RE: Big Government v. Big Corporations (Full Version)

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Mercnbeth -> RE: Big Government v. Big Corporations (7/22/2009 3:12:21 PM)

quote:

As much as I hate to say so, I really think that the issue has, once again, become one of special-interest pressures and politicizing instead of good leadership.
Why because you can't address the issues raised? Is "good intent" enough; without implementation and cost consideration? Without consideration for the pragmatic impact on all the ancillary issues?
quote:

A free-market, for-profit solution is not going to function under the constraints of a universal health system where the physician decides what is 'medically necessary' and treatment is provided and paid for without the ability to beat up the patient (at least financially) for having the NERVE to get sick.
A universal health system will eliminate these issues? How? Where did you read in the Bill that if I walk into a Doctors office saying I want a full body scan for a tummy ache that there won't be a physician or some other gate keeper determining the treatment is appropriate? Hell if this debacle passes I hope there is. Which one of those progressive countries currently with universal health coverage can I walk into as a citizen and do that today?



philosophy -> RE: Big Government v. Big Corporations (7/22/2009 3:23:08 PM)

quote:

ORIGINAL: Mercnbeth

Where did you read in the Bill that if I walk into a Doctors office saying I want a full body scan for a tummy ache that there won't be a physician or some other gate keeper determining the treatment is appropriate?


.....physicians aren't gate keepers. They're trained professionals. Who actually know what medicine works and what doesn't. You're arguing that people ought to be able to walk into a physicians office and demand anti-biotics for a cold, and get given them. Despite the fact that they're useless for that condition and actually help create antibiotic resistant strains of other bacteria.

Choice at all costs, eh? Even when those choices are irresponsible, stupid and materially effect others......

Anyway, under every other country's healthcare systems you always have the choice of going private and paying some hack to perform whatever procedure you want.......so you can get your full body scan for indigestion if you want, so long as you pay the full cost.



CallaFirestormBW -> RE: Big Government v. Big Corporations (7/22/2009 3:26:54 PM)

quote:

ORIGINAL: Mercnbeth

quote:

ORIGINAL: CallaFirestormBW

As much as I hate to say so, I really think that the issue has, once again, become one of special-interest pressures and politicizing instead of good leadership.


Why because you can't address the issues raised? Is "good intent" enough; without implementation and cost consideration? Without consideration for the pragmatic impact on all the ancillary issues?


I was actually nominally -agreeing- with you here, Merc.

quote:

A universal health system will eliminate these issues? How? Where did you read in the Bill that if I walk into a Doctors office saying I want a full body scan for a tummy ache that there won't be a physician or some other gate keeper determining the treatment is appropriate? Hell if this debacle passes I hope there is. Which one of those progressive countries currently with universal health coverage can I walk into as a citizen and do that today?


A physician is not a gate-keeper, but IS the appropriate individual to determine what medical care is necessary. Right now, the determination for what procedures are approved and what care is given is based on what an insurance company will pay for. I see it every single day at my job, as we put together care plans for cancer patients -- for most of them, the cost of getting the -recommended- care for their cancer is more than they can manage, so rather than consenting to care they can't possibly afford, they choose alternative, less effective options, because those options are covered under their insurance plan.

In -every- progressive country with universal health care, the physician and patient determine what care will be provided. Any physician worth his salt won't approve un-necessary medical conditions, but I will bet good money that un-necessary, expensive treatments are advocated a LOT more often here (in the land where people get bombarded with drug ads to ask their doctor for via the TV, radio, internet -- along with exactly what to tell their doctor to -get- the drug du jour!) than in countries that have universal health care, because nobody is making a huge profit from overbilling, overdiagnosing, or recommending expensive, un-necessary procedures or expensive brand-name designer drugs. And, as I said in my other post, if you want more choices, it is perfectly feasible to have commercial, for-profit insurance companies who can provide supplemental insurance to get name-brand drugs over generics or pay for your full-body scan for a headache or tummy ache.

I honestly don't understand where the mental block is on this, but maybe it's just me. The purpose of a government, to me, is to serve and protect its constituency. To me, serving and protecting their health through a universal healthcare program is in the same pool as providing their shores and resources through a standing army/navy. Basic common sense. End government waste by ending the war on drugs and farm subsidies to corporate megafarms and there would be plenty of money for healthcare, even without a tax increase. Of course, if we want to keep the drug war and paying corporations to co-opt our family farmers and use their land to grow crap or not grow food, then of course we'll need to tap into other resources, as sucky as that is.

