[aquaadverse]

Originally Posted by Mavdog

yes, an attempt to stop the rapidly escalating costs of health care is better than not attempting to stop the rapidly escalating costs of health care.

Any proposal that blows off tort reform isn't serious. If you concentrate on simply handing out a coverage card, you are going to lose people delivering the service. It's accurate to say it's better to take steps that will lower cost. Call it the oh, Jesus principle. You take an action that seems like the thing to do. Light a match to check the fuel level. Sit on the branch so your cut is between you and the tree trunk so you can get a longer stroke. Then when it causes disaster you say "Jesus I wish I hadn't done that." Motion isn't the same as efficiency. The result and not the intent is the important thing. I believe I'll skip the disfigurement and deal with running out of gas and have to saw longer.

there is clearly going to be costs to the proposed plan, and there are costs that by most estimates are much greater to not reforming the system.

You need to clue in the CBO. They evaluated the proposal and said it would increase costs. And that's using the rosy projections supplied by Congress. Everyone agrees our health care system costs too much. That's not even worth mentioning. It's hard to see how mandating coverage at a set rate without dealing with the costs as beneficial.

as for "congress directly managing the system", I don't agree that is an accurate statement.

If you pass a law mandating coverage, setting the amount of payment for procedure and do almost nothing to reverse costs except dictating the amount of payment you will end up with no private carriers. See Medicare. Doctors are refusing Medicare patients because it takes too long to get paid and the amount doesn't pay their cost to do it. If your outgo exceeds your income your up keep becomes your down fall.

HMOs existing a half century prior to congress mandated coverage, their 1970s bill didn't really change the structure nor the procedures of the insurers, after all they are mostly governed by state regulations not federal.

It forced them to offer procedures at a set price regardless of risk factors. It defined them as 25 members or more. Insurance classes have been around a long time. Schools would fit the same conditions you pointed out. They are mostly state and local governed. But you have to have school x number of days, a student is defined to meet narrow criteria. States and districts pile criteria on top of it. But if you want to receive federal funds you have to meet federal guidelines.

HMOs gave companies some pretty nice benefits for managing costs. Corporate taxes were reduced, locking in to only using a small group of providers gave them lower charges for the same reasons agreeing to exclusivity does in everything else. The legislation that followed with PPOs saw them become a moot point, it tried to correct the flaws and make administration and reporting easier. But the original move was what set the direction. I could go to any Doctor I wanted pre-HMO. They could refer me to any specialist.


the previous system worked for thiose who were provided employee based coverage, but that is now less of the population than before, and the % of the pop who are provided coverage by their employer is less and less.

You're leaving out how it spiraled the costs of everything that wasn't controlled, making it even worse for the uninsured. Even the uninsured could afford run of the mill office examines and medicine. Pro Bono was common and the treatments were done by need instead of dictated to keep liability low.

The reason less and less are offered employer health plans is because it's too expensive. Your premise is flawed. Medical coverage wasn't a huge expense for either the employer or the employee. It didn't go up because employers stopped offering coverage, they stopped offering coverage because it got too expensive.

why should insurers be allowed to deny the insured procedures based on the insured's age, or their health, or a pre-existing condition? that contradicts the reason the person has paid for coverage!

Do you just not understand how insurance works? Because insurers have to charge an amount to cover the risk. They can't print money or raise fees and taxes to make up a shortfall. They can't be like California and just pass out IOUs or run a deficit.

If I have a bunch of speeding tickets and accidents or DWIs the odds are I'm more likely cause Geico to stroke a $50K or more check. They have to maintain reserves, mandated by law, to cover claims. They charge me more, but the rest of the people who didn't act recklessly didn't pay more for me.

Why do I have to pay more out of network? Because there is no agreement to cut a break because of exclusive promise.

You spread the risks and costs so the incremental creep is spread. If I had pancreatic cancer, I should be able to buy life insurance for the same cost as someone who doesn't have it? After all Life insurance is there to give your family funds after you can't. It's the whole purpose! Here's my $300 bucks for the six month premium, stroke my wife a $10,000,000 check. WTF? How come it's so hard to find life insurance?

The HMO act of 1973 did exactly what you you propose, They couldn't refuse coverage or take age or health into the premiums for the group.

My big problem with the current proposals is an almost total absence of attention to the things that drive the costs up. It is just going to drop the payments received.


caps on non-economic damage is a good idea, but the issue is how to provide recourse to a person who is victim of medical malfeasance. a very difficult line there...but that isn't the cause of the high increases in health care costs, and reforming the malpractice awards won't by itself solve the issue.

Maybe not, but it's certainly in the top 3 reasons on any analysis I've seen. It's high enough to merit attention in any attempt to reform the system. We shouldn't let people who don't have the expertise to properly evaluate the the situation decide civil damages. There should be some screening in place to blow out the obvious crap.

Only looking at the premiums isn't an accurate representation of the cost, either. It doesn't address purely defensive procedures or expensive equipment in place to head off "diligence and negligence" claims. Unnecessary procedures take staff and resources to do. Administration to record and file, administration to evaluate and release payment, apply payment etc.....

I wasn't kidding about that small hospital where my Dad was Controller. He was an insurance auditor for a decade, the guy they sent to hospitals of every size to ensure the facilities were meeting standards, claims were actually for procedures performed, and they weren't just inflating claims from slipping some unneeded ones.

And he was checking for a single provider. He knew how to efficiently manage risks and resources, the most common conditions and treatments to plan for and allocation of resources. He didn't tell Doctors how to treat patients or refuse to adjust charges and take a loss for humanitarian reasons. That facility closed because much of that was taken from him.

Even though the actually process of quality treatment didn't change a lick, some big payouts and the decision of some civilians that you needed to have rarely used, expensive equipment or you were negligent closed that place. The numbers stopped working.

That was over a decade ago. You won't find any value assigned to it on malpractice economic impact, just like the gas and room and board families incur because the nearest hospital is now over 100 miles away.

You need to be perfect or have enough quantity to buy the impression you have every base covered. You might feel better watching shysters trolling for class action clients on national television, that it is making your care better and more accessible, but I could introduce you to someone who disagrees vehemently.