Why does everyone hate "socialist" healthcare here?

[SteveHI]

Originally Posted by revstriker couldn't disagree more. And you really think the government would be "better"? I can't think of much that the government could do better than the private sector. Certainly not anything with healthcare. I understand that California is the only state that mandates disclosure of health insurance claims denial rates. From 2002 - 6/30/09, 21% of claims (or 31.2 million) have been denied by private insurers in CA. I don't know how many were were physician-recommended and how many were fraudulent, but that seems like a lot. http://www.reuters.com/article/press...09+PRN20090902 When you couple this data with the natural profit motive of private insurers, it becomes clearer to me that the government could easily provide equal, if not better, outcomes with claims processing. Originally Posted by revstriker The problem is, many on the left will want to legislate this change in behavior. Don't like the statins stat? Well if the government were in control, they could make it harder for doctors to prescribe. Do you really think this is unlikely in a government controlled program? I seriously doubt it. The ACLU is on the left, remember?

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[SteveHI]

Originally Posted by LRM1

And have tort reform. Just about every cost you pay, even in my business is based on paying either for insurance or lawyers, becasue you WILL be sued.

All the MRI's, CT scans, drugs, are more because the doctor wants to cover his ass than for any "fat" reasons.

This is the only country in the world where being stupid pays.

I forgot to include tort reform, which I favor.

[SteveHI]

Originally Posted by MG

Who is going to pay these taxes?

You agree to a flat tax on every dollar of income earned regardless of total income levels (and by income I mean to include Cap Gains, Dividends, Muni bonds, and other NON Retirement investment disbursements with regular salary and specifically exclude intra family transfers such as bequests, education assistance, insurance payouts and property transfers) and I will agree to put every socialist concept you can imagine to a vote.

Right now 49% of the country pays no Federal Income Tax. None. Its easy to vote "YES" to more benefits when you get all the gain and pay none of the taxes.

While I fully grasp the concepts of progressive taxation, I actually favor flat tax as a practical alternative. Yes, a large percentage pays no fed tax. But the top income brackets don't pay anywhere near the highest marginal rates, either. There would need to be a poverty-level exclusion (say, the first $35k of income), which I'm sure you would oppose, though.

Besides, the increase in tax will be more than offset by the elimination of private insurance premiums for basic coverage and the associated cost savings. Employers should, in theory, be willing to compensate their employees with the employer-share of premiums which would go away; if not, perhaps this would need to be mandated.

[MG]

Originally Posted by SteveHI

There would need to be a poverty-level exclusion (say, the first $35k of income), which I'm sure you would oppose, though.

Actually, I wouldn't, in fact I've proposed exactly that with one caveat, regional indexing by zip code should absolutely be reinstated. And you can look that up in my posting history on this forum.

[LRM1]

Originally Posted by SteveHI

I understand that California is the only state that mandates disclosure of health insurance claims denial rates. From 2002 - 6/30/09, 21% of claims (or 31.2 million) have been denied by private insurers in CA. I don't know how many were were physician-recommended and how many were fraudulent, but that seems like a lot. http://www.reuters.com/article/press...09+PRN20090902

When you couple this data with the natural profit motive of private insurers, it becomes clearer to me that the government could easily provide equal, if not better, outcomes with claims processing.

Those types of statistics however can't differentiate between denial due to a denial of a given service or denial due to fraud, double billing, etc. as you mentioned, and therefore aren't reliable. There are no known records of "Denial of a required treatment" available, though estimates show that upwards of 70-80% of denials are in fact administrative issues.

Medicare is mostly automated and it's estimated that there is roughly $80B in fraud per year. As long as the proper code is entered, the provider gets paid, whether they're a doctor in Lake Geneva Wisconsin, or a scammer in Kiev. The government doesn't have the resources or the motivation to properly manage Medicare claims without losing money like crazy. The "profit motive" you point to as a negative with regards to insurance companies actually serves to prevent or reduce fraud and administrative errors.

So how can you say the government can do it better?

Originally Posted by SteveHI

I seriously doubt it. The ACLU is on the left, remember?