To me, the problem is that everyone talks big about 'change', but really, they have NIMBY syndrome -- you can change whatever you want, but don't change MY stuff -- so we just keep building new crap on top of the last administration's layers of crap and then wonder why it stinks and we're buried in crap.

Dame Calla



Politesub53 -> RE: Big Government v. Big Corporations (7/22/2009 3:30:36 PM)

quote:

ORIGINAL: Mercnbeth

Which one of those progressive countries currently with universal health coverage can I walk into as a citizen and do that today?


Try not being so extreme, your example is far fetched and you know it. You can go and see your GP ( general practitioner ) here in the UK, he will advise you what the cause is likely to be and if he thinks you need it, send you for a scan.

The important point here, which you choose to overlook, is that the service is open to everyone. No sane person expects instant access to everything for everyone.



Mercnbeth -> RE: Big Government v. Big Corporations (7/22/2009 3:35:27 PM)

quote:

ORIGINAL: philosophy
quote:

ORIGINAL: Mercnbeth
Where did you read in the Bill that if I walk into a Doctors office saying I want a full body scan for a tummy ache that there won't be a physician or some other gate keeper determining the treatment is appropriate?


.....physicians aren't gate keepers. They're trained professionals. Who actually know what medicine works and what doesn't. You're arguing that people ought to be able to walk into a physicians office and demand anti-biotics for a cold, and get given them. Despite the fact that they're useless for that condition and actually help create antibiotic resistant strains of other bacteria.

Choice at all costs, eh? Even when those choices are irresponsible, stupid and materially effect others......
Choice at all cost currently requires the consequence of paying. Under a universal program an "irresponsible" and "stupid" person doesn't have to think twice. He's got a belly ache and he can just walk into whoever the gatekeeper is and sign up for a scan. While he's in line, at no cost, the person behind him with a tumor gets to have it keep growing while the "irresponsible, stupid" person gets evaluated. Now - it won't happen, no money, no insurance, and a consequence. Put universal coverage into the equation and walk me though how it can't and won't happen.

However in the macro and to the OP, you give my exact my position regarding Fascism taking place in the US today.

The government is not the "trained professional" in ANY industry. Why put them in charge of any? Why see them as a solution?



philosophy -> RE: Big Government v. Big Corporations (7/22/2009 3:43:23 PM)

quote:

ORIGINAL: Mercnbeth

Under a universal program an "irresponsible" and "stupid" person doesn't have to think twice. He's got a belly ache and he can just walk into whoever the gatekeeper is and sign up for a scan. While he's in line, at no cost, the person behind him with a tumor gets to have it keep growing while the "irresponsible, stupid" person gets evaluated.


....you're not a stupid man Merc, far from it. So i am forced to conclude you're being economical with the verite.

As Politesub pointed out, under universal care you don't just get to demand a body scan, tying up resources and killing deserving cases. What actually happens in the real world is that the physician examines a patient and refers them to the appropriate treatment option.

Your example is irrelevant because it doesn't happen......and i suspect you know it.

Is this all you got now Merc? Under universal health care you're all going to dieeeeee?



Mercnbeth -> RE: Big Government v. Big Corporations (7/22/2009 3:52:41 PM)


quote:

ORIGINAL: philosophy

quote:

ORIGINAL: Mercnbeth

Under a universal program an "irresponsible" and "stupid" person doesn't have to think twice. He's got a belly ache and he can just walk into whoever the gatekeeper is and sign up for a scan. While he's in line, at no cost, the person behind him with a tumor gets to have it keep growing while the "irresponsible, stupid" person gets evaluated.


....you're not a stupid man Merc, far from it. So i am forced to conclude you're being economical with the verite.

As Politesub pointed out, under universal care you don't just get to demand a body scan, tying up resources and killing deserving cases. What actually happens in the real world is that the physician examines a patient and refers them to the appropriate treatment option.

Your example is irrelevant because it doesn't happen......and i suspect you know it.

Is this all you got now Merc? Under universal health care you're all going to dieeeeee?

