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Post by E on Sept 1, 2009 7:55:44 GMT -5
E, I like and have great respect for your opinions, but interpret the situation a bit differently; For most of my working life I didn't have health insurance. Not because I didn't want it, and not because I couldn't afford it, but because I have preexisting conditions and no insurance company would take me. Contrast that with car insurance; If you have 14 drunk driving convictions and multiple accidents you can still buy car insurance. It is called the 'assigned risk pool', and all auto insurance companies are required to take a bite of that bitter pill, it's a cost of doing business. Why is there no medical insurance equivalent? When you buy life, auto or homeowners insurance there are defined terms such as fire, flood, liability etc. and they all mean the same thing, one insurer cannot redefine fire insurance to exclude fires on Tuesday. That greatly facilitates comparison shopping. Why is there no medical insurance equivalent? In California, one of the largest health care providers - Blue Cross had a reputation for canceling your insurance if you developed an expensive medical condition; the very thing you bought the insurance for. By the way, once they kicked you out, no other insurer would take you either, as you now have a 'pre-existing condition'. As an aside, sometimes they wouldn't cancel you, but your premiums would go up, as much as $70,000 per year - per family. Mike, The above sounds like a fantastic reason for a government option, really. The rest of your post hinges on MediCal, which you apparently really dislike and I know nothing about, and taxes and campaigns and such, so I'm going to let those be.
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Post by mike on Sept 1, 2009 12:12:42 GMT -5
E,
I see things differently. We have an insurance commission specifically so those abuses don't happen. They still exist however because the insurance commission does not do their job. When the insurance commission does not do their job, the cure isn't to turn things over to them. In this case I have bundled the ineffective insurance commission together with the regulatory arm of government, which isn't totally fair, however they both are governmental agencies over which we have little or no control. When a business is operating for profit, it's motivations are clear. If you do a poor job in industry, you lose your job. When you do a poor job in government there are no repercussions. In private business, the promise of financial reward gives you an incentive to do a better job, in government there is no such incentive.
Whether someone works for private industry or government they are still made out of the same ectoplasm, and neither is a more virtuous career, it's simply the work environment and incentive system that creates differences.
Although our government is supposed to work for the greater good of society, often it does not. If a store overcharges you, you simply take your business elsewhere, so the corrective forces are simple and effective. Now lets say the FTC doesn't do a good job curtailing illegal wall street activity, what is your recourse? Simply put, you have none. Even your congressperson doesn't have much say in the matter, so what is the motivation to do a good job? Many in government do good jobs, but when you have no say in the matter some people like me feel very uncomfortable.
The reason I keep using MediCal in my examples is that it is an extreme case of a poorly run government medical program. If I were to use the VA or MediCare as examples the issues would be more contentious. Each of those have their own issues, but each is quite different. The VA for example provides health care directly, whereas MediCare reimburses existing health care providers. The other reason I keep using MediCal is because it is a good example of a system created with good intentions, run by the government, that has devolved into a really poor system due to political and economic realities. What assurance do you have that another government run program won't do the same?
As far as the VA, some people really like it, but consider the following issues: 1. You need to travel to the VA facilities to receive care. In my case that would be 60 miles, but for others it is much farther. 2. When joining the military we were promised VA health care as a benefit - however, to be eligible you are subjected to a means test. Predicated upon how much money you make (or have), you are placed into one of eight levels, (their term is priorities). Each year, depending upon economic conditions, the VA sets a 'cutoff point', so for example if you are a lower priority than 6, you will not receive any care at all. Between say 4 and 6 you will be entitled to 50% coverage. Assuming you have assets, you may not be covered at all until you have sold your assets, lost your income and otherwise become destitute. As you edge toward destitution, you are placed higher in the priority system. This is a government program, would you like it if you were forced to sell all your business interests before becoming eligible? Again, what is your assurance that will not happen? Keep in mind that just like in the cases of the FTC and insurance commissioner, YOU HAVE NO SAY in the matter, you cannot take your business elsewhere, you are simply screwed.
I have no doubt the people working on the current proposals intend well, and I have no doubt the country needs a fix, however I am quite dubious that the people who created several poor systems before, will now somehow do an excellent job, and the program won't devolve like all the previous systems have.
