Wednesday, May 6, 2009

Let's NOT think this through - as usual.

My hero

According to the May 5th New York Times, Senator Charles Schumer (D-NY) has proposed a health care reform “compromise” on the creation of a new public plan to compete with private health insurance. No doubt Schumer is trying to convince moderates that they should ignore Rep. Jan Schakowsky (D-IL) frank admissions that a public plan is just the first step of an unprincipled strategy to achieve government run health care.

Schumer’s compromise would require that the public plan and private plans would abide by the same rules and regulations. But even the NYT identifies some huge holes in his claim. Would the public plan be subject to state premium taxes, like private health plans, or state insurance laws, or solvency requirements with the private plans in states with which it is competing? Could the public plan be allowed to become insolvent? Or will it become another candidate for an eternal Congressional bail out?

We have even more questions than the NYT does:

Will public plan officials be subject to the same state and federal tort laws?

How about the same accounting standards as private companies?

Could they be sued for breach of contracts?

Will they have to negotiate rates and benefits like private plans, set up provider networks, and set prices in the market, just like private plans do today? Market prices? (No special advantages, remember)

Will the officers of the public plan be able to reject doctors or medical professionals who do not meet quality standards like private plans can do today, or will they be forced to take any willing provider?

Will the benefit setting of the public plan be transparent and benefits packages be completely transparent, defining clearly what is and is not covered? No confusion on these points, like that which afflicts Medicare beneficiaries today.

Would the public plan officers have budgets to market their products, just like private plans? Would those marketing costs be subsidized by the taxpayer or paid out of public plan premiums? ( Otherwise, looks like those awful administrative costs would be incurred by the taxpayers).

Of course, Senator Schumer and his colleagues invite us to ponder a problem in elemental logic. If the public plan and the private plans are really going to abide by the exact same rules, what is the point of a public plan in the first place?

Of course, the public health plan would be a wholly owned subsidiary of Congress Inc. That means that it would be a political institution, just like every other government sponsored enterprise, including Fannie Mae and Freddie Mac. It will be ground zero for special interest lobbying – by doctors, hospitals, drug companies, and insurers, as well as every special interest to the left of Pearl Jam, on a scale unprecedented in health care history.

If Fannie and Freddie, and AIG and the Automakers, and the Big Banks and whatever else is in line for a big bailout at taxpayer expense is “too big to fail”, guess what would be the congressional response to a shortfall in the income of a newly minted, congressionally created public health plan with millions of enrollees? There’s no guess work here. Unless you believe in Unicorns. Author: Bob Moffit

It might be universal care, but one thing is for sure, it won't be universal access. Unless, of course, you enjoy standing in line and waiting months for "elective" surgery.


Mike West said...

This much I know. Our health care system is way too expensive. THAT in my mind is border line criminal. Sick? Be prepared to pay. "Yeah, but my health insurance pays for it." Perhaps, but employers pay the cost for the insurance if we don't. I believe there is a compromise between the system we currently have and universal care. I would like to see some sort of watchdog become involved to put a cap on what can be charged for all major procedures and what hospitals can charge. This watchdog committee should also be allowed to review all malpractice suits prior to them getting to court and have the ability to toss out frivolous suits. The problem is who is the watchdog? Health care for the poor? Everyone below the poverty level still pays but they pay from a sliding scale determined by their income. Health care for the illegals? Show us your legal papers and we'll treat you. Otherwise, we will be providing 1-way tickets out of the country twice per year. Medical emergency? Everyone gets treated, legal or illegal. But we will ask for your papers after treatment is given. Health care should be treated differently than all other privatized industries because it cares for people and people still do matter; or at least I hope they do.

vwatt said...

I hate to jeopardize Mike's reputation, but I agree with about 95% of what he says-now he needs to work on his brother to get his "mind right". The medical contingent of my family(brother-cardiologist, daughter-medical school, two sisters-in-law, internal medicine M.D. and a nurse)-the front line folks-all pretty much agree that big changes are needed and a public insurance option is not all bad-it will keep the private plans honest if nothing else. Believe me, many discussions have taken place amongst us on this subject.
For example, just yesterday a private insurance industry spokesman offered to reduce the higher premiums charged to single parent mothers(high stress, workload risk?) as part of an agreement not to have a public insurance option. You see, they want to just cover the healthy and the low risk, charge them and their companies an arm and a leg, then deny or jack up rate coverage to everyone else they deem a risk.
The Republican "argument" is that they don't want the government to stand between you and your doctor. Well, guess what? Right now
you have an insurance executive and a claims adjuster between you and your doctor-and they are absorbing 15% of every health care dollar in the U.S. as compared to 3% for Medicare.
As to "guvmint"(a la Rush) health care, 70% of my brother's private heart hospital revenues come from the government via Medicare(procedure/care rates are set)-and they still make a profit and turn no one away! Gee, why couldn't a form of this system(medicare) work for all of us-or those who choose to use such a plan? Guess who provides care for active duty military and veterans?? A lot of false boogeymen in this argument-all designed to get someone re-elected, whether a Republican from Alabama or a blue dog Dem. from Kansas. As Mike says, and my family Docs say, it should be about caring for people and not another "insurance industry"!!

Brodad Unkabuddy said...

My point still stands. Government involvement in any endeavor has never resulted in lower costs. When the government sets a limit or a cap, that number becomes the minimum charged until the government raises the cap.

In a competitive environment, which could be encouraged by the government with tax relief, then there's a much stronger possibility the prices charged would lower. For example, if Hospital A charges less than Hospital B for an appendectomy, then I have a CHOICE as to which hospital I go to. But if the government sets the price framework for the industry, then the industry will operate within that framework lowering costs where they can in order to make money. And where do they lower costs? In the quality of care - doing more with less, taking short cuts, etc.