The ACLU is too busy preserving the rights of terrorists to waste any time questioning a leftist policy. They only go after policies which protect us from crime or external enemies.

[LRM1]

Originally Posted by SteveHI

Besides, the increase in tax will be more than offset by the elimination of private insurance premiums for basic coverage and the associated cost savings. Employers should, in theory, be willing to compensate their employees with the employer-share of premiums which would go away; if not, perhaps this would need to be mandated.

I have a fantastic insurance plan. I can assure you that my tax nut every pay period is MUCH larger than my insurance premiums (of course that is because my employer pays most of it, I realize that, but that is factored in when you accept/refuse a job offer as a compensation package)

I can assure you, that if the employer share went away that employees would not get so much as 50% of that savings passed on to them. Companies are always looking to cut costs. That is an IDEAL way of legally cutting costs and being able to say "wasn't us, blame the government". I am always pro corporation (unless there is negligence) and I understand why they would take that stance, but frankly it would be naive to think that if the employer portion went away that companies would pass that amount on to the employee without keeping at least some itself.

And again, here we go with mandating. Regulation on business should be kept enough to prevent harm to individuals (for example denial of coverage for pre existing conditions), but to then start telling them now to spend their money pushes it.

[revstriker]

Originally Posted by SteveHI

I understand that California is the only state that mandates disclosure of health insurance claims denial rates. From 2002 - 6/30/09, 21% of claims (or 31.2 million) have been denied by private insurers in CA. I don't know how many were were physician-recommended and how many were fraudulent, but that seems like a lot. http://www.reuters.com/article/press...09+PRN20090902

When you couple this data with the natural profit motive of private insurers, it becomes clearer to me that the government could easily provide equal, if not better, outcomes with claims processing.

Not sure how this shows that the government could do it better.

I seriously doubt it. The ACLU is on the left, remember?

The ACLU is hardly going to challenge anything which is pro socialized medicine. They stopped being about "Civil Liberties" a long time ago.

[mleskovar]

Originally Posted by LRM1

...I can assure you, that if the employer share went away that employees would not get so much as 50% of that savings passed on to them..... it would be naive to think that if the employer portion went away that companies would pass that amount on to the employee without keeping at least some itself....

Safe assumption. My last employer gave everyone the choice dropping their medical benefits in return for payment if their spouse had a plan they could use instead. The payment was about $200. It was Blue Cross and there's no way you could get family coverage for $400 from Blue Cross. In fact, the HR geeks wanted us to pitch to the rank and file during "true value" compensation indoctrinations that about $7000 should be added their paychecks for the medical benefits they received.

[MG]

Originally Posted by SteveHI

When you couple this data with the natural profit motive of private insurers, it becomes clearer to me that the government could easily provide equal, if not better, outcomes with claims processing.

How the hell does that become clear? Profit motive is a good thing, not an evil thing, it drives efficiency, it drives a desire for customer satisfaction, it drives a meritocracy. Any one who has a claim denied already has an automatic outlet to appeal to a government based insurance review board.

There is no need for the government to interfere with 85% of the population's insurance to deal with a problem affecting 3/10 of a % of the population.

[NdnMbLova]

Originally Posted by MG

It is, its called "Government Subsidy" You are referencing the OTC price.

He is referring to patent protection. They have none in canadia or mehico or anywhere else(hint hint, china)

[LRM1]

Originally Posted by mleskovar

Safe assumption. My last employer gave everyone the choice dropping their medical benefits in return for payment if their spouse had a plan they could use instead. The payment was about $200. It was Blue Cross and there's no way you could get family coverage for $400 from Blue Cross. In fact, the HR geeks wanted us to pitch to the rank and file during "true value" compensation indoctrinations that about $7000 should be added their paychecks for the medical benefits they received.

Companies have recently begun "penalizing" employees who's spouses can get insurance through their employer in order to avoid paying out "family premiums".

The thought that companies would give a dime of that money to their employees is naive.

[SteveHI]

Originally Posted by MG

How the hell does that become clear? Profit motive is a good thing, not an evil thing, it drives efficiency, it drives a desire for customer satisfaction, it drives a meritocracy. Any one who has a claim denied already has an automatic outlet to appeal to a government based insurance review board.

