supplies and medications, etc. will be considered part of the
>doctor's overhead and will be paid for by the attending physician. This
>should get rid of the $15 aspirins, $20 Band-Aids, etc.
>
>7. A doctor receives no payment until all work is complete to the
>patient's satisfaction.
>
>8. A money back guarantee will be issued with all procedures performed.
>
>I'm sure the group can think of others...
Regards,

Tom Watson
http://home.comcast.net/~tjwatson1/

"Swingman" wrote:

> Not true, sounds reasonable, but is unfortunately an urban myth, not
> supported by research ... "the growing ranks of the elderly are
> projected to account for just 0.4 percent of the future growth in
> health care cost" - Center for Studying Health System Change.

Sounds like you and/or your source haven't been in a nursing home
lately.

The scenario goes something like this:

Nursing home cost is in the $160-$180/day range.

Medicare covers either 90 or 120 days (I forgot which), then the
patient covers the cost until their total assets are less than
$1,500.00 then Medicaid kicks in.

Patient is allowed to keep $40/month from their monthly S/S payment
and signs over the rest to Medicaid which now covers all expenses.

At a minimum, your are looking at $4,800-$5,400 per month plus medical
costs such as doctors and drugs which can easily add $1,000-$1,500 to
the monthly total.

Had a guy tell me it cost him over $65,000 the previous year to keep
his wife in the same nursing home my mother was in for almost 2 years.

Go to a nursing home with 200-300 patients and your looking at some
serious money.

I'm sure Robert (NailShooter) is looking at a similar cost structure
for his parents right now.

It's not pretty, but it is reality and something MUST be done while we
still can.

Sounds like your source needs to do a little more research.