Pointing out the need does not correlate with the solution. Many people feel like you, that we need a government system, but many others, like me, feel the solution is for government to DO THEIR JOB, enforce current insurance regulations, adequately fund the programs currently in place, and do intelligent things such as collective drug purchasing like Canada to reduce costs. When those things don't happen, I am extremely doubtful that turning the system over to the same folks who are not currently doing their job will improve matters.
That said, I don't believe I have a monopoly on insight and welcome competing views such as yours. Please don't think that I feel you are not a fine, intelligent individual just because we disagree on this point, obviously we have had different life experiences leading each of us to our own conclusions. My biggest point is to illustrate that the naysayers have valid, legitimate concerns. It is not a simple matter of being cheap, stingy, or not wanting to help others. That view is too simplistic; it makes a good rallying cry, but is not an accurate representation of the opposing viewpoint.
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Phil
Junior Member
Posts: 82
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Post by Phil on Sept 1, 2009 17:05:23 GMT -5
Mike,
We have an insurance commission here, and what you're stating as happening there, doesn't happen here. Ever. After 24 years of disability, I can tell you that I've never spent a dime on co-pays for medical equipment. Never. 6-7 wheelchairs alone are figured into that. I do pay co-pays on medications which run up to $2.00 per prescription. Income levels are limited, but should you exceed them, you can "buy back" into the system with a monthly co-pay. Perhaps the problem isn't government, but your STATE government?
E's post is dead on accurate. It's inexcusable that people in this country face total financial ruin should something catastrophic happen to them. Providing coverage for them helps prevent it, AND it allows folks to seek yearly exams they normally wouldn't have. That alone makes us all healthier and sometimes less likely to run up insane bills, yes?
Bottom line: If you're really sick, you're going to seek medical treatment at an ER because they can not deny you, by law, based on your ability to pay. So, you create a huge bill. If you can't pay the bill, who does? Santa Claus? ;D No, someone or something will cover (or eat) those free care costs someway. Offering insurance won't create a flood of folks looking for life-saving surgery. They're going to get it, either way. If we're paying either way for it, and paying into a corrupt & GREEDY system that has no qualms about charging you $8.00 for an aspirin, isn't more sensible you cover everyone and reel in these ridiculous costs?
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Post by mike on Sept 1, 2009 18:32:30 GMT -5
Phil,
You are probably correct about the insurance commission in your state, I am only familiar with the commission in California. It does not work. Other states may in fact have much better systems, I am only looking at the experiences I have had.
I don't know what state you are in, but my medication co-pays are $25 to $40, and some medications are not covered at all.
I have Blue Cross insurance, which in California is one of the best, although still not good.
We both agree that it is inexcusable that people face total financial ruin, but if you would like I would be happy to give you the link to the MediCal site that stipulates precisely that. If you have assets, you must divest them before you are eligible. That is one of my big problems with it. Each state may have slight variations in their MedicAid program, as it is a joint federal/state program. In my opinion, you should NOT face disaster, but that is what is REQUIRED here, you don't get any help until you are destitute. Assume you own a home, but are unemployed - possibly by your medical condition, you are REQUIRED to sell your home & use the proceeds first before MediCal kicks in. If your parents have the medical condition, MediCal will come to YOU to be reimbursed.
If this was private insurance, you wouldn't buy it, but because it is government you have no choice. Therein lies the problem.
Here is the wording I was referring to:
How can my family and I qualify for Medi-Cal coverage? If you are in one of the groups listed in “Who can get Medi-Cal?” above: • We look at your income and subtract some expenses you pay to decide your family’s countable income for Medi-Cal • We look at things you and your family own (bank accounts, vehicles, etc.) to see if you meet the resource limit. Please Note: Not all the things you or your family own are counted; your local social services office can give you more information
The problem we have is not that either of us wants a medical condition to precipitate financial disaster, but as you can see, at least here in California that is precisely what the program stipulates.
Not all programs are this bad, but they can become this bad or worse, and YOU HAVE ABSOLUTELY NO SAY IN THE MATTER. That is the problem.