There is no need for the government to interfere with 85% of the population's insurance to deal with a problem affecting 3/10 of a % of the population.

Profit motive is not inherently evil, but in this case, it drives health insurance companies to monetarily incentivize their claims reviewers based on denial rates. This is like rewarding private security employees for not responding to alarms because it saves money.

[SteveHI]

Originally Posted by LRM1

I have a fantastic insurance plan. I can assure you that my tax nut every pay period is MUCH larger than my insurance premiums (of course that is because my employer pays most of it, I realize that, but that is factored in when you accept/refuse a job offer as a compensation package)

I can assure you, that if the employer share went away that employees would not get so much as 50% of that savings passed on to them. Companies are always looking to cut costs. That is an IDEAL way of legally cutting costs and being able to say "wasn't us, blame the government". I am always pro corporation (unless there is negligence) and I understand why they would take that stance, but frankly it would be naive to think that if the employer portion went away that companies would pass that amount on to the employee without keeping at least some itself.

And again, here we go with mandating. Regulation on business should be kept enough to prevent harm to individuals (for example denial of coverage for pre existing conditions), but to then start telling them now to spend their money pushes it.

If the majority of employers' contributions morphed into increased tax withholdings, it would be profit-neutral to the companies and income-neutral to the employees. If there's a few dollars left over, then the employer can have it or share it with the employee, I don't much care. I don't see how the employers should somehow reap windfall benefits from this massive reform, though.

I agree with you that companies won't do it without a mandate, though, which is why it would probably be necessary -- this money hasn't been, and won't be, theirs to spend.

[whiteongrey]

The bottom line is most Canadians do not know good health care and have no clue that %50 of gov't revenue pays for it.

Here good health care is that a) you can see a doc if needed even if it's a drop in clinic, b) they hand our prescriptions freely, c) it's cheap (not pharma though), and at some point you will get a surgury if needed.

I would call it high quality 2nd world health care.

Keep in mind that overall we're mostly just a bunch of farmers, miners, factory workers, and ranchers with a minority posing as sophisticated white collar workers - combined delivering the lowest productivity and innovation in the industrialized world.

Our health care reflects the nation.

At least they could borrow an American practice - outsourcing to ultra quality care in Singapore and India to drop the excruciating wait times!

[LRM1]

Originally Posted by SteveHI

Profit motive is not inherently evil, but in this case, it drives health insurance companies to monetarily incentivize their claims reviewers based on denial rates. This is like rewarding private security employees for not responding to alarms because it saves money.

Where do you get this stuff? I mean really, do you have some sort of internal memos that say "The more claims you deny, the bigger your bonus? I've taken care two elderly, dying parents, a grandmother and an aunt that were NEVER died coverage despite cancer, Parkinson and Alzheimers.

My family and I also have never been denied a claim other than an adminstrative error on the doctor's part.

So where exactly do you get this "incentivize their employees" stuff? Do you have anything to back that up?

[LRM1]

Originally Posted by SteveHI

If the majority of employers' contributions morphed into increased tax withholdings, it would be profit-neutral to the companies and income-neutral to the employees. If there's a few dollars left over, then the employer can have it or share it with the employee, I don't much care. I don't see how the employers should somehow reap windfall benefits from this massive reform, though.

I agree with you that companies won't do it without a mandate, though, which is why it would probably be necessary -- this money hasn't been, and won't be, theirs to spend.

So wait. You don't like Insurance companies who you claim give bonus out for screwing people, but you have no issue with employers, who suddenly don't have to pay benefits keeping the money from not having to cover employees?

Huh?

[LRM1]

Originally Posted by whiteongrey

The bottom line is most Canadians do not know good health care and have no clue that %50 of gov't revenue pays for it.

Here good health care is that a) you can see a doc if needed even if it's a drop in clinic, b) they hand our prescriptions freely, c) it's cheap (not pharma though), and at some point you will get a surgury if needed.

I would call it high quality 2nd world health care.

