[iltos]

Originally Posted by Fyzbo

GM might have done poorly, but it doesn't matter. Capitalism allows for multiple companies and competition. The car industry as a whole has not done poorly, unfortunately all companies that have done well are not based in Detroit. AIG did have regulation and intervention, it was governments involvement that caused so many problems. Neither of these however relate to health care, so why are we talking about them?



Why does healthcare need to be "fixed"? It seems most people feel the system is broken as a whole, but are very satisfied with their personal coverage (http://www.gallup.com/poll/112813/am...fferently.aspx). If every individual is happy with health care, how can it be broken as a whole? Seems like people constantly saying it's broken and that it needs to be fixed have convince the public that true, now matter how good their doctors are.

the issue is confusing...i have private insurance....at 60, i pay over 1300/month for my family....without it, i'd be behind the 8 ball now, as my wife spent 5 days in the hospital back in january with some (frighterning, but relatively minor) bleeding in her brain....between that stay and the followups, the bill so far would have been over 25g for an uninsured person....our share, including the deductable is about 3g....with the insurance company having paid another 5g

i'd vote that i'm "happy with my coverage"....but she's got one doctor who routinely charges for tests he never performs, and we had to stand our ground back in january to get the hospital to release her after 5 days -imo, the only reason they wanted to keep her ("observation") was a euphemism for running up the bill...from the standpoint of care, they were done with her after 3 days.

as far as the doctor who charges for stuff he never does....he's a good doctor -my wife likes the quality of his care- his ethics vis a vis his relationship with the insurance company are, frankly, secondary to the fact that he's a good doctor.

but how much money is he bleeding out of the insurance company every year? how pervasive is this across the industry?

same can be said about the issue of her hospital stay.

both those "cost overruns" are buried by the bureacracy of managed health care.... and while obviously a contributor to health care costs, i don't see how it's gonna change because of a public option....

it's only suppose to offer a more competitive product for people who can't afford the kind of coverage i have.....least that's what i'm getting out of this.

maybe the thing to wonder about is: will it address the problem of bankruptcies triggered by medical costs?

http://pnhp.org/new_bankruptcy_study...uptcy-2009.pdfIn 2007, before the current economic downturn, an American family filed for bankruptcy in the aftermath of illness every 90 seconds; three quarters of them were insured.
Since 2001, the proportion of all bankruptcies attributable to medical problems has increased by 50%. Nearly two thirds of all bankruptcies are now linked to illness.
How did medical problems propel so many middle-class, insured Americans toward bankruptcy? For 92% of the medically bankrupt, high medical bills directly contributed
to their bankruptcy. Many families with continuous coverage found themselves under-insured, responsible for thousands of dollars in out-of-pocket costs. Others had private
coverage but lost it when they became too sick to work.

[Fyzbo]

Originally Posted by iltos

the issue is confusing...i have private insurance....at 60, i pay over 1300/month for my family....without it, i'd be behind the 8 ball now, as my wife spent 5 days in the hospital back in january with some (frighterning, but relatively minor) bleeding in her brain....between that stay and the followups, the bill so far would have been over 25g for an uninsured person....our share, including the deductable is about 3g....with the insurance company having paid another 5g

I'm sorry you had to go through that, I hope everything worked out well. It is a lot of money, in your opinion, how much should the hospital stay cost?

Originally Posted by iltos

i'd vote that i'm "happy with my coverage"....but she's got one doctor who routinely charges for tests he never performs, and we had to stand our ground back in january to get the hospital to release her after 5 days -imo, the only reason they wanted to keep her ("observation") was a euphemism for running up the bill...from the standpoint of care, they were done with her after 3 days.

as far as the doctor who charges for stuff he never does....he's a good doctor -my wife likes the quality of his care- his ethics vis a vis his relationship with the insurance company are, frankly, secondary to the fact that he's a good doctor.

but how much money is he bleeding out of the insurance company every year? how pervasive is this across the industry?

both those "cost overruns" are buried by the bureacracy of managed health care.... and while obviously a contributor to health care costs, i don't see how it's gonna change because of a public option....

I agree, a public option will not prevent doctors from breaking the law. The government does not need to create a socialized health care system in order to stop this from happening.

Originally Posted by iltos

it's only suppose to offer a more competitive product for people who can't afford the kind of coverage i have.....least that's what i'm getting out of this.

maybe the thing to wonder about is: will it address the problem of bankruptcies triggered by medical costs?

I don't know if "competitive product" is the right phrase.