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Post by mike on Sept 1, 2009 18:42:32 GMT -5
By the way Phil, here is wording directly from the mediCal application: Does anyone have cash or uncashed checks? If “Yes,” list amount here (See instructions) Does anyone have a checking, savings account, or life insurance? (See instructions) Is there one car or more in the household? (See instructions) Does anyone have a court ordered settlement or judgement? (See instructions) Does anyone have Long-Term Care insurance? (See instructions) Does anyone own any items such as stocks, bonds, retirement funds, trusts, real estate, motor vehicles for a business, business accounts, promissory notes, mortgages, deeds of trust, recreational vehicles, burial trusts or funds, annuities, jewelry (not heirloom or wedding), oil or mineral rights? (See instructions) Has anyone listed on this form transferred, sold, traded or given away any items such as those listed above in the last 30 months? (See instructions) Have any items listed in this section been spent or used as security for medical costs?Phil, this includes you, your spouse and children. The complete application can be found here: www.dhcs.ca.gov/services/medi-cal/Documents/PDF_Medi-Cal%20Applications/English/English%20Application.pdf
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Phil
Junior Member
Posts: 82
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Post by Phil on Sept 1, 2009 19:00:58 GMT -5
Mike,
I have no doubt that CA system doesn't work. From what you've posted, it clearly doesn't.
My point was that it doesn't HAVE to be that way. The program, as it is, is badly flawed. I live in Massachusetts, and it's not like that here. You can own a house, car and have a little cash in the bank. You can't own investment property, or anything like that, but you can keep your house... until you become old and the nursing home takes it (another rant for another day, lol).
I think the government can pull this off, IF they want to. That's the great unknown: Do they want to, or are they just bought & paid by lobbyists & special interests? Right now, the medical insurance industry spends 1.4 million dollars A DAY in lobbying Congress. You can bet they're not pushing for this to happen. Does Congress have the backbone to hold the line on that bought power? I guess we'll see, if this ever comes to be.
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Post by mike on Sept 1, 2009 19:12:00 GMT -5
Phil, Here is a copy of verbiage from the LA Times that shows what i am talking about when I say our current systems are devolving. The very concern I have about any new program: You can find this article at: www.latimes.com/news/opinion/la-oe-johnston22-2009aug22,0,1180883.story That does not sound to me like things are getting better, and will almost certainly also happen to any new program that is instituted.
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Post by mike on Sept 1, 2009 20:25:54 GMT -5
Here is a link to an article that underlines my statements about inadequate compensation from Medi-Cal: www.victorhanson.com/articles/halderman102107PF.htmlThe salient part is: Where Have All the Doctors Gone? California physician participation in Medi-Cal is the lowest of any State-sponsored program in the United States. Medi-Cal payments to California physicians rank 49th in the country. The rates are based on 1969 data, with only a single increase in 20 years. Because Medi-Cal reimbursement is often less than the cost of keeping a doctor’s office open during the visit ( e.g., $24 for a consultation with a Breast Cancer Surgeon, $253 for a two-hour breast-preserving cancer operation and 90 days of care that follows), accepting Medi-Cal destroys the viability of California medical practices. In order to keep their doors open, the vast majority of California doctors must refuse or severely limit the number of Medi-Cal patients they accept. Under the current system, nearly 60% of patients in the Medi-Cal program report significant difficulty finding a doctor. Wait times are long, particularly for specialists and mental health professionals. Again, the reason I am highlighting Medi-Cal is because it is an excellent example of what a government solution can become. If you would like similar information regarding MediCare VA or other programs, let me know and I will get it for you. Meanwhile, contemplate the predicament of the cancer surgeon mentioned above, and tell me he could stay in business if all his patients paid similar rates.
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Post by Triassic on Sept 1, 2009 23:43:20 GMT -5
you know...jason, e, wind and mike ALL make such excellant, reasoned arguments that i found myself agreeing to each in their turn. yet-jason is arguing for one thing and the others f or something quite diffe rent.
so...i wonder if there could be some meta-issue, some over-arching question that is being missed, overllooked in this case.
also...these points are all pretty theoretical and academic. i always seek to get to the ground-level 'realpolitik' as well as theory. it seems to me that there are 2 basic points here;
1, the public is finally demanding SOME sort of government involvement in the providing of health care for americans. SOMETHING.
2, obama is not about to destroy or even to risk damaging the insurance industry by proposing a 'single-payer' solution. just ain't gonna happen. so the plan will have to factor that in.
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Post by mike on Sept 2, 2009 0:43:48 GMT -5
Tri,
I agree with your points. Subsequent to the last exchange with Phil, I did research the Mass. version of Medicaid, and it looks way better than the California program. That would account for our vastly different perspectives. I think if the folks in Mass looked at what the folks in California are receiving it would be obvious why we distrust a government program while they like theirs.