Oh, so the patient gets to see a Doctor to determine - and that waste of time isn't a factor in the overall treatment provided? You again - point to a fact in support of my position, not in opposition to it. WASTE is what government bureaucracy does best. You grant in my example that it is a waste of the aforementioned Doctor's time, yet you don't indicate it can or can't happen, or provide any consequence to the person you identified as "stupid" and "irresponsible" with the bellyache.

Keep going - you're convincing more to my side with every post.

However, the subject here is the attempt by this administration to more toward Fascism.

BTW - We're all going to die - maybe there is even a maximum age you can live buried in the unread parts of this Health-care Bill.



philosophy -> RE: Big Government v. Big Corporations (7/22/2009 4:05:27 PM)

quote:

ORIGINAL: Mercnbeth


Oh, so the patient gets to see a Doctor to determine - and that waste of time isn't a factor in the overall treatment provided?


...well according to you, a five/ten minute consult will doom the person behind them to a grisly death. Utter rubbish and pure scaremongering.


quote:

WASTE is what government bureaucracy does best. You grant in my example that it is a waste of the aforementioned Doctor's time, yet you don't indicate it can or can't happen, or provide any consequence to the person you identified as "stupid" and "irresponsible" with the bellyache.


......why the hell should there be consequences to someone who thinks they're ill but aren't? Oh, of course, in your world everything has to cost money.  

quote:

Keep going - you're convincing more to my side with every post.


...i seriously doubt it.

quote:

However, the subject here is the attempt by this administration to more toward Fascism.


...oh and i thought it was about how anyone who wants a universal health care system is fundamentally submissive. Wasn't that your original thesis?

quote:

BTW - We're all going to die - maybe there is even a maximum age you can live buried in the unread parts of this Health-care Bill.


......yanno, this sort of scaremongering isn't particulary edifying. You know there isn't such a clause, don't you. But you can't resist having a pop.........



Politesub53 -> RE: Big Government v. Big Corporations (7/22/2009 4:12:16 PM)

Phil, spot on about scaremongering and you saved me from posting. We both know you walk into the doctors for a ten mimute consultation, and mercs waste of time is normally all thats needed to cure you. I would guess I get sent to hospital for tests ect maybe once in every 7 or 8 trips to the GP. Normally that only entails a simple blood test or an xray.




willbeurdaddy -> RE: Big Government v. Big Corporations (7/22/2009 4:29:00 PM)

quote:

ORIGINAL: philosophy



.....physicians aren't gate keepers. They're trained professionals. Who actually know what medicine works and what doesn't.


It may not be a term of art over there, but in the US "gatekeepers" refer specifically to physicians who have the ability under managed care schemes to approve or deny a specialist visit. The problem with that structure is that in most cases the individual already knows when he needs a specialist, and the trip to the gatekeeper is just extra cost and extra paperwork.

Which, after reading the later posts, is exactly mercs point and is an area of waste in a universal health care system that requires gatekeepers. The flip side is when its "free" <cough cough> health care the extra cost from a gatekeeper may keep be less than the cost of those who are over-reacting ("you have gas sir, not a heart attack") and tying up the specialist. Unfortunately that just highlights a problem with "free" health care...you overburden the system one way or another.

It has long been known that the essential buying side problem with US health care costs is that the consumer is removed from the paying process due to the employer/insurance company intermediaries and is therefore less sensitive to what he "spends". Single payer health care increases that problem, not decreases it.



philosophy -> RE: Big Government v. Big Corporations (7/22/2009 4:37:57 PM)

quote:

ORIGINAL: willbeurdaddy
The problem with that structure is that in most cases the individual already knows when he needs a specialist, and the trip to the gatekeeper is just extra cost and extra paperwork.


...how? Are US citizens trained in self disgnosis in school? Or when you say that people 'know' when they need a specialist, what you're really saying is that they think they do because they saw it on House the night before.



Politesub53 -> RE: Big Government v. Big Corporations (7/22/2009 4:47:36 PM)

quote:

ORIGINAL: willbeurdaddy

The problem with that structure is that in most cases the individual already knows when he needs a specialist, and the trip to the gatekeeper is just extra cost and extra paperwork.