As for bankruptcies, I guess the other option is to go with out. Having the best possible care and procedures costs a ton of money and always will, the issue is that everyone feels they are entitled to the best, but don't know why or where it will come from.

[wacor]

Might depend upon the hospitals Bob. Around here they try to get you out as fast as possible. Also it depends upon the patients attitude. When my wife was admitted last month they said they WANTED to keep her over night for observation and more tests. If it had been me I would have preferred to have gone home. It was her call but they made it clear what they wanted to her to do so she stayed. They also did not actually admit her to a normal room. They have temp rooms down in the emergency. That would have cost me over $10k without the insurance.

[iltos]

Originally Posted by Fyzbo

I'm sorry you had to go through that, I hope everything worked out well. It is a lot of money, in your opinion, how much should the hospital stay cost?

thanks.....and she's doin fine....lost a little "names of things" type memory, but unless you live inside her head, you'd never notice......as one of her friends told her, "it brought you down to the level of the rest of us"
i'm not real savvy in the "should have cost" department my share was more that i WANTED to pay .....but, in contrast to the poor guy without any insurance at all -who would be stuck with the full 25g- it was a bargain

I agree, a public option will not prevent doctors from breaking the law. The government does not need to create a socialized health care system in order to stop this from happening.

yeah....there's a link in one of these health care theads to an article by doctor who has worked all over...it discusses the dispartiy of costs around the country, and points to the change in attitudes within the medical profession itself as a major culprit.

I don't know if "competitive product" is the right phrase.

maybe not...but its the one the senate used in its hearings on insurance policy recissions, and the insurance industry agreed was an option -if the feds mandated that health insurance was a requirement for everyone.

As for bankruptcies, I guess the other option is to go with out. Having the best possible care and procedures costs a ton of money and always will, the issue is that everyone feels they are entitled to the best, but don't know why or where it will come from.

but many of those bankruptcies were in spite of the folks having health insurance...all i can figure is that they weren't paying for "catastrophic coverage"....there is no way my one time costs for any incident would approach 25g.....or even 10g

still -including insurance, which amounts to about 75% of the bill- i'm paying 20g a year for everything health related....and honestly, if i weren't married, i'd probably only now be even considering health insurance.
but then....i'm a risk taker, and have always been a healthy guy

[iltos]

Originally Posted by wacor

Might depend upon the hospitals Bob.

that's definately true, Bill.....it is a point the doctor-turned-jounalist link speaks to.
would a public policy on health insurance allievate that?
i'm thinking of kaiser, which seems successful because it has at least standardized a portion of health care for its members....

the private insurance companies certainly have done something similar -in terms of individual treatment and procedure costs, but they don't have the administrative control to watchdog it, allowing hospitals to develop different policies based on....whatever.

Around here they try to get you out as fast as possible. Also it depends upon the patients attitude. When my wife was admitted last month they said they WANTED to keep her over night for observation and more tests. If it had been me I would have preferred to have gone home. It was her call but they made it clear what they wanted to her to do so she stayed. They also did not actually admit her to a normal room. They have temp rooms down in the emergency. That would have cost me over $10k without the insurance.

actually, it was a pretty similar situation....they kept my wife in one of those temp rooms overnight, awaiting the results of an mri and a cat scan....then they moved her into the "regular" hospital....the issue of "how long" she was gonna stay only surfaced after they got the swelling and associated pain under control (that was resolved after another 15 hours or so....but only on her insistance that they take her off the morphine drip)

then it turned into another day and half of sitting around, waiting for the neurologist to drop in every eight hours and say hi, do nothing, and disappear again.

[jmosmith]

Originally Posted by Stoner

GM and AIG aren't in the health business.

No....I didn't make criticisms of the Federal programs, but I could have. I pointed out that the Federal Government did not manage the financial aspects of running those programs, properly.

I didn't claim that either.

I had to look up the meaning of 'public goods' in the economic sense.
Wikipedia was my source.
( edit: link--------> LINK )
Paul Samuelson:

All medical concerns , from pharmaceutical supplies to hospital space to the time a medical practicionor spends in treatment......all seem rivaled and excludable.
From the Wiki article:

I don't understand how you can claim that health care is a 'public good'.
Are you arguing that it should be a 'public good' by socializing the health industry?
If so, how do you intend to keep costs down as there would be little competitiveness to the concept?.......To the contrary.......health care would then become non competitive and like the night light example at Wikipedia.......excesses become the norm so that there is no intrusion by the individual. More is generated than needed ( by theory ) and waste/unused results.

The argument isn't about regulations imposed upon the functioning of the health industry....it's about socializing it.

