Impeding changes to our Health Care system

[TheMercenary]

Sam, I think those are all valid points. But there are some things that must be considered when looking at those raw numbers. The whole story is not there.

Health services research has consistently documented an insurance disparity in access to and use of medical services.

They:
receive less preventive care,
• are diagnosed at more advanced disease states,
• and once diagnosed, tend to receive less therapeutic care and have higher mortality rates.

It has been my experience that many people in this group also fails to seek care until the last minute, over uses care that they know they don't have to pay for, and is often less compliant with their care when they do receive it. I think the reason that they may receive less theraputic care because the hospitals know they are not reimbursed for much of it, so they get just what they need when the hospital has to eat all the costs. The other reason for the disparity is that healthcare is a business. It has been that way for over 20 years. Insurance companies get to cut deals to bring in the numbers (just like the Dems have done with the mandatory insurance issue) and those who end up paying cash don't get the deal and have to pay the higher costs. Those who don't pay and can't pay still will not. One of the biggest failures in this new plan is that very little has been written into the bill which controls what the insurance companies can charge those who are already insured in the matter of deductables and co-pays. The trade off for them in the advantage of dropping the pre-existing condition clauses is that they get the numbers, millions of new payers. You only need to look at the state of Mass and see how their experiment in healthcare reform to see many of the same failures in this new plan. There is absolutely no promise that people are going to go out and get insurance, mandatory or not. That is exactly what happened in Mass. People still waited to the last minute to seek care, they still did not go out and get the mandatory insurance, and the costs were shifted to the state and individually insured to pay the bills. It is breaking their bank.

[SamIam]

Originally Posted by TheMercenary

It has been my experience that many people in this group also fails to seek care until the last minute, over uses care that they know they don't have to pay for, and is often less compliant with their care when they do receive it.

Well, my experience has been the opposite. I think one reason the uninsured don't seek help until the last minute is probably about fear of having yet another bill that they can't pay. Plus, a visit to the ER frankly sucks. Its often over-crowded, you get to see a doc for about 5 minutes after a 3 hour wait, there is no continuity of care, etc., etc. Its also hard to be compliant when you have little or no money. It costs a fortune to fill many prescriptions. But we are both speaking anectdotally here. I would like to see some actual numbers/studies.

I think the reason that they may receive less theraputic care because the hospitals know they are not reimbursed for much of it, so they get just what they need when the hospital has to eat all the costs.

It is my understanding that the Federal Government actually makes payments to hospitals to cover care for the uninsured. This is one reason hospitals are not as interested in universal coverage.

You only need to look at the state of Mass and see how their experiment in healthcare reform to see many of the same failures in this new plan. There is absolutely no promise that people are going to go out and get insurance, mandatory or not. That is exactly what happened in Mass. People still waited to the last minute to seek care, they still did not go out and get the mandatory insurance, and the costs were shifted to the state and individually insured to pay the bills. It is breaking their bank.

I would be interested in seeing a source for this.

P.S. Thanks for the cites. I'll take a look at them.

[TheMercenary]

Originally Posted by SamIam

Well, my experience has been the opposite. I think one reason the uninsured don't seek help until the last minute is probably about fear of having yet another bill that they can't pay. Plus, a visit to the ER frankly sucks. Its often over-crowded, you get to see a doc for about 5 minutes after a 3 hour wait, there is no continuity of care, etc., etc. Its also hard to be compliant when you have little or no money. It costs a fortune to fill many prescriptions. But we are both speaking anectdotally here. I would like to see some actual numbers/studies.

I will look for some numbers for you.

It is my understanding that the Federal Government actually makes payments to hospitals to cover care for the uninsured. This is one reason hospitals are not as interested in universal coverage.

The feds make payments to the states. The states divi up the money to pay the hospitals. The states determine what they are going to pay individual hospitals for indigent care.

(Mass)I would be interested in seeing a source for this.

http://www.boston.com/bostonglobe/ed...is_failing_us/

http://www.pnhp.org/news/2009/februa...tts_is_no_.php

http://www.huffingtonpost.com/iyah-r..._b_380718.html

http://articles.latimes.com/2009/oct...assachusetts17

http://www.lawlib.state.ma.us/subjec...insurance.html



This supports the changes but points out the issue of costs and costs to the patients in individual insurance.

http://healthcarereform.nejm.org/?p=2135

[SamIam]

OK, I read Merc's links and I'm on information overload. I might be able to make an intelligent comment after a night's rest.

[SamIam]

OK, I'm recovering from information and opinion overload. I don't know if anyone besides me and Redux and Merc and C-Man care about this much detail, but here goes. Critics of the bill say among other things that:

• Congress will never do any cost cutting of Medicare and the Sustainable Growth Rate adjustment for doctors (SGR)
  
• If you give people insurance, they will use it (duh)
  
• Congress is dancing with special interests

I checked out the Center on Budget and Policy Priorities (a NONPARTISAN think group) http://www.cbpp.org/cms/index.cfm?fa=view&id=3021 and here's what they state

on Sustainable Growth Rate adjustment for doctors

Congress likely will never let the full SGR cuts take effect, and it probably won’t offset the cost of scrapping them. But that cost is neither part of, nor in any way a result of, health care reform — the federal government will incur this cost regardless of health care reform, not because of it. This fact is undeniable: if health reform legislation were to die tomorrow, the full SGR cost would remain. To be sure, it would be better if Congress offset the cost of cancelling the SGR cuts. But that issue is separate from the question of whether the health care reform bills themselves add to the deficit or not.