Lew

Swingman wrote:
> Friend of mine, a doctor and fellow musician, came up with the
> following, an intriguing plan to revamp the US health care system
> from a practicing physician's perspective.
>
> Be sure to read the entire plan before making any judgments, it's
> tricky in few spots.
>
> <Open Letter>
>
> Dear Mr. President,
>
> Here are the basic principals upon which a sound, sustainable and
> ethical health care system can and should be built:....
>
> 1. It shall be illegal for physicians to contract with anyone other
> than their patient or patient's legal representative. There shall be
> no contracts with the government, with any "managed care" entity or
> insurance company, or with any other third party.....
>
> 2. It shall be illegal for physicians to receive payment directly
> from a third party "payor." Payment must come from the patient
> directly and shall be made at the time of service.....
>
> 3. It shall be illegal for third parties to request discounts from a
> physician for their clients. The price for various services is to be
> negotiated between patient and physician, as is the case with all
> other professions. ....
>
> 4. Each American citizen shall have a Health Savings Account
> established at birth. The HSA will be maintained with an investment
> firm or bank, the accounts being insured by the Federal government to the
> amount of
> $150,000, as are bank deposits. Increases in value on these accounts
> via interest, dividends or increases in investment value are not
> taxed, and these assets are protected from creditors, as with the
> usual IRA. (Regulations will need to be developed regarding the type
> of investment, allowing a certain low percentage to be invested in
> more volatile investments.) Funds in the HSA can be spent only for
> Health Care, but can be passed on to heirs over multiple generations, to
> be used for
> the heir's health care needs. ....
>
> 5. Each American citizen shall be able to exclude from taxation the
> amount of $5000 per year (adjusted for inflation) for deposit in his
> or her Health Savings Account, with catch up contributions allowed if
> the prior year's expenses exceeded this amount. There shall be no
> limit to the total amount of capital the citizen can accumulate in his or
> her
> HSA. ....
>
> 6. Businesses may no longer subtract from taxable income any payments
> to "insurance companies" for health insurance plans. They can,
> however, deposit money yearly into their employees' HSAs as a
> dedutible business expense, the yearly maximum contribution per
> employee to be determined after study by qualified economists. ....
>
> 7. Each American citizen shall have a catastrophic health insurance
> plan in place that covers yearly health care expenses over $20,000
> (adjusted yearly for inflation). This plan will be sponsored and
> financed by the Federal Government. See below for Comments about
> administration of this plan.....
>
> 8. Citizens with income below the poverty level will be provided
> yearly with a "tax rebate" from the Federal Government, deposited
> directly into their HSA.....
>
> 9. The government will mandate that each state educate its citizen
> about this "self-reliant" system. Every citizen must realize the need
> for preventive health care and a healthy lifestyle. They must realize
> that prudent use of these funds and maintaining a healthy lifestyle
> are the surest route to security. They must be made aware that
> contribution yearly to the HSA must come before purchase of consumer
> goods, a new
> car, or a vacation, for example. There will be no free “safety net”
> other than the catastrophic coverage.....
>
> 10. Citizens who become ill before they have accumulated sufficient
> funds in their HSA to cover the "gap" (whose HSA balance falls below
> zero in a given year) will be LOANED the needed funds by the Federal
> government, to be repaid with interest in the future. This loan will
> show up on their credit report and will influence their ability to
> borrow for other purposes until it is repaid. ....
>
> Comments.....
>
> This plan relies on human nature to reduce costs. When payment is
> coming directly from funds controlled by the patient, the patient
> will make wiser choices. There will be less desire to obtain expensive
> tests
> that are marginally indicated for minor complaints or to obtain
> expensive tests when less expensive tests will do. Less expensive, but
> equally
> effective, medications will be demanded by the patient..... and so
> forth.
> With this system, the medical profession will be restored to an
> ethical status, it being unethical to allow outside influences to
> intrude on the physician-patient relationship (as contracts with
> third parties invariably do). ....
>
> The public will demand transparency in the pricing of services and
> will cease to tolerate overpriced services. ....
>
> The nation will then be pooling health risks that are in the
> catastrophic range, rather than simply using the "insurance industry"
> as a (leaky) conduit of money from employer to physician or hospital for
> everyday care. ....
>
> With prudent living and prudent saving, within five to six years each
> citizen will have in their HSA sufficient funds to cover the $20,000
> "gap" in any one catastrophic year, and within ten or so years should
> have the funds to cover the gap for several years of catastrophic ill
> health. With good health and good planning, these funds can be passed
> from generation to generation, allowing those families with good
> health to become fully covered with only rare intervention by the
> government. ....
> The government can negotiate with the current managed care industry to
> obtain management of the catastrophic funds with minimal
> administrative expense, or can set up its own administrative agency
> (to replace the current CMS, for example) to manage and administer
> the catastrophic coverage program.....
>
> Physicians will now be free to concentrate on what they do best, care
> for patients and maintain their knowledge base, and will no longer
> have to waste time dealing with managed care contracts and meaningless
> requests from managed care companies. ....
>
> I urge you not to let the powers that be within the current managed
> care industry or within the established government agencies to bring
> pressure against the adoption of such a rational and beneficial
> plan.....
> Respectfully yours,
>
> Lawrence E. Mallette, MD, PhD, FACP, FACN
> April 2009
>
> </Open Letter>
>
> Once again, chew on it for a while before rushing to judgment.

This plan does not rely on "human nature" to reduce costs - it relies on
government setting rules on how health care contracts should be negotiated
and enforced. There is nothing that would prevent, today, a physician from
demanding payment up front from the patient and refusing all third-party
involvement.

dpb <[email protected]> wrote:

>I don't understand the 30% example--typically insurance carriers are
>covering 80% or "standard and normal" for any particular procedure.

My wife has had two serious hospitalizations. The billed rate was $110,000 for
the first and $60,000 for the second. The hospital accepted $60,000 for the
first and $28,000 for the second from the insurance company as payment in full.
The first cost us $800 out of pocket and the second $100.

The insurance company paid rates negotiated with the hospitals. And this is
part of the problem. Uninsured people, the ones who can least afford it, pay
the highest rates. I'm no socialist, but that just ain't fair.

Incidentally, that is another good reason to maintain even a high-deductible
health insurance policy. You will get the negotiated rate even if you pay most
of it yourself.

-- Doug

"Lew Hodgett" <[email protected]> wrote in message
> What I am saying is that a significant portion of the 6 and under
> population are not receiving adequate preventative health care in
> their formative years which leads to higher cost medicine in later
> years.