Look at the computer industry. The price of computers have continually dropped over the last 15 years. Why? Competition and technology- two things the government does not encourage. If the government had become involved in the computer industry, we would be paying $4000 (or whatever the cap would've been back then) for a laptop today. Caps never go down, they only increase.

As Vance says, the industry makes a ton of money off Medicare. Why? Medicare pays a fixed amount for services rendered. That amount will NEVER go down. So why charge less? There's no incentive to find a cheaper more innovative way to provide services. In a competitive environment the price would go down as competing companies look for ways to provide better service cheaper. With a government controlled industry there's no reason to take risks, to develop new and better ways to do things.

If Obama gets control of the healthcare industry, the price will only go up and the quality will only go down. Your insurance premiums may not increase, but you'll pay more - taxes and quality of care.
Unless of course you're a welfare recipient or an illegal alien. Then it's free.

I defy anyone to show me convincing evidence that the people of Europe, Canada, China, Cuba, or Venezuela have a better healthcare system than we do. I don't think it exists.

Brodad Unkabuddy said...

One other thing (if I may continue to comment on my post) is my teeth still ache to this day when I think about one particular airman trying to clean my teeth at the Pope AFB dental clinic, or how about the time half the Cadet Wing came down with the flu when they got the dosage wrong on our mandatory flu shots? I remember Susie's room at the Ft. Bragg hospital being the hallway due to lack of beds.How come most veterans avoid VA hospitals? Hey Mike, would you like an Air Force surgeon have a go at that knee of yours? Talk about do-overs. Yeah, we're going to love that universal health care.

vwatt said...

Actually, most hospitals and doctors do not make "a ton of money" off Medicare reimbursements. The only reason my brother's Heart Hospital makes money is by being extremely efficient and specialized: things like one patient room that meets all needs from post-operation critical care to routine recovery, one set of cardiac trained nurses,etc. Of course, this is why so-called "not for profit" public hospitals have been successful in blocking these specialty private hospitals-they take away their main source of profits-and Republican John Thune(S.D.) was instrumental in lobbying(prior to his election)in getting a three year ban on all new private specialty hospitals. These same "not for profit" hospitals also routinely hire MBAs who are paid 800k a year(yes, in South Dakota!) as CEOs, whose only goal is to control(not manage efficiently) all health care in their region in order to eliminate "competition"!
This is why my brother and his partners left just such a hospital-whenever profits went down, the CEO answer was to cut the physician reimbursement amount for medical procedures from 45%, to 42%, then to 38%, etc. To compare military medical care to "universal care" is a totally false argument. Universal care can be attained while retaining doctor choice and quality. We went to the moon 40 years ago-I think we can figure this one out!-Unless you have no compassion for the children and the poor! Ha!-a variation the old right wing "why do you hate America?" argument. what goes around.....

Brodad Unkabuddy said...

Somebody's making money on Medicare. Is this is a "company" you'd invest in? Typical Big Government efficiency. What's a billion here and there?

Medicare’s annual anti-fraud budget is $465 billion. (Miami Herald, August 11, 2008)

Medicare and Medicaid made an estimated $23.7 billion in IMPROPER PAYMENTS in 2007. These included $10.8 billion for Medicare and $12.9 billion for Medicaid.

Medicare and Medicaid lose an estimated $60 billion or more annually to FRAUD, including $2.5 billion in South Florida. (Miami Herald, August 11, 2008)

Medicare spends LESS THAN 0.2 CENTS OF EVERY $1 of its $456 billion annual budget combating fraud, waste and abuse. (Miami Herald, August 11, 2008)

Medicare PAID DEAD PHYSICIANS 478,500 claims totaling up to $92 million from 2000 to 2007. These claims included 16,548 to 18,240 deceased physicians. (U.S. Senate Permanent Committee on Investigations, 2008)

Nearly one of three claims (29 percent) Medicare paid for durable medical equipment was ERRONEOUS in FY 2006. (Inspector General report, Department of Health and Human Services, August 2008)

Medicare and private health insurers pay up to $16 billion a year for NEEDLESS imaging tests ordered by doctors. (American College of Radiology, 2004)
edicaid Fraud

Vance, you're the one who brought up care for the military. ("Guess who provides care for active duty military and veterans??") I assume you were talking about government provided (universal) healthcare. Thus my diatribe on the excellent care we received in the USAF.

Brodad Unkabuddy said...

Give an example of children and the poor in the United States who have not received medical care when they needed it.

vwatt said...

I guess you're Bush famously said(approx. words), "No one is ever denied health care in this Texas the Mexicans just go the emergency room....." Guess who pays for that??

Brodad Unkabuddy said...

In every state in the union, Mexicans just walk in and get medical care. Would that change under universal health care? Nope. The only difference is we would be in line behind them. Either way, we pay.

vwatt said...

Oh please, Massa Obama, don't make us compete with a public plan-we PROMISE to clean up our act, cover everyone, and stop denying claims..right. See there-just the THREAT of a public OPTION is already saving money...think how many more effciencies will occur when we actually get one or something even close:

WSJ WASHINGTON -- Major health-care providers are planning to pledge Monday to President Barack Obama that they will work to reduce cost increases in the nation's health-care system by $2 trillion over the next decade, officials said.

The move shows how the private sector is eager to appear cooperative as Congress tries to pass major health-care legislation by the summer. Opposition from many parts of industry, including doctors and health insurers, helped kill President Bill Clinton's plans for overhauling health care in the early 1990s.