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Thread: More Playing With Numbers ( US National Health Care )

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    Default More Playing With Numbers ( US National Health Care )

    Leaving aside the cost of the various proposed National Health Care plans ( as much as $1.6 Trillion over 10 years) a lot of people are starting to focus on how many people will actually be helped.

    The Dems like to claim that there are 47 million "uninsured". When that number is actaully examined and it is determined WHO is actually included, the number drops like a stone. If one leaves out illegals, young people eligible under someone else's insurance, families making at least $85,000 per year and those already eligible for Medicare and Medicaid, the number drops to as few as 12 million and no more than 15 million people. All of whom can and should be taken care of by vouchers for health insurance.

    Without the so called "uninsured", just what are we supposed to be accomplishing with Obamacare ? Other than a complete Federal takeover of the entire nealth care system ?

    The proponents claim that it will result in lower costs and greater efficiency. Would someone please point to a single Federal program that has successfully controlled costs and promoted greater efficiency ? The ONLY way it can and will be done is rationing. The government will decide whether or not you get an MRI; which surgical procedure; what drugs wil be prescribed for you and for how long.
    How many patients your doctor can see per week at how much per.

    Who seriously thnks any such program will "only " cost $ 1.6 Trillion over 10 years.

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    Default Re: More Playing With Numbers ( US National Health Care )

    The ONLY way it can and will be done is rationing. The government will decide whether or not you get an MRI; which surgical procedure; what drugs wil be prescribed for you and for how long.
    Indeed if US national health care is structured like European or Canadian versions, there will be a gov't board responsible for deciding A. whether or not your needed medical treatment is 'justified' ( i.e. cost effective enough that your future taxes have a chance of paying the money back), B. whether or not you qualify for expedited access to de-facto 'rationed' health care facilities (i.e. half as many new MRI's and other advanced diagnostic equipment installations as are taking place now) or must wait for months, C. what large city you must travel to for your treatment ( as rural / exurban facilities are closed down and large urban facilities expanded to supposedly control costs ) etc.

    Actually, with a huge number of aging 'baby boomers' soon needing expensive treatments that the medicare system cannot pay for, some 'excuse' is needed to abandon the medicare system. Similarly, as more and more long term unemployed become eligible for medicaid and needing treatments that the states cannot pay for, some 'excuse' is needed to abandon the medicaid system. National health care provides that 'excuse', as well as providing the gov't with new tools to control overall medical costs.

    One new tool will be de-facto wage and price controls for drug companies, for HMO's, for personnel from nurses' aides to highly skilled specialist doctors, to the substitution of older less effective but lower cost medicines, etc. Another new tool will be waiting lists and treatment priority setting, which will introduce enough 'time lag' into the system to allow older patients or patients with low cure rate diseases to not outlive the waiting list.


    On a related subject, I happened to run into a handful of US corporate execs 'floating around' a resort near my new home. One topic of inebriated discussion was in fact the Obama national health care proposal. One of the CEO's had his CFO along - they made some back of the envelope calculations, and decided that getting away with paying an 8% 'penalty' to the US gov't was far less expensive in the short term and far less risky in the long term than continuing their existing private health insurance plan for employees. I'm sure they are not alone !!! Thus Obama's national health care proposal VASTLY underestimates the potential program costs, since literally millions of US workers that currently have 'good' employer provided health insurance coverage will definitely be 'dumped' into a gov't run health plan as soon as it is legally possible for employers to do so.

    There was also inebriated discussion of the fact that the 'rich' will always have immediate access to top notch health care. Thus the only real question that this CEO and CFO had was whether a separate 'cash payment based' health care network would be allowed to remain functional within the USA, versus whether they would be forced to fly to Thailand, Switzerland etc. to receive top notch private health care as their European division counterparts already do. They see US national health care as one more step towards converting America into a two class society (i.e. further damaging the middle class). However they also see US national health care as a necessary step to reduce the costs of doing business for US corporations to a level that is somewhat closer to that of major competitor nations.

    ~
    Last edited by Melonie; 06-22-2009 at 05:21 PM.

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    God/dess Paris's Avatar
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    Default Re: More Playing With Numbers ( US National Health Care )

    Quote Originally Posted by Eric Stoner View Post
    Would someone please point to a single Federal program that has successfully controlled costs and promoted greater efficiency ?
    The CDC does a very good job.

    The USPS is right up there with fed programs that do a darn good job (who else will come to your house and deliver a letter thousands of miles away for just .44 cents?).

    Not that you care, but the current health care system is on a path of self destruction. This isn't the nebulous "the sky is falling" kind of rhetoric you hear about social security going broke, this is a serious problem of systemic dysfunction. If the private system isn't fixed, the only available health care insurance will be from your government employer, because that is the only buyer that will be able to afford the premiums.

    So, you can get behind a public option today, or have one shoved upon you in 7-10 years. (that is, if you can land a government job or a wife w/ a government job)


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    Default Re: More Playing With Numbers ( US National Health Care )

    Quote Originally Posted by Paris View Post
    The CDC does a very good job.