Ok, my mistake. I thought you were referring to the entire lifeline, not
children in their formative years. And, what you say does make sense, but
why are they not receiving adequate preventative health care? Is it solely a
financial reason?

"dpb" wrote:

> immaterial to the point...

No it is exactly the point.

Health care costs esclate as the end of life approaches which is
exactly why Medicare/Medicaid are in trouble and a solution must be
found.

Lew

"Upscale" wrote:

> Essentially, that's the same as saying the entire county population
> has to
> undergo a complete lifestyle change. What are the chances of that
> happening?
> Sounds good in theory and in practice, but it ain't going to happen
> in a
> dozen lifetimes.

No, not at all.

What I am saying is that a significant portion of the 6 and under
population are not receiving adequate preventative health care in
their formative years which leads to higher cost medicine in later
years.

As far as a change in lifestyles is concerned, a healthier population
may want to live a healthier lifestyle, but it isn't something you can
quantify.

Lew

Larry Blanchard wrote:
> On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote:
>
>> They must be made aware that contribution yearly to the HSA must come
>> before purchase of consumer goods, a new car, or a vacation, for
>> example. There will be no free “safety net” other than the
>> catastrophic coverage.....
>
> Someone has a lot of faith in people acting responsibly. It'll never
> happen. And what happens to the health needs of children of
> irresponsible parents?
>
> Make the HSAs mandatory, deducted from earnings, and the plan has a
> pretty good chance of working.

Just what we need, more government micromanagement.

Leon wrote:
> "HeyBub" <[email protected]> wrote in message
> news:[email protected]...
>> This plan does not rely on "human nature" to reduce costs - it relies on
>> government setting rules on how health care contracts should be negotiated
>> and enforced. There is nothing that would prevent, today, a physician from
>> demanding payment up front from the patient and refusing all third-party
>> involvement.
>>
>
>
> Precisely, and that is the beauty. Once again competition between doctors
> and their services would keep costs low. Already there are groups of
> doctors, clinics, pharmacies, and hospitals that will not accept insurance.
> You have to join their group for well under $100 per month for your whole
> family but a typical office visit costs around $35.

But what do you do for critical care wherein costs can easily run into
the $100's of K numbers--a friend had heart valve replacement at roughly
$300K recently.

The routine office visit is simple; the costs are in the high-dollar
items that are less frequent, high liability (tort) costs and the costs
for unreimbursed care that have to be picked up by those who do pay.

The "competition" between physicians for expert medical care is a
fallacy -- in general the consumer has insufficient expertise to judge
quality or to know how to select alternate care options for the highest
efficacy. When forced to make difficult decisions on perhaps
life-or-death issues, in the end its not likely that the overriding
concern will be the cost. Easy enough to hypothesize that's what the
so-called rational consumer SHOULD do, but just as the markets are as
much or more emotion-driven, health care choices are as well.

--

Larry Blanchard wrote:
> On Sat, 30 May 2009 08:02:12 -0700, cm wrote:
>
>> I agree that changes are needed in our current system, but it scares the
>> heck out of me to think that the government would be more involved.
>> These are the same democrats and republicans that have sent our economy
>> into a tail spin.
>
> But yet the SSA administers Social Security with an almost negligible
> amount of overhead. A government program can work efficently, but the
> devil is in the details.
...

Yeah, so efficiently they have thousands on the roles that have been
deceased, some for decades (GAO investigation I heard reported not long
ago)...

--

Leon wrote:
> "dpb" <[email protected]> wrote in message news:[email protected]...
>> Leon wrote:
>>> "HeyBub" <[email protected]> wrote in message
>>> news:[email protected]...
>>>> This plan does not rely on "human nature" to reduce costs - it relies on
>>>> government setting rules on how health care contracts should be
>>>> negotiated and enforced. There is nothing that would prevent, today, a
>>>> physician from demanding payment up front from the patient and refusing
>>>> all third-party involvement.
>>>>
>>>
>>> Precisely, and that is the beauty. Once again competition between
>>> doctors and their services would keep costs low. Already there are
>>> groups of doctors, clinics, pharmacies, and hospitals that will not
>>> accept insurance. You have to join their group for well under $100 per
>>> month for your whole family but a typical office visit costs around $35.
>> But what do you do for critical care wherein costs can easily run into the
>> $100's of K numbers--a friend had heart valve replacement at roughly $300K
>> recently.
>
> The only reason that the procedure cost that much is because insurance
> companies probably only pay 30% of that cost. Eleminate the insurance
> companines and you get the better pricing because every one is paying their
> fare share and the medical industry does not need nearly as many on staff
> whose only job is to "try" to collect what is owed them by the insurance
> companies.
>
> The "groups" that I referred to so surgery also at a dramatic reduction in
> cost.
...