I also might add that the perception that Congress will not act to control Medicare costs is a false one. Again check out the documentation in the link above if you're interested.


If you give people insurance they will use it (duh)

Providing insurance coverage for tens of millions of uninsured Americans will necessarily raise total health care spending in the short term. The real issues here are: (1) whether health reform includes provisions to cover the costs of these insurance expansions so that deficits and debt do not increase; and (2) whether health reform includes steps that begin to slow the rate of health cost growth so that total health spending is lower in the longer run than it otherwise would be. The House and Senate bills meet the first test, according to the Congressional Budget Office (CBO), with the House bill reducing deficits by $138 billion over ten years, the Senate bill reducing deficits by $130 billion over that period, and both bills continuing to reduce deficits for at least a decade after that. The bills also hold promise for the second test, CBO says, although policymakers will need to do more to slow health cost growth as we learn more about how to do it, such as by applying the knowledge gained in the coming decade from pilot projects in the health bills, comparative effectiveness research, and the like.

Congress is dancing with special interests

This is just my opinion. Congress dances with special interests on EVERYTHING. And look at Dick Cheney's connection with Halliburton or Bush's tie with big oil and the Bin Laden's. I won't say that this complaint does not have some validity, but it is part of a larger over-all problem in American government. Republicans are lapdogs to one set of groups and Democrats to another. And often special interest groups will try to play one party off against another. I'm sure the Roman Empire had the same problem. It would be nice if we could cure it, but I feel it is an issue seperate from the health care debate.

[Shawnee123]

Here are my posts:

Oh bullshit.

This is the next step after avoiding any points: talk about how nice you are about it all.
Seriously? Oh well, at least you got merc to suck your dick again.

Oh, am I being a name-caller? Well, YES I am! I freely admit it.

Oh, merc? It's challenge, not CHALLANGE. And, when you mean MORE THAN, as in TOO MUCH, it's T-O-O. Not TO MUCH. Unless you're going to a town called MUCH, in which case TO MUCH would be correct.

Maybe someone will learn something today after all.

Lies.

And thanks for all your valuable input. I gave up providing valuable input a long time ago, when I realized you don't listen, you don't discuss: you dance around and throw quotes around but it's never anything with meaning or purpose.

As Redux said, when you are confronted with facts you play "who me?" and bat your eyelashes, oh so innocent, which I think is infinitely worse than a REAL and TRUE "OH YEAH? FUCK YOU, ASSHOLE."

I mean, it's so passive-aggressive. That's worse than truth telling, even if the truth points out what a dick you can be. You really don't know what you're talking about half the time, do you?

This is what classhole man turned them into:

Originally Posted by Shawnee123
Lies.
you don't listen,
you don't discuss
you dance around
never anything with meaning or purpose.
FUCK YOU, ASSHOLE."
what a dick you can be.

Posted by classicman: and yet again. You do all this trash-talking, name-calling and hurl accusations while acting like I'm the guilty party simply because I disagree. Boy I really must have struck a nerve

Stop bastardizing my quotes, correcting my grammar, and generally being a public nuisance. You hope no one will go back and check and call you on your lies. Wrong.

[classicman]

Originally Posted by Shawnee123

classhole

I kinda like that - thanks.

[Shawnee123]

Oh, honey baby doll, you're so welcome.

[TheMercenary]

SamIam, check these out.

http://www.harpers.org/archive/2009/12/0082740

http://www.realclearpolitics.com/art...sts_99526.html

http://www.washingtonpost.com/wp-dyn...06.html?sub=AR

http://healthaffairs.org/blog/2009/1...health-reform/

[jinx]

I don't see one.

[jinx]

What about them?

[Clodfobble]

Originally Posted by SamIam

Cancer, heart disease, crippling accidents, and all the others ills that human flesh is heir to.

Well, no, it's not the cancer, because that gets diagnosed first, and then treatment takes awhile--plenty of time to buy insurance and get the treatment covered. But a sudden heart attack: that rush to the ER and immediate bypass surgery isn't going to be covered. The crippling car accident, that surgery isn't going to be covered. There are plenty of terrible things that can happen that aren't cured over the long term, but rather incur giant costs right then and there.

Of course, the reality is we will still treat the uninsured who show up at the ER, even if they haven't paid their yearly penalties. So as long as your brother is cool with having to declare bankruptcy after the fact if he does need an emergency procedure, then yes, his logic makes sense for his situation.

Originally Posted by Clodfobble

Of course, the reality is we will still treat the uninsured who show up at the ER, even if they haven't paid their yearly penalties. So as long as your brother is cool with having to declare bankruptcy after the fact if he does need an emergency procedure, then yes, his logic makes sense for his situation.

Consider also that after declaring bankruptcy, if you have another catastrophic medical emergency within 6-7 years, you cant declare bankruptcy again and you should expect to have some percent of your wages garnished...or you can hire a lawyer and fight it.

[xoxoxoBruce]

Originally Posted by Redux

The flaw is that if you have an unanticipated catastrophic event...

Ah yes, thanks, I'll pass that along.

Originally Posted by Clodfobble

So as long as your brother is cool with having to declare bankruptcy after the fact if he does need an emergency procedure, then yes, his logic makes sense for his situation.

No, we own considerable property, and he owns commercial buildings, so that would not be a happy prospect.

But you know how those Republicans are always scheming, although I think he's been voting Libertarian in the last few.

[classicman]

In that case glatt - her dental issues arose from a medical situation and should be covered by her medical insurance - not dental.
(again speaking from experience I wish I had none of)