My point is not that one state program is better or worse than another, simply that whether you receive good services or poor services is simply the luck of the draw. I sincerely doubt Phil is any more or less responsible for the Mass version than I am for the Calif version.
The primary issue with me is that whether you receive good services or poor services is purely a matter of chance, Dependant upon the state you reside in. Mass could easily devolve into the Calif system or worse, and there is nothing you can do about it. That should give you pause, the Mass Medicaid program and the Calif MediCal system are both implementations of the federal Medicaid program, but are vastly different in implementation. I think if you had our system you wouldn't like it either.
The problems are deeper than simply the recipients of MediCal; for example the healthcare providers mentioned in a previous posting ($24 for a consultation with a Breast Cancer Surgeon, $253 for a two-hour breast-preserving cancer operation and 90 days of care that follows) are forced to shift a much greater portion of the cost of providing this service to insured patients. This causes the insurance companies work harder to contain their costs, and they do so by pushing the costs back onto us, the policyholders.
The insurance companies are not innocent, but keep in mind who is precipitating the cost-shifting, in this case it's MediCal. Demonizing the insurance companies won't solve this problem, the solution is for the political leaders to conjure up the courage to adequately fund programs like MediCal.
To me, if they cannot pay for what already exists, how are they going to pay for the next system?
By the way, the reason I am so acutely aware of the MediCal issues is that I have had a significant interest in a large Pathology lab, and we could never justify MediCal work, but accepted it as an unfortunate requirement of taking work from hospitals. Here is the more insidious part; we wouldn't sign up hospitals in poor neighborhoods because we knew they would have higher percentages of MediCal recipients. Our competitors wouldn't either. We would have gone out of business if much of our work was MediCal. How did that benefit the patients?
Here is another example of the problems we face: In pathology their are several types of services that are performed. In histology, you have pieces of tissue that you put on a microscope slide, stain and look at. In Cytology, you have cells floating in a liquid solution. The vast majority of cytology cases are PAP smears. Because MediCare sets the price too low, and the insurance companies index their reimbursements off MediCare, cytology is always run at a significant loss. The only reason a lab would accept cytology cases is because the customers (hospitals) will not give you histology cases unless you take their cytology cases too. This makes for an unwieldy economic model. Something that costs you $12 to perform, and you bill at $35, will in fact pay about $6.50. You are losing $5.50 on each transaction. And that is for Insurance, MediCare and private pay. MediCal is worse. What would make anyone think a new system will not just be a repeat of what is going on now?
There are other insidious effects as well; for example, prosthetics (artificial limbs) is currently very lucrative, whereas orthotics (braces) is quite the opposite. Why? Because Medicare arbitrarily sets the prices. So now in the field of prosthetics a lot of research is being done, and people can readily get artificial limbs that are really sophisticated (expensive), whereas people who wear braces are locked into stone age technology. There are companies that have made progress such as automatic knee locks, but the challenge that has so far stymied their progress is that they cannot get paid for the new systems. They languish, and that discourages companies from spending any money on R&D in the field of orthotics. If we don't like the pricing structure Medicare sets, there is nothing we can do about it.
Despite everything I have said, I am not categorically against government programs, but I am deeply suspicious, particularly when there is no clear, consistent source of funding. Where does the current proposal stand on this issue? Well we have some vague suggestions such as paying for it via Medicare efficiency improvements, and taxing the rich. Neither of these would come even close to funding the proposed system, therefore it is reasonable to expect a repeat of previous systems. We don't need a vague, underfunded BS system to claim political capitol, we need a real system, one that is carefully thought out, ADEQUATELY FUNDED, managed properly and with safeguards to preclude a repeat of past experiences. What has evolved up 'til now is simply more 'feel good' BS.
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Post by mike on Sept 2, 2009 13:00:48 GMT -5
Someone just sent me the following, which about summarizes the issue:
Obama's health care plan will be written by a committee whose head says he doesn't understand it, passed by a Congress that hasn't read it and whose members will be exempt from it, signed by a president who smokes, funded by a treasury chief who did not pay his taxes, overseen by a surgeon general who is obese, and financed by a country that is broke.
What could possibly go wrong?