Who's giving up, James?
Who is acting stupidly?

NASA could be considered a public goods I suppose and no other business entity has the ability to compete in their realm....but when they do experience a failure....it's a biggie.

The analogy with NASA is that those 'mistakes' were extremes of 'crash and burn' involving a handful of people put at risk. An experiment with socialized medicine presents new economic and health risks involving a whole nation.

No argument there.........abusive malpractice law suits, the insurance industry and the HMO concepts have had considerable negative influences, imo.

I haven't yet seen anyone successfully make the argument that the US would be better off with socialized medicine, James.
Looks to me like a shift of attention to those that couldn't afford ....with the detraction of the quality of service for everyone while the funding aspects are controlled by an entity ( The Feds ) known to be careless in all things of a financial nature.

I've supported the concept of welfare for the indigent ....the support for those unable to provide for themselves, support to bring people back into society as self sufficient.
But the financial system has been under duress, and not just the last year or so and I think it's become apparent that there are some things that are not affordable at present.....especially with the grand plans of reconstruction in place.
SS, Medicare and Medicaid are coming to an end, with out intervention. It's a practical situation......the funds are running out and the means to stabilize them seem mathematically and politically non doable.
When was the last time you saw much in the news about Congress addressing them?
I remember Bush addressing SS. Obama? Maybe I missed it with everything else that's going on.
Now the arguments fly for an even grander plan of universal health care.
At a time of a deep recession that has incredible financial obligations spanning a decade at minimum.....if....IF.....everything works out. Bush made the same claims and look where we are. Deeper in debt and creating even more debt at a greater rate as if it's a race to see just how far that credit rating stretches.

There is only so much money in existence......the rest is credit and debt.....
I saw not too long ago that the incurred debt the Feds have bound us to, is somewhere on the order of $550,000 per household. Not considered was the fact that not all households make enough to pay taxes of any consequence, so that leaves a greater commitment to those that participate in our economy successfully.
Now...it's being asked of these people to fund an experiment in an even more costly social experiment.

IMO......I think we're starting to see a society feed upon itself to the point it no longer retains a reason for being other than existing to feed upon itself.

Holy Cow Jack!!!...

Originally Posted by Stoner

GM and AIG aren't in the health business.

Health businesses fail too (check out "The Oath", health insurance), and hospitals

No....I didn't make criticisms of the Federal programs,...

You sure you didn't?...

The inability of the Feds to manage the Social Security, Medicare and Medicaid trusts...

That sounded like "criticism" to me, but I get your meaning now, but not the first time.

I didn't claim that either.

wasn't saying you did; my fault. It's just the thing that comes up in these discussions and I was just adding it; not saying you said it.

I had to look up the meaning of 'public goods' in the economic sense.
Wikipedia was my source.
( edit: link--------> LINK )
Paul Samuelson:

Yep, Samuelson is the guy that first started to study this stuff; he's good, but as the original writer on the subject, we've learned a bit since then.

All medical concerns , from pharmaceutical supplies to hospital space to the time a medical practicionor spends in treatment......all seem rivaled and excludable.
From the Wiki article:

The section of road you occupy when you're out driving/riding around is also "rivaled and excludable", but roads are still public goods. The same is true of the swing set in a public park, or the bench you sit on to feed the birds, but parks are also still "public goods". Turns out it can be a bit of a sticky whicket: "public health", is a "public good",... but the individual services of a single medical practitioner, would not be. Anyway, it get's ambiguous; my intended meaning was "public health".

I don't understand how you can claim that health care is a 'public good'.

see above

Are you arguing that it should be a 'public good' by socializing the health industry?

nope, not arguing that.

If so, how do you intend to keep costs down as there would be little competitiveness to the concept?.......To the contrary.......health care would then become non competitive and like the night light example at Wikipedia.......excesses become the norm so that there is no intrusion by the individual. More is generated than needed ( by theory ) and waste/unused results.

"Competition", is not the actual driving factor in healthcare. When you're in an accident, and you're not awake, they take you to the ER/Trauma Center,... no shopping around. When you're told you need surgery, and confirm it with a second opinion, many patients do NOT want the "cheapest" provider, and again, shopping around isn't usually done. We don't select our surgeon and anestesiologist (sp?) ala cart. In these cases we want "the best", and tend to view price as an indication of who that is. Turns out that healthcare is much like gas, in terms of the market demand,... it's fairly inflexible, we want our healthcare needs met, no matter the cost!... the statistics show that for most people, of all the money they spend on healthcare their entire life, HALF of that is spent in the last one year of their life!!!... because healthcare at this level is when the consumer is up against the wall!!!.. and the options are extreme, or extremely scary,... so "price" does not really factor at that point.