Keep in mind that overall we're mostly just a bunch of farmers, miners, factory workers, and ranchers with a minority posing as sophisticated white collar workers - combined delivering the lowest productivity and innovation in the industrialized world.

Our health care reflects the nation.

At least they could borrow an American practice - outsourcing to ultra quality care in Singapore and India to drop the excruciating wait times!

But wait! According to American liberals here, you Canadians are completely satisfied with your health care. That's why we need it.

Are you suggesting, as a Canadian, living in Canada, that your health care is not something to be emulated????

[whiteongrey]

Originally Posted by LRM1

But wait! According to American liberals here, you Canadians are completely satisfied with your health care. That's why we need it.

Are you suggesting, as a Canadian, living in Canada, that your health care is not something to be emulated????

My opinion is a fractional minority. I am a minority who travels globally regularly and has an inkling of what's out there - albeit only from the prof / educated population.


With US being a %75 consumption based economy, current health care costs very high, and coverage rates unacceptable I conclude this industry is in the same boat as textiles and shipbuilding a century ago and auto production today.


I would propose:

1. Ban the health care related unions, or, outsource at least %65 of health care services to high quality for profit care providers in Mexico and overseas. Once you see these hospitals and service levels you'll never go back to an American facility let alone one in Canada!

- Nationalizing it for even those not covered will kill America financially because these are the least healthy people. Regulating the pricing will seriously drive down quality.

OR

2. Adopt the German model

OR

3. Create special Health Care regions / centers in each state that are union free, tax free and have open policy / fast immigration to the many high quality doctors and health care profs in the world.

AND

%500 tax on all junk food and %300 tax on red meat plus a $50 / lb income tax on every lb that one is overweight. $15 cigs.

[SteveHI]

Originally Posted by LRM1

Where do you get this stuff? I mean really, do you have some sort of internal memos that say "The more claims you deny, the bigger your bonus? I've taken care two elderly, dying parents, a grandmother and an aunt that were NEVER died coverage despite cancer, Parkinson and Alzheimers.

My family and I also have never been denied a claim other than an adminstrative error on the doctor's part.

So where exactly do you get this "incentivize their employees" stuff? Do you have anything to back that up?

Dr. Linda Peeno was contracted by Humana to review claims, and testified to Congress about her first-hand experience. Although her testimony is 13 years old, she contends that not much has changed since then, and I haven't seen anyone effectively discredit her statements. http://en.wikipedia.org/wiki/Linda_Peeno

Lee Einer, a former health insurance employee, has described in detail some of the tactics used by insurers to avoid substantial claims.
http://www.honestmedicine.com/2007/0...hitman-le.html
http://www.nomanagedcare.org/DrPeenotestimony.html

These are two pretty well-known industry whistleblowers. There may be others, but I'm also sure there are many who are well compensated and do the job they're asked to do by their employers.

I'm not contending that the majority of claims are being denied. I've never had a problem personally, either. But if any company can save money to benefit its shareholders, I would fully expect them to do everything they could to do so -- basic economic principles apply,

My contention is that the profit motive makes for murky, at best, decision-making when it comes to rationing care. And based on that, I believe a single-payor option is at least as attractive as the current system with respect to claims processing.

[MG]

Originally Posted by SteveHI

My contention is that the profit motive makes for murky, at best, decision-making when it comes to rationing care. And based on that, I believe a single-payor option is at least as attractive as the current system with respect to claims processing.

The non profit motive makes for non efficient processing, and entitlement mentality by the employees and a complete nightmare of red tape accompanied by zero innovation. The fact that it is government mandated means that there is no choice, there is no freedom, there is no alternative, there is a completely autocratic sense of superiority that overrides the need to listen to your consumers.

the worst possible solution to any problem is a monopsy.

Of course, this is a solution without a problem, but since when have the Left ever let that stop their power grab?

[markopolo]

len56,
with "socialist" healthcare you wouldn't get such a treatment:

A woman is being shown around the hospital. During her tour she passed a room where a male patient was masturbating furiously.