    The USPS is right up there with fed programs that do a darn good job (who else will come to your house and deliver a letter thousands of miles away for just .44 cents?).
    All the private sector fanboys out there need to recall that Fedex will do the same thing for $12.50 or so.

    I would add to your list the Federal Aviation Administration. They separate more airplanes than the rest of the world combined and with greater safety.

    Another thing our federal government does very well is voting rights. Before 1964, about 20% of the population was effectively disenfranchised. In four short years, they were enfranchised, and their voting rights are still protected.

    Last, I would nominate the National Park Service. This spring BF and I went to Charleston, SC for a vacation. We visited Ft. Sumter. All I can say is "WOW". Not all that government does is a foul up.

    Z

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    Banned Eric Stoner's Avatar
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    Default Re: More Playing With Numbers ( US National Health Care )

    Quote Originally Posted by Paris View Post
    The CDC does a very good job.

    The USPS is right up there with fed programs that do a darn good job (who else will come to your house and deliver a letter thousands of miles away for just .44 cents?).

    Not that you care, but the current health care system is on a path of self destruction. This isn't the nebulous "the sky is falling" kind of rhetoric you hear about social security going broke, this is a serious problem of systemic dysfunction. If the private system isn't fixed, the only available health care insurance will be from your government employer, because that is the only buyer that will be able to afford the premiums.

    So, you can get behind a public option today, or have one shoved upon you in 7-10 years. (that is, if you can land a government job or a wife w/ a government job)
    WHAT ???? Nobody pointed to Social Security, Food Stamps, Veteran's Benefits Medicaid or Medicare ????

    The CDC does an essential job that no private agency can do.

    The Postal Service cannot compete with UPS, FedEx and other private carriers. They show a profit. The USPS runs a continual deficit. They compete with each other AND the USPS on package and freight delivery. The USPS has a monopoly on home and business delivery of mail.

    There are a number of reasoned approaches to make health care and health insurance more affordable; none of which involve a government takeover.

    Since Obama and the Dems hate doctors, hospitals and drug companies ; since Teddie, Arlen and all other members of Congress are completely covered for life, for free and will continue so regardless of what crappy plan they foist on the American people; the least they can do is be honest about what they are doing. The whole point of a "public option" is to get the camel's nose into the tent. It will encourage employers to stop offering coverage and encourage private policyholders to opt for cheaper government provided benefits. Unlike private insurers, a government insurer will not have to make a profit and will not be answerable to anyone.

    It seems clear that this latest advances the Dems dependency agenda. They want to make Americans more equal by making them equally dependent on government.

    It is claimed that the government option wil provide competition and promote choice. There are already over 1000 health insurance providers. Consumers have been able to figure out what product to buy without government help. Including a lot of complex stuff. They can and will be able to buy their own health insurance.
    Last edited by Eric Stoner; 06-23-2009 at 10:15 AM.

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    Default Re: More Playing With Numbers ( US National Health Care )

    Not that you care, but the current health care system is on a path of self destruction. This isn't the nebulous "the sky is falling" kind of rhetoric you hear about social security going broke, this is a serious problem of systemic dysfunction. If the private system isn't fixed, the only available health care insurance will be from your government employer, because that is the only buyer that will be able to afford the premiums.
    Arguably this would not be the case if the gov't was not 'forcing' doctors and hospitals to artificially increase charges to privately insured patients in order to recoup financial losses generated when treating medicare / medicaid patients at 'below market' gov't reimbursement rates. Same is true of artificially increased charges to privately insured patients in order to cover treatments provided to the non-insured without the ability to pay etc. If the gov't takes over health insurance, this 'cost shifting' will come to an end i.e. the gov't will wind up having to pick up the full tab for treating medicare / medicaid / 'poor' paitents without the 'assistance' of private sector insurers and ratepayers !!!

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    Default Re: More Playing With Numbers ( US National Health Care )

    Quote Originally Posted by Melonie View Post
    Arguably this would not be the case if the gov't was not 'forcing' doctors and hospitals to artificially increase charges to privately insured patients in order to recoup financial losses generated when treating medicare / medicaid patients at 'below market' gov't reimbursement rates. Same is true of artificially increased charges to privately insured patients in order to cover treatments provided to the non-insured without the ability to pay etc. If the gov't takes over health insurance, this 'cost shifting' will come to an end i.e. the gov't will wind up having to pick up the full tab for treating medicare / medicaid / 'poor' paitents without the 'assistance' of private sector insurers and ratepayers !!!
    Can you cite a source that states this as fact (not conjecture)? I did about 15 minutes of searches, but was unable to find profit/ loss numbers for any health care publicly traded corporation. I did notice that the more ramped up the rhetoric for a public option gets, the more the stock prices drop on these entities.

    Since there is no actual public health insurance proposal on the table yet, I think the panic is a bit premature. Can we at least wait until something has actually been proposed before we completely reject it? Unless y'alls crystal ball is working better than mine?