Going to see a general practicioner, for aches and pains, is a little different, but not much. Doctors don't move into poor neighborhoods and offer cheaper prices because they can, or want to, or have found a way to reduce costs,... they are forced into those places because other doctors have reputations they cannot compete with, so they get to set up in wealthy neighborhoods.... competition doesn't drive prices in this industry.

Only at the level of your local drug store and pharmacy,... that's when people shop around and competition does drive prices, but doctors don't put up "buy one get one free" signs outside their clinic when they don't have enough patients.

The argument isn't about regulations imposed upon the functioning of the health industry....it's about socializing it.

ya lost me there,... but I'm still not saying I'm "in favor" of, well, of anything yet. I've just been saying that some of the criticism offered here isn't as "absolutely conclusive" as it has been presented to be.

Who's giving up, James?
Who is acting stupidly?

Not saying that anyone is specifically doing either. I'm saying its a goal to figure out a solution for and not to give up. And I'm also saying I'm NOT willing to just accept a "stupid" plan -- I haven't heard a "smart" one yet.

NASA could be considered a public goods I suppose and no other business entity has the ability to compete in their realm....but when they do experience a failure....it's a biggie.

The lack of competition doesn't change it, but there is the ESA, and the Russians, now Japan and China too, so there are other players in this realm now. From the very basic nature of the work, the extremely high costs, do make every failure "big"... in terms of expense, or lives lost in a dangerous endeavor.

The analogy with NASA is that those 'mistakes' were extremes of 'crash and burn' involving a handful of people put at risk. An experiment with socialized medicine presents new economic and health risks involving a whole nation.

Sure.... but exactly what "experiment" with socialized medecine are you refering to?... I don't know of any specific plan yet; in fact, all I've heard so far is a general idea of a "dual" system, which would not involve the "whole nation". I don't know what it would involve yet. (Do you?)

No argument there.........abusive malpractice law suits, the insurance industry and the HMO concepts have had considerable negative influences, imo.

as you say, no argument.

I haven't yet seen anyone successfully make the argument that the US would be better off with socialized medicine, James.
Looks to me like a shift of attention to those that couldn't afford ....with the detraction of the quality of service for everyone while the funding aspects are controlled by an entity ( The Feds ) known to be careless in all things of a financial nature.

Are we talking about "socialized" medecine, or "nationalized"? I dunno. But as a social animal, we've changed as technology advanced and we've become more "civilized". When we still lived as tribal peoples, we provided "universal health care"; yet now that we are so advanced, with REAL medecine, somehow we can't. Even Iraq has universal health care for all the people, written into it's constitution.

I'm not saying it's easy, or that I have solutions, in fact, I'm saying that solving the question of universal/national health care is perhaps the largest challenge our nation has faced yet, and that succesfully solving it will be a great achievement that should not be given up on. It is a massive challenge for any modern economy. We live in the richest nation in the world, with the most advanced technology; yet we could "afford" more compasion when we lived in the stone-age.

I've supported the concept of welfare for the indigent ....the support for those unable to provide for themselves, support to bring people back into society as self sufficient.
But the financial system has been under duress, and not just the last year or so and I think it's become apparent that there are some things that are not affordable at present.....especially with the grand plans of reconstruction in place.

All very valid questions; I agree.

SS, Medicare and Medicaid are coming to an end, with out intervention. It's a practical situation......the funds are running out and the means to stabilize them seem mathematically and politically non doable.

That may be the numbers in this case, but I think that it will be politically impossible to let SS fail, IMHO.

When was the last time you saw much in the news about Congress addressing them?

The "news" is about the last thing I trust!!!...

I remember Bush addressing SS. Obama? Maybe I missed it with everything else that's going on.
Now the arguments fly for an even grander plan of universal health care.
At a time of a deep recession that has incredible financial obligations spanning a decade at minimum.....if....IF.....everything works out. Bush made the same claims and look where we are. Deeper in debt and creating even more debt at a greater rate as if it's a race to see just how far that credit rating stretches.

There is only so much money in existence......the rest is credit and debt.....

Actually, the amount of "money" in "existence", is infinite,... but its value is not. But both the money and the value are based on the US economy, our ability to produce goods and services that the world wants. That remains high. But even so, there are serious problems with massive gov't debt, and this has gotten NUTS!!!....