For the most part this is nonsense, the average person in the street hasnt a clue what may or may not be wrong.

quote:


Which, after reading the later posts, is exactly mercs point and is an area of waste in a universal health care system that requires gatekeepers. The flip side is when its "free" <cough cough> health care the extra cost from a gatekeeper may keep be less than the cost of those who are over-reacting ("you have gas sir, not a heart attack") and tying up the specialist. Unfortunately that just highlights a problem with "free" health care...you overburden the system one way or another.



Thats not the case either, normally the GP will filter out people who dont require hospital treatment. If you think I am wrong about this please direct me to a study.



willbeurdaddy -> RE: Big Government v. Big Corporations (7/22/2009 5:11:20 PM)


quote:

ORIGINAL: philosophy

quote:

ORIGINAL: willbeurdaddy
The problem with that structure is that in most cases the individual already knows when he needs a specialist, and the trip to the gatekeeper is just extra cost and extra paperwork.


...how? Are US citizens trained in self disgnosis in school? Or when you say that people 'know' when they need a specialist, what you're really saying is that they think they do because they saw it on House the night before.



Funny thing about human beings. Without training they generally can tell how sick they are and whether a GP is sufficient or a specialist. That is precisely why the gatekeeper model has lost favor here. Are they always right? No, but they also generally err on the side of caution ("that is just a fatty deposit not a tumor", Dr. Onco told me).

From a study on migration from gatekeeper models to open-access models:

"Loosening restrictions on patients' direct access to specialists via a POS approach appears to have little impact on healthcare expenditures or the relative use of specialists versus generalists, when compared with more traditional HMOs. This study provides substantial evidence that the POS plan represents a reasonable option for private and public sector health plan designers looking to balance managed care controls with patient choice. This study also suggests that the growth in POS plans and other "open-access" models will not lead to a dramatic shift in the demand for generalists versus specialists in the US healthcare workforce."

So if the demand for specialists doesnt change (ie self-referral and gatekeeper result in similar numbers of specialist visits) then obviously the cost of gatekeepers is redundant.

Another study contrasts the need for gatekeepers in the US vs the UK. The primary driver for the increased need for gatekeepers in the UK is simply the lower supply of specialists that are there...gatekeepers are needed to ration scarce specialists time. And why is there a lower supply of specialists? Because their compensation possibilities are so much more limited under the UKs health care system, so they go elsewhere.



tazzygirl -> RE: Big Government v. Big Corporations (7/22/2009 6:40:20 PM)

quote:

I have no problem with having a private, single-payor system, or a public one. Unlike you, Merc, I don't think that there is any real benefit to a 'choice' when it comes to basic health care, hospitalization, prescriptions, mental health care, vision care, and dental care. Having a solid single-payor system, whether public or private, and funded by either a flat-percentage premium or through a specific, flat-percentage tax would, I think, provide the basics of decent coverage for every American citizen. Beyond that, I think people should have the -option- of additional, supplemental coverage that would, perhaps, provide some coverage for optional procedures like non-medically-indicated cosmetic surgery, transgender surgery, and other obscure and not-medically-critical procedures (Botox, anyone?), and this is a place where for-profit, free-market insurance systems would be perfectly acceptable.


Must be the schooling, because i so totally agree with you here. But its not exactly what is needed. There are so many ways to fix this problem. Military has its own insurance, and does a pretty good job from what i see with my parents. not perfect, i dont think any system ever will be. The system needs to be revamped, from the inside out.

This is just my opinion, based upon my nursing experience.

Preventative care is a must. An absolute must. And much cheaper than the system we have now. Its so much cheaper to pay for a prescription than to cure the results of NOT having that prescription. Thats just simple math, and it infuriates me that the insurance companies and health care officials wont recognize it.

I do prefer GP's for all initial contact. Too many people have gotten into the habit of self diagnosis based upon web sites and what a "friend" said happened to them.

From GP's, then specialists can be contacted. Tests ordered. I dont forsee long lines at a cat scanner... you would still need a Dr's order, just like for medication. If medical is paid for... and ill get back to that in a moment... then specialists would need that bride between them and the patients. Imagine the waiting period for a surgeon because a patient thinks they have a bad gallbladder only to discover they have a stomach bug.

Part of the high cost of medicine is people with no insurance. They cannot afford it, it isnt offered at work.. they have no job.. whatever the reason. They use the ER as a Dr's office, given no other choice. So hospitals have the added expense of non emergency use of their services, equating to higher costs. many tests in the ER are ordered stat.. again.. higher costs. 600 dollars a stich isnt for the Dr to put them in.