    Everyone freaked out over the public service act and the stimulus bill. Both of those passed handily, despite the best B.S. arguments from the opposition. Guess what? The sky didn't fall, Big Brother didn't take over, the terrorists didn't invade, China didn't dump US bonds and things do seem to be pretty much business as usual, wouldn't you say?

    Methinks the lady doth protesteth too much!


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    Default Re: More Playing With Numbers ( US National Health Care )

    a large number of factual footnotes are included at

    (snip)"If Congress creates a public plan modeled on Medicare--as some have previously proposed--the result, of course, would be to undercut any pretense of a promised "level playing field" for competition with private health insurance.[4] Public plan premiums would be 25-40 percent lower than private insurance premiums as the public plan would reimburse providers less than private payers would--and often less than the cost of care delivered.

    Payment rates for doctors and hospitals under public programs are set administratively, not by the market. They are, on average, lower than private payment rates for similar care.[5] Medicare provider payments for hospital care are only 71 percent of private rates, while Medicare provider payments for physician care are only 81 percent of private rates.[6] In other words, Medicare payment levels are roughly 19-29 percent lower than private levels.

    Congress's ability to impose low provider payments and artificially reduce the cost of the public option compared to private insurance will increase enrollment in the public plan while crowding out, or displacing, existing private coverage."(snip)


    Publicly traded health care companies, as well as private practices, are at present not mandated by the gov't to provide treatments to medicare / medicaid funded patients. Thus at present those health care companies and private practices can remain profitable because they are still free to refuse to provide 'at cost' or 'below cost' treatments that will only be reimbursed at below market price levels through gov't health care programs. However, if National Health care becomes a reality, or if a mandate is issued that health care companies and/or private practices MUST accept National Health Insurance patients i.e. must provide them treatments at official gov't set price levels that are 'at cost' or 'below cost', today's profits will instantly turn into losses.


    (snip)The cost-shift dynamic plays a prominent role in the health care sector. A study by the actuarial firm Milliman calculated that public programs currently shift $88.8 billion in costs onto private payers per year, increasing the typical American family's annual private health insurance premium by $1,512, or 10.6 percent.[15] Moreover, Lewin speculates that a new public plan could increase the annual cost-shift per privately insured by as much as $526, which will only serve to further perpetuate the crowd-out of private insurance.[16]

    Lower Incomes for Physician and Hospitals

    A new public plan could also significantly reduce provider incomes. As more people gain insurance, physicians and hospitals would benefit from decreased levels of uncompensated care. However, the increase in public coverage along with new demands to provide services to the newly insured could outweigh any increased revenues from reductions in uncompensated care.

    If all employers become eligible for the public plan, the annual net income of hospitals could fall by $36 billion while the annual net income of physicians could drop by $33.1 billion. Increasing demands on health care providers coupled with decreasing provider incomes could compromise patients' access to high-quality care. Faced with low reimbursement, doctors are already reportedly opting out of Medicare--a problem that is likely to be exacerbated with the creation of a new public plan.[17]"(snip)


    In other words, the current costs to gov't budgets of medicare / medicaid based patient care are understated by a minimum of some 20%. At present, the 'missing' 20% is being made up for by structurally overcharging privately insured patients in order to subsidize medicare / medicaid patient based 'losses' incurred by every health care provider who accepts medicare / medicaid patients. The introduction of National Health Insurance will undoubtedly cause a large segment of privately insured patients to shift to the gov't system ( by their employer choosing to drop private coverage, by the lure of lower initial cost of health care premiums etc.) In doing so, the introduction of National Health Care insurance will leave a smaller pool of remaining privately insured patients to subsidize a growing pool of gov't funded patients ... which will in turn create a snowball effect that prices private health insurance right out of the market.

    At that point, as is the case in Canada / Europe, gov't dictated health care reimbursement rates that are at or below the actual cost of providing said health care services will end private investment in medical care facilities / diagnostic equipment, will prompt many private practice health care providers to retire early or change careers, will create de-facto 'rationing' of medical care for the growing number of gov't system patients relying on a shrinking pool of doctors and private medical care facilities / private diagnostic equipment. At this point the gov't will also be forced to deal with the fact that their existing ~20% private health insurance 'cost shifting' subsidy money stream has ended, and will thus be forced to raise additional revenues by other means (i.e. tax increases, cost increases in National Health Care insurance premiums etc). At that point, the gov't will also be forced to deal with the bailout / takeover / permanent subsidization of bankrupt privately owned medical care facilities to prevent the shortage of medical care facilities available to National Health Care insured patients, and the waiting lists for patients trying to receive treatment from remaining medical care facilities, from becoming untenable. It will be at this point where the TRUE costs of National Health Insurance finally become apparent ... but by then there will not be a remaining private option to return to ( within the USA at least ).


    Methinks the lady doth protesteth too much!
    Methinks the other lady doth ignoreth too many inconvenient facts !

    things do seem to be pretty much business as usual, wouldn't you say?
    no I wouldn't ... but that's a topic for a different thread. See the new 'Now It's Personal' thread!

    ~
    Last edited by Melonie; 06-24-2009 at 01:25 AM.

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