I saw not too long ago that the incurred debt the Feds have bound us to, is somewhere on the order of $550,000 per household. Not considered was the fact that not all households make enough to pay taxes of any consequence, so that leaves a greater commitment to those that participate in our economy successfully.
Now...it's being asked of these people to fund an experiment in an even more costly social experiment.

Again, without specifics, we don't know what you're being "asked", yet.

IMO......I think we're starting to see a society feed upon itself to the point it no longer retains a reason for being other than existing to feed upon itself.

An idea worth consideration and exploration; perhaps that too can be understood, and fixed.

But it is a common pattern of many biological/organic systems that they "poison" themselves, unintentionally, and start to cause their own decline -- in a Petri dish, bacteria do this from the acumulation of their own waste by-products, because the system doesn't provide a removal of them. Every "system" will make mistakes, have flaws, even cause it's own problems, but many times they are unknown until the system is up and running; the solution is the need for periodic reforms and refinements,... the only alternative, is the even greater inefficientcies of the absence of a system (chaos).

We have a healthcare "system" now,... it's just a bit out of whack and produces inequitable solutions.

J.

[jmosmith]

Originally Posted by wacor

JMO please tell me where you draw the line between criticism and smart criticism? In most cases it probably boils down to which side of the argument one is siding with. Sure there is much to speculate about with a single payer public national health care system. But clearly concerns about it being mismanaged like the VA system and SS and medicare should be reasonable. Those have a track record of either poor treatment or mismanagement of funding.

One argument which proponents make is that such a national health care plan will actually be cheaper for the country. That flies in the face of common sense. How can there be an honest discussion when this is used as a selling point? I say that because the main crux of the argument is the millions that are uninsured. If they suddenly get health care that is so called free do we expect them to only use it when they are severely ill like currently when they would go to a hospital? Or will they not also be going to the doctor for every sneeze? Now I realize that some will probably not be too keen on going to a doctor. Heck I try to avoid them but in reality it seems there should be a large influx of new patients. Does it not make sense that more patients means either there will be longer waits or more doctors needed? If more doctors are needed then normally supply and demand would keep the doctors fees at a certain level but if the govt is paying the bills it seems folly to assume the govt won't control doctors fees. And with that control it seems logical that some will find another profession such as law where they can sue doctors and hospitals since Obama has no interest in controlling malpractice which is another area where costs must be controlled in some fashion.

Have a rip my friend.

Originally Posted by wacor

JMO please tell me where you draw the line between criticism and smart criticism?...

Well, see below. Right about there is where I draw it:

One argument which proponents make is that such a national health care plan will actually be cheaper for the country. That flies in the face of common sense.

First "card", in the house you construct below,... (You've named the fallacy here yourself, "Common Sense" - "unfortunately, there simply isn't a common-sense answer for many questions. In politics, for example, there are a lot of issues where people disagree. Each side thinks that their answer is common sense. Clearly, some of these people are wrong. " LINK

How can there be an honest discussion when this is used as a selling point? I say that because the main crux of the argument is the millions that are uninsured. If they suddenly get health care that is so called free do we expect them to only use it when they are severely ill like currently when they would go to a hospital?

Second "card",... and it always takes two cards to start building a house of them, one leaning on the other, and all the rest on them.... this is a hypothetical "expectation" that you've introduced as "fact", and it isn't. It's far more of an unknown. Only sick people suddenly "take advantage" of access to health care when they suddenly get coverage; not EVERYONE. Many others actually take advantage of it when they are about to lose coverage.

Or will they not also be going to the doctor for every sneeze? Now I realize that some will probably not be too keen on going to a doctor. Heck I try to avoid them but in reality it seems there should be a large influx of new patients.

Card Three,... Begging the Question.

Does it not make sense that more patients means either there will be longer waits or more doctors needed?

Begging the question (again)

If more doctors are needed then normally supply and demand would keep the doctors fees at a certain level but if the govt is paying the bills it seems folly to assume the govt won't control doctors fees.

"Supply and Demand" are not the driving factors for doctor's fees. (see response to Jack)

Gov't controls Medicare, yet they do not control actual doctor's fees!!! (This being a "counter-example" which shows your "logic", in fact, fails.) Medicare sets a schedule of payments for given services; those are "modified" by relevant factors, like being the only provider for 50 miles, et. al., and the Doctors themselves actually choose if they are going to participate in Medicare,... so in fact, gov't's involvement does nothing to "control doctor's fees".

All non-participating doctors, still control their own fees, 100%. The only idea I've heard so far is for a "dual coverage" system, both public and private; leaving "non-par" doctors still in contoll of their own fees.