I like to take a common ailment and use it as an example. High BP... common enough these days. Most pay around 300-500 for meds a month, without prescription insurance. There are many complications that can arise from uncontrolled BP, stroke, heart attack, passing out (think stitches here), renal failure and dialysis, just to nake a few. all could land a person in the hospital for a few days to weeks. not everyone is compliant when they see a Dr. a roommate of mine had to see his Dr every three months, and even with insurance his meds ran around 100 a month, on top of the co pay and deductable he had to pay the Dr. At times, he plain didnt have it, and his health suffered, putting himself at risk ( thankfully he never had complications, at least when i was with him).

In 1995, the average cost of a stroke-related hospitalization alone was estimated to range from approximately $12,000 (5) per patient discharged from the hospital to more than $20,000 (6) for patients with the most severe ischemic strokes (ie, 4 or 5 on the modified Rankin Disability Scale [7]).
http://radiology.rsnajnls.org/cgi/content/full/228/3/659

Stroke Costs Reaching Trillions
Without Action, Financial Cost of Strokes to Reach $2.2 Trillion by 2050
By Jennifer Warner
WebMD Health NewsReviewed by Louise Chang, MDAug. 16, 2006 -- The financial cost of strokes in the U.S. will soar to more than $2.2 trillion over the next 45 years if no action is taken to improve preventive care or treatment, according to a new study.

http://www.webmd.com/stroke/news/20060816/stroke-costs-reaching-trillions

Now, i dont pretend to have all the numbers, or the answers. But, wouldnt it be rational to think that preventative care would save millions?

Now, on to single payors. I have mixed feelings on this. It makes sense that paying into one system for a hospital or Dr's office would save money. Elimination of paper work and time saved from filing many different forms to different insurance companies, as well as not having to spend time plowing through paper work to find out what insurance company allows what procedures, or even if the Dr is within the patients coverage.

And, as hard as i have tried, i cannot find what the operating costs are for any insurance company. It would be interesting to discover how much goes to overhead, how much to shareholders, how much to lobbyists, drug reps ect. I seem to recall seeing a complaint by Workman's Comp over their payouts going up to 12 %, up from 8.something after 9/11 and how the government passed a bill that would prevent that from happening again. My concern here is that they were upset over it going from 8% to 12%. Is WC a profit organization? Im not sure.

In the end, preventative care, along with the basics of medical care being provided for.. and.. yes.. dental is just as important.. would be far cheaper than dealing with the system we have. Moving towards a single payor would also be cheaper, provided the system was stream lined.

Beyond the basics... then you need insurance, as Calla so wisely posted earlier.




Mercnbeth -> RE: Big Government v. Big Corporations (7/22/2009 9:23:30 PM)

quote:


...well according to you, a five/ten minute consult will doom the person behind them to a grisly death. Utter rubbish and pure scaremongering.
Didn't mean to frighten you, perhaps you shouldn't have watched tonight's sermon by the President. But lets take your low number, 5 minutes times the number of people who may have a tummy ache or a tumor, divided by the doctors who it takes to see them. And that won't slow things down?

quote:

......why the hell should there be consequences to someone who thinks they're ill but aren't? Oh, of course, in your world everything has to cost money.
Because if there isn't any charge or fee you waste the resource of the Doctor's time more often. Why should a Doctor's time be free? How much do you work for an employer for no compensation per day?
quote:

......yanno, this sort of scaremongering isn't particularly edifying. You know there isn't such a clause, don't you. But you can't resist having a pop.........
To make a point confirmed by President tonight that he doesn't know if there's a maximum age in the program or not.
quote:


...oh and i thought it was about how anyone who wants a universal health care system is fundamentally submissive.
No. It was a suggested reason to like a fascist system. Short attention span, ADD? How Long, and through how many Doctor's would you have to get an appointment with to have that diagnosed?



willbeurdaddy -> RE: Big Government v. Big Corporations (7/22/2009 9:44:16 PM)


quote:

ORIGINAL: tazzygirl


And, as hard as i have tried, i cannot find what the operating costs are for any insurance company.