Do they do the difficult surgeries or are they like the private heart
clinics and others I'm aware of that "cherry-pick" the routine cases w/
high probability of success and low probability of complications and
leave the rest to the others thus driving up average costs drastically.
Again, _there's_ where the rub is.

I'd wager it's the latter--every one of those groups I've ever seen have
very selective membership criteria.

I don't understand the 30% example--typically insurance carriers are
covering 80% or "standard and normal" for any particular procedure.

I'll agree there is some overhead in processing claims but I'm yet to be
convinced it is a preponderant fraction of costs--rate it compared to
liability cost and uninsured/uncompensated care costs and I'd wager it's
the tail of the dog. Just as I'm totally unconvinced electronic records
will have any discernible effect on actual costs--it may help in some
cases w/ precision, add errors in coding in others and every large
data-processing implemented I've ever seen simply transferred one group
of overhead costs to a different set to implement/maintain/operate the
system.

--


--


--

dpb wrote:
> Leon wrote:
>> "dpb" <[email protected]> wrote in message news:[email protected]...
>>> Leon wrote:
>>>> "HeyBub" <[email protected]> wrote in message
>>>> news:[email protected]...
>>>>> This plan does not rely on "human nature" to reduce costs - it
>>>>> relies on government setting rules on how health care contracts
>>>>> should be negotiated and enforced. There is nothing that would
>>>>> prevent, today, a physician from demanding payment up front from
>>>>> the patient and refusing all third-party involvement.
>>>>>
>>>>
>>>> Precisely, and that is the beauty. Once again competition between
>>>> doctors and their services would keep costs low. Already there are
>>>> groups of doctors, clinics, pharmacies, and hospitals that will not
>>>> accept insurance. You have to join their group for well under $100
>>>> per month for your whole family but a typical office visit costs
>>>> around $35.
>>> But what do you do for critical care wherein costs can easily run
>>> into the $100's of K numbers--a friend had heart valve replacement
>>> at roughly $300K recently.
>>
>> The only reason that the procedure cost that much is because
>> insurance companies probably only pay 30% of that cost. Eleminate
>> the insurance companines and you get the better pricing because
>> every one is paying their fare share and the medical industry does
>> not need nearly as many on staff whose only job is to "try" to
>> collect what is owed them by the insurance companies.
>>
>> The "groups" that I referred to so surgery also at a dramatic
>> reduction in cost.
> ...
>
> Do they do the difficult surgeries or are they like the private heart
> clinics and others I'm aware of that "cherry-pick" the routine cases
> w/ high probability of success and low probability of complications
> and leave the rest to the others thus driving up average costs
> drastically. Again, _there's_ where the rub is.
>
> I'd wager it's the latter--every one of those groups I've ever seen
> have very selective membership criteria.
>
> I don't understand the 30% example--typically insurance carriers are
> covering 80% or "standard and normal" for any particular procedure.
>
> I'll agree there is some overhead in processing claims but I'm yet to
> be convinced it is a preponderant fraction of costs--rate it compared
> to liability cost and uninsured/uncompensated care costs and I'd
> wager it's the tail of the dog. Just as I'm totally unconvinced
> electronic records will have any discernible effect on actual
> costs--it may help in some cases w/ precision, add errors in coding
> in others and every large data-processing implemented I've ever seen
> simply transferred one group of overhead costs to a different set to
> implement/maintain/operate the system.

More to the point, even if the actual cost is only 100K and not 300K, that's
still more than most people can afford out of pocket.