And with that control it seems logical that some will find another profession such as law where they can sue doctors and hospitals since Obama has no interest in controlling malpractice which is another area where costs must be controlled in some fashion.

I'm guessing you're just kidding at this point, because if you're suggesting that doctors that got into, and completed med school, then passed their boards, would give all that up, and go back to school to study Law, and DOUBLE their student loan debt,... which presumes they even could. (assuming the result in the argument, so again, Begging the question.) This is an absurd suggestion on it's face.

However, it identifes the potential for a real problem in the dual system currently under consideration -- sorting the market into "par" and "non-par" ("par" is an insurance term which is short for "participating provider"), then the prices for non-par doctors would be under their own control and higher (or else there is no motivation for them to not participate in the program, same price, more patients, equals more money for them, so there would have to be a price difference for there to exist/persist a difference). The potential to get higher returns actually REWARDS doctors, and rather than discourage them, it entices more of them to enter the market in the hopes of being able to be a high-end doctor. This is the actual result of the Law of Supply and Demand. It's the opposite of what you suggest.



Now this is the rest of your first paragraph (it was just easier to answer your post this way).

In most cases it probably boils down to which side of the argument one is siding with. Sure there is much to speculate about with a single payer public national health care system.

And you provide a lot of that speculation, then call it conclusive. There is where I draw the "line".

But clearly concerns about it being mismanaged like the VA system and SS and medicare should be reasonable. Those have a track record of either poor treatment or mismanagement of funding.

They do,... but haven't those issues been addressed? If they haven't, aren't they idnetified as "problems" now? Wouldn't it make sense that they could be avoided now?...

...well, if it "made sense", then I doubt it would come from the Fed Gov't, or that we'd be debating about it. (and yes, that's a very similar style of fallacious argument that I just show you were using -- but I presumed you didn't realize it ).

Those are fair concerns to raise, and be sure they are addressed -- if they can be.

Have a rip my friend.

Was that a "rip"?...
...was it good!!!

As I said, I'm all for criticism, and I'm against enacting a bad plan out of desperation to enact "something",... but the critique you've created is guess-work; a house of cards that fails quickly and easily.

I "draw the line" between legitimate critiques, and those that are just concerns about the "unknown".

J

[wacor]

JMO you are too much like Stoner. You guys make a long winded response which is too tiresome to reply to in total. I should have stated that IMO those were what I would expect Obamacare to turn into. Of course it is speculation. That is all we have. But I believe I am on pretty firm ground to see things be troublesome should he get what he is asking for.

Now this on the otherhand I will respond to directly

Gov't controls Medicare, yet they do not control actual doctor's fees!!! (This being a "counter-example" which shows your "logic", in fact, fails.) Medicare sets a schedule of payments for given services; those are "modified" by relevant factors, like being the only provider for 50 miles, et. al., and the Doctors themselves actually choose if they are going to participate in Medicare,... so in fact, gov't's involvement does nothing to "control doctor's fees".

How can you say medicare does not control doctors fees? Medicare determines what they will pay a doctor for services. The doctor gets paid what medicare dictates. Maybe I am missing something as you usually are more lucid than that explanation.

[Stoner]

Originally Posted by jmosmith

Holy Cow Jack!!!...

...........edited for brevity.

J.

Health businesses fail too (check out "The Oath", health insurance), and hospitals

All organizations including government are prone to failure.

You sure you didn't?...

Not in this thread ....

That sounded like "criticism" to me, but I get your meaning now, but not the first time

Sounds like....but does not refer to their purpose. Financial functionality.... most definitely

The section of road you occupy when you're out driving/riding around is also "rivaled and excludable", but roads are still public goods.

Poor analogy, imo.
Public roads are a network whose whole is funded by taxation of the many. It is a socialist concept to begin with.

The same is true of the swing set in a public park, or the bench you sit on to feed the birds, but parks are also still "public goods".

Also technically socialist concepts.

Is it fair to say that all socialist 'things' are 'public goods' by the nature of their being of socialist design?
Of course, not all public goods would be socialist......such as the air we breathe.

Turns out it can be a bit of a sticky whicket: "public health", is a "public good",... but the individual services of a single medical practitioner, would not be. Anyway, it get's ambiguous; my intended meaning was "public health".

imo...I think that clouds the issue even more.
"public health" is an abstraction, not a physical entity like a road or swing set. It can not be used, bought or sold. So, how can it be either a public or private good?

"Competition", is not the actual driving factor in healthcare

But it is removed from the process of administering healthcare services and products when it's converted to a 'public good', is it not?.
Presenting healthcare( or public health ) as a public good does seem to introduce issues of pricing through that projected lack of competitors.