You wont find the kind of detail that youre looking for anywhere, thought you might come close in the audited financials that are available to shareholders, and may be posted in the "Investors" link of the company's website.

For broadbrush numbers the 10k filings come close for health only insurers, and segment breakdowns for multi-line companies.

Eg from Cigna's website, the health care segment is posted for 2008.

Looking at medical premiums only, $8,856 million, med claims paid $7,252 or 82%. the other 18% can't be broken down, but by far the largest piece is salaries.



tazzygirl -> RE: Big Government v. Big Corporations (7/22/2009 9:46:31 PM)

was the 8 billion profit or total?



willbeurdaddy -> RE: Big Government v. Big Corporations (7/22/2009 11:17:02 PM)


quote:

ORIGINAL: tazzygirl

was the 8 billion profit or total?


total medical premiums (excludes mail order pharmacy etc)



DemonKia -> RE: Big Government v. Big Corporations (7/23/2009 1:17:06 AM)

I'm ready for the kind of change you're talking about, Calla . . . . .

I've lived my adult life in the bottom half of the income pyramid, with & without medical insurance (both private & Medic-Aid), & at least two people very close to me died in the last few years in part because of the lifelong lack of regular access to basic medical care . . . . . When I hear people in the US say 'talk to your doctor' it sounds like a cruel joke to my ears . . . .

Your posts in this thread, Calla, were, as usual, excellent & informative . . . . . Thank you for taking the time to share your understanding, insight, & experience . . .

quote:

ORIGINAL: CallaFirestormBW

To me, the problem is that everyone talks big about 'change', but really, they have NIMBY syndrome -- you can change whatever you want, but don't change MY stuff -- so we just keep building new crap on top of the last administration's layers of crap and then wonder why it stinks and we're buried in crap.

Dame Calla




Alphascendant -> RE: Big Government v. Big Corporations (7/23/2009 1:35:35 AM)

At first glance, big government versus big corporations appears to be that they are opposed to each other in some way, when they are actually the same. Pardon my simple way of thinking, but I think that the government is only there to take the blame for the big businesses, we blame one side for four or eight years , then we blame the other side for four or eight, while both sides are leading us down the same road. Amazing how all the doctors take something called Hippocrate's oath, swearing to help those who need it, yet turn their back on those who need it most, Hippocrate's=hypocrites. Mandatory health insurance? Just another way to fine those who can't afford it so the average working person has even less money and has to rely on the government even more while still ending up with the same quality of health care. Start paying doctors minumum wage and then you will find people who really care about helping others. Oh, so the brightest minds won't be attracted to medicine? Paying teachers all kinds of money hasn't exactly done wonders for education. When I was in high school, auto mechanics was the bottom of the barrel, last resort job. Now they can make almost as much as some doctors.


Initially, our police forces were formed to protect little old ladies from street thugs. now they hand them jaywalking tickets and serve as a revenue maker for the government, staffed by a majority of needle dicked whimps that were picked on in high school, in an ever growing effort to maintain that they and their masters will not ever have to get a little bit of dirt under their fingernails. The U.S. Constitution was written to prevent a government from becoming what it is today. I am really surprised they haven't legalized marijuana yet, slowing down the mind and making people lazy, hungry for the junk that the corporations serve plays right into their hands. Trusting the over-fed-ral glove-ment for anything other than telling other countries we will drop a world of hurt on them if they don't smarten the fuck up is what is leading this country to ruin. Oh, wait, we want other countries to join in the fun so we can print more money!! The left versus the right will become obsolete. When the gum-ment eventually has to downsize because Asia decides it doesn't want to visit Disneyland anymore it will be one party versus the people who know how to grow a year's worth of vegetables and milk a goat. Oh, they are even beginning to try and regulate how we can grow vegetables, and in at least one state cops have arrested people for buying unpastuerized milk.


It's all happening right before our eyes, and yet here we are arguing, debating about it online where it really isn't doing a bit of good. If the new leader of the gum- ment of the free world is really interested in change in favor for the welfare of the American people, the corporations will gun him down. So much shit on the supermarket shelves causes cancer, yet they sell it to you any way, why? Because we are stupid enough to buy it, the same way we are stupid enough to buy any thing the gum-ment wants to sell us. Think about it, when did the gum-ment actually solve or fix anything since Hiroshima?



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