' Oh my GOD! ' screamed the woman. ' That ' s disgraceful! Why is he doing that? '

The doctor who was leading the tour calmly explained, "I ' m very sorry that you were exposed to that, but this man has a serious condition where his testicles rapidly fill with semen, and if he doesn ' t do that
at least five times a day, he ' ll be in extreme pain and his testicles could easily rupture."

"Oh, well in that case, I guess it ' s okay," said the woman.

As they passed by the very next room, they saw a male patient laying in bed while a nurse performed oral sex on him. Again, the woman screamed,
"Oh my GOD! What is that"?

Again, the doctor spoke very calmly: "Same illness, better insurance".

[LRM1]

Originally Posted by SteveHI

Dr. Linda Peeno was contracted by Humana to review claims, and testified to Congress about her first-hand experience. Although her testimony is 13 years old, she contends that not much has changed since then, and I haven't seen anyone effectively discredit her statements. http://en.wikipedia.org/wiki/Linda_Peeno

Lee Einer, a former health insurance employee, has described in detail some of the tactics used by insurers to avoid substantial claims.
http://www.honestmedicine.com/2007/0...hitman-le.html
http://www.nomanagedcare.org/DrPeenotestimony.html

These are two pretty well-known industry whistleblowers. There may be others, but I'm also sure there are many who are well compensated and do the job they're asked to do by their employers.

I'm not contending that the majority of claims are being denied. I've never had a problem personally, either. But if any company can save money to benefit its shareholders, I would fully expect them to do everything they could to do so -- basic economic principles apply,

My contention is that the profit motive makes for murky, at best, decision-making when it comes to rationing care. And based on that, I believe a single-payor option is at least as attractive as the current system with respect to claims processing.

Ok, I will grant you this since you aren't screaming from the rooftops how this is everyone.

What you say about "profit motive makes for murky at best decision making" ok, will grant you that too.

But I wholeheartedly disagree that the government, with it's 100% record of ineptitude is an improvement over anything. While decision making in profit based business may be "murky" it is non existant and blatantly stupid in government.

I'm sorry I am not one of those who believes that 85% should be screwed so that 15% can get more.

The fact is we pay more for many goods that many other countries don't. And I belive you agreed that tort reform, real reform (which is unlikely to happen) can fix alot of that. That should be step one. The problem is that no one in government wants to tackle the real problem, instead, the Democrats push for "ice cream" solutions, entitlement and stupidity because most Americans are too dumb to see 4 feet down the road.

[Kaz]

Government medicare denies the most amount of claims, private insurance pays out the most amount of claims.



http://biggovernment.com/2009/10/05/...h-care-claims/

[SteveHI]

Originally Posted by Kaz

Government medicare denies the most amount of claims, private insurance pays out the most amount of claims.



http://biggovernment.com/2009/10/05/...h-care-claims/

There's definitely some good information on the AMA report. It's worth noting, though, that the single metric that Breitbart pointed out on his site is one of many that the AMA uses to grade the various insurers. Not surprisingly, he excluded Metric 5 (Contracted Payment Rate Adherence) and Metric 10 (Percentage of Claim Lines Reduced to $0 By Edits), both of which Medicare scored significantly better than the private insurers. Many of the other metrics were fairly comparable amongst the insurers.

I've not argued that Medicare claims processing is or will be superior to the private sector - there are a lot of variables at work here. But the private sector will and should always do whatever they can to benefit their shareholders because that's their primary mission. And I'd prefer that important health care decisions be made in accordance with well-established guidelines rather than driven by the profit motive inherent in all private companies.

[MG]

Why is it that whenever anyone *****es about "profit motive" they focus on it potentially driving shoddy product rather than the opposite tendency to provide superior product as driven by the existence of "consumer choice"?

This of course is a rhetorical question because I know the answer. Leftists fall into one of two groups

1) the anti corporatist who ignore all facts because they simply hate uncontrolled corporations (these are the Religious Fanatics, the jihadists if you will, of the left who beleive that the existence of choice is simply wrong)
2) the insular elitists who beleive that 98% of "the unwashed masses" are simply not capable of taking care of themselves (thus obviating the existence of informed choice) and should be taken care of......by the government, lol, you didn't expect the elitist to actually do it themselves did you?