When you're in an accident, and you're not awake, they take you to the ER/Trauma Center,... no shopping around. When you're told you need surgery, and confirm it with a second opinion, many patients do NOT want the "cheapest" provider, and again, shopping around isn't usually done.

James.....you are formulating an event to prove a particular point.
Healthcare is a much broader topic than an ER.
Healthcare extends far from the concept of trapped consumers in an ER .....and most seeking the needs of medical care are not in the situation you described.
Should a model be based on the expectations of the few rather than the many?
Do we penalize the many to satisfy the few?

so "price" does not really factor at that point.

In your fabricated example.....not the healthcare industry in general.

Going to see a general practicioner, for aches and pains, is a little different, but not much. Doctors don't move into poor neighborhoods and offer cheaper prices because they can, or want to, or have found a way to reduce costs

Ah...social injustice raises it's ugly head.
As far as costs go....Expertise being equal, the costs of the same level of healthcare would logically only be affected by the cost of operations relating to the rent or purchase of the facility and contents.

they are forced into those places because other doctors have reputations they cannot compete with

Indeed.

so they get to set up in wealthy neighborhoods.... competition doesn't drive prices in this industry.

Competition exists by offering greater value.
Better usually does cost more.
Better is usually seen by the consumer as advantageous.

Only at the level of your local drug store and pharmacy,... that's when people shop around and competition does drive prices,

I've heard of people electing to choose less expensive medical procedures. Why see a specialist for a cold when a GP can be seen for less and get the same results?
Your argument of 'competition' is one of the consumer shopping a cure, but competition also exists between the providers to entice the consumer to shop their 'goods'.
I think this is why we see a generalization for equivalent levels of expertise being offered at similar rates.
When that concept is broken......like with unionizing teachers, we tend to see a reduction in the quality of their services. Accepting a generalized level of compensation tends to filter out those that aspire to greater rewards (by providing a greater level of expertise). Mediocrity and professionalism then tend to meld .

But even so, there are serious problems with massive gov't debt, and this has gotten NUTS!!!

Agreed.

Again, without specifics, we don't know what you're being "asked", yet.

'Wait and see how much it's going to hurt' economics
LOL!
I think Bush sold us the same soggy bag, if you get my drift

We have a healthcare "system" now,... it's just a bit out of whack and produces inequitable solutions.

I doubt there is a 'perfect' solution......just better or worse results.



Take care, Bud

[jmosmith]

Originally Posted by wacor

JMO you are too much like Stoner. You guys make a long winded response which is too tiresome to reply to in total. I should have stated that IMO those were what I would expect Obamacare to turn into. Of course it is speculation. That is all we have. But I believe I am on pretty firm ground to see things be troublesome should he get what he is asking for.

Now this on the otherhand I will respond to directly
How can you say medicare does not control doctors fees? Medicare determines what they will pay a doctor for services. The doctor gets paid what medicare dictates. Maybe I am missing something as you usually are more lucid than that explanation.

Well, as you said, it was getting long winded,... but it wouldn't have had too if you hadn't DEMAMDED it,... "show me where",... that sound familiar?

And this isn't "Civilized OPINION", it's supposed to be a debate; so engage it as one and don't just shrug your shoulders and cop-out by saying, "it's my opinion,..." Especially after it's so easy to shoot it full of holes (). And speculation is certainly NOT "all we have", that's just another cop-out (it really is).

You ARE on "firm ground" to be concerned about trouble ahead, but just not hypothetical trouble, as you created to try and support this. It is very hard to have specific worries about him getting "what he wants", when we only have general ideas about it. And in the mids of all your speculating, when you get the economics dead wrong, so you get the "long winded" respons after refusing to let go of an obviose house of cards the first time it was pointed out,... and then insisting on it; asking where the line is drawn; so again, stop pissin on my boots and tellin me it's raining,... you insisted, and invited!!! ---> "Have a rip..." I'm not makin this up, these are your own words!!!

In general, yes, I am greatly concerned about the kind of track record the Fed has with similar programs (Medicare and the VA). In general, I am greatly concerned about the idea of a two payer system, or payers being private and Fed only, based on the potential for very bad economics.

I am VERY concerned about all of this stuff, but I am not prepared to muddle complex issues by guessing, or speculation; nor am I willing to accept such arguments as support for definitive positions on this. <---- This much I think I've been very clear on, as I've said it every time now.



As for doctor's fees,...