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Post by Dee Dee on Sept 2, 2009 21:02:47 GMT -5
Someone just sent me the following, which about summarizes the issue: Obama's health care plan will be written by a committee whose head says he doesn't understand it, passed by a Congress that hasn't read it and whose members will be exempt from it, signed by a president who smokes, funded by a treasury chief who did not pay his taxes, overseen by a surgeon general who is obese, and financed by a country that is broke. What could possibly go wrong? Mike, Wouldn´t it be more efficient and productive to ask the following questions? Switching to realpolitik so to speak. - What does it mean, when the head of the committee says, that he/she doesn´t understand it? Is that all of it or some of it? Are there other people in that committee, who do understand?
- How do you know that the members of Congress haven´t read the health care plan? If it has been explained to them and they understand it and agree about it - isn´t that what really is important here?
- Do you believe that the private smoking habits of the President is going to affect the overall consequences of the health care plan?
- Where is the link between one single person not paying his taxes and the health care plan? Should one person´s failure to pay his taxes be allowed to influence a plan that important?
- Do you seriously believe that an obese surgeon cannot perform operations on his patients?
- What if people being healthier, provided that the plan goes through, is actually going to contribute to making the country richer in general; i.e. moving away from being broke?
Or do you just find all of this to be a joke of some sort? Despite my sense of humour I don´t find this to be funny. At all.
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Post by Ouch on Sept 2, 2009 22:51:03 GMT -5
I got away from this discussion, because a few other things have been taking up my time, but I'm going to add a little more into the mix in a bit...
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Post by mike on Sept 3, 2009 0:49:58 GMT -5
Devodiva,
The serious discussions I meant as quite serious, the last entry was intended to be funny, sorry if you took that part seriously. It was not my intent to upset anyone.
Aside from my last entry, I am quite serious about the things I said. It is normal that not everyone will agree, but I seriously think everyone should consider the concerns I have raised.
We hear a lot of things about what this plan is or is not about, but if you look back on the previous plans, and consider what has happened to them, it is quite reasonable to project that unless this plan is substantially different, it will devolve into something quite different from what is intended.
I have been around long enough to have witnessed the promises and subsequent failure of Medic-Aid and the decline of MediCare. I also experienced the VA system and military medicine, compared the promises with the reality and feel the gap is quite wide.
I don't disagree with the need for a system, I really do think we need a better system but, having been seduced by the promises and disappointed by the execution several times before, am quite skeptical about yet another round of hollow promises.
You may think this is a criticism of Obama, but it's not. Keep in mind, he can request, recommend and press for a system, but ultimately it is congress who must write, compromise & agree on a system.
As Phil indicated earlier, the lobbyists for the insurance companies are spending $1.4 Million a day persuading congress to coerce the plan to their liking. I think this substantially reduces the likelihood you will get something that helps the ordinary citizen. How much do you think the drug companies have been spending, for the same purpose?
If you haven't yet done so, please read what I have posted regarding Medi-Cal, and then tell me what you think. I bring Medi-Cal up because it is something that was sold to the American public not all that long ago, and the concerns & promises when it was created were quite similar to those of today.
If you have reason to believe things will be different this time, please share your ideas. I am not here to criticize anyone's opinions, but add a contrary viewpoint that is based on facts and not emotion.
Ultimately I believe we all share the same dream, but having followed similar programs in the past, with disappointing results, I am looking for reasons to believe things will be different this time.
If they aren't different I believe we are all in for disappointment, and I would be really sorry to see us repeat what has happened in the past.
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Post by BA on Sept 3, 2009 7:39:43 GMT -5
Someone just sent me the following, which about summarizes the issue: Obama's health care plan will be written by a committee whose head says he doesn't understand it, passed by a Congress that hasn't read it and whose members will be exempt from it, signed by a president who smokes, funded by a treasury chief who did not pay his taxes, overseen by a surgeon general who is obese, and financed by a country that is broke. What could possibly go wrong? A salient, tongue-in-cheek point. Very, very good. Look, I am of the opinion that all civilizations and societies go through a building up process, a levelling off process, and finally a decline or devolution. I firmly believe that we are in the latter days of decline with regard to ALL manner of things (economic, moral, health, cultural etc., etc.) and that this is something that we do not ultimately have much control over other than to effect a slight slowing down of the process. Sorry I didn't mean to broaden the debate out of the health-care arena, but I thought I'd share my realistic/pessimistic POV with you.
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