It works like this:
Any participating doctor charges what ever fee he likes to whom ever he likes. Medicare get's those bills, and ignores the billing value and "prices" the services based on their own schedule and modifiers for thoese services, they then pay the doctor that amount for the Medicare patients the doctor saw. But those were NOT the only patients the doctor saw...

For every other insured patient, by a payer other than Medicare, the same kind of thing happens, where regardless of the actual amount charged, there is already a pre-negotiated reimbursement rate with each insurance co.

All non-insured patients the doctor saw, get billed at the full rate, and many times they will offer a cash-discount,... if you pay your bill right then and there, it is reduced, otherwise, the doctor is taking a risk that he will not be paid and charges you a premium for him to bear that risk -- with insured patients, he knows he will likely be paid.

In any event, the doctor himself is always the one that is choosing to accept Medicare or otherwise insured patients, and accepting those payment schedules, or to refuse such patients entirely and take cash only. And in every case, he is submiting his own billing rate,... which comes in VERY HANDY at tax time, when he can report that he billed at some level "A", but was only paid at level "B", and calls the difference "losses",... yeah-right, those are the "losses" he agreed and expected to endure before he accepted those patients.

Then, there's another handy trick,... "Outlier Payments",... doctors (and hospitals) are paid according to the proceedures they write on the claim, and it is less than what they bill, but if those proceedures pile up, and the bill amount gets large enough, then they qualify for a much higher rate of reimbursement, and this is where the REAL money is!!! And why your "bills" are so outrageous,... it's how the "game" here is played!!!

...doctors will always choose the number they are putting on your bill, and they never get to choose how much of that number they actually get to collect.





One last important bit here,... that "schedule plus modifiers" for proceedure payments at Medicare, is determined based on an average of the ACTUALL billing that doctors submit to Medicare, over the last 3 to 5 years, which is another reason why doctors keep those billed values VERY high, deliberately much higher than actually needed, because if they do not, then their actual reimbursement can GO DOWN. And we wouldn't want that now would we?...

(Y'all really wanna know about all this stuff?)

J.

[jmosmith]

Originally Posted by wacor

JMO you are too much like Stoner.

Thanks!!!

You guys make a long winded response which is too tiresome to reply to in total. ...

They are tiresome to make too, so quit whining and step up to the plate!!!... Are you here as a dillitante, or can you take a debate seriously?

thanks,
J.

[TooBad]

Originally Posted by jmosmith

Thanks!!!

They are tiresome to make too, so quit whining and step up to the plate!!!... Are you here as a dillitante, or can you take a debate seriously?

thanks,
J.

One can only debate one that makes sense. Your circular reasoning does nothing to add to the debate, it is just confusing to try and follow that lack of logic.

[Sarge]

Originally Posted by jmosmith

The point is this is just more of the same idiotic gotcha-journalism, which is evident in the presentation of the question, because breaking a hip is not reason for a "hip replacement",... that's actually miss named, because it has nothing to do with replacing the hips, but rather the ball joint at the top of the femer bone, the part that inserts into the hip...

The "journalist" in question here, made up a (bad) hypothetical, in order to trap the President in a way that looks bad by design,... "Obama wouldn't help little old ladies!!!..."

HOOEY!!!

...the only answer to that question is, "That's for a doctor to evaluate, and I can't possibly speculate as to what 'would' happen..."

It's the same old "gotch" BS, someone got the President to speculate,... which was a mistake, and now they are making lots of political-hay out of it, running around claiming that these hypothetical claims "prove" that the sky is falling,... and you bought it.

This fallacy is called "argument to the future"; things like saying, "In the future scientist will show that air causes cancer so breathing is just wrong!"

I was kidding, note the ""

He didnt answer the question about the 100 year old lady that recieved heart surgery either. Was that idiotic gotcha-journalism also?

Speaking of idiotic journalism...Arent you missing your favorite shows, Maddow or Olbermann.

[jmosmith]

Originally Posted by TooBad

One can only debate one that makes sense. Your circular reasoning does nothing to add to the debate, it is just confusing to try and follow that lack of logic.

Pig Crap!

[jmosmith]

Originally Posted by Sarge

He didnt answer the question about the 100 year old lady that recieved heart surgery either. Was that idiotic gotcha-journalism also?

Speaking of idiotic journalism...Arent you missing your favorite shows, Maddow or Olbermann.

Who didn't?... Me, or the President? (I didn't see the news conference).

And yes, it is more of the same gotcha-crappola.

Don't know Maddow, not sure about Olberman yet, but neither are my "favorite show", which I would gladly miss to continue watching you make a damn-fool of yourself.