Heatlth care reform - cost reductions - be careful what you ask for

[Whip]

My god -- Whip and I agree on something!

 

 

 

I'm honored.

 

As my good friend Tom(azkaisr) would say.

 

"I'm all about solutions"

 

 

Back and White baby.

 

 

 

I sure hope to head your way this fall. Maybe we can solve all the worlds problems after we handle this minor health care issue.

 

 

All the best my friend

 

 

L

 

 

 

[Ken H.]

The whole premise of insurance is to spread the risk among as large a group as possible

No, no, Nannette. Private health insurance as practiced in the US is a combination of:

• Excluding applicants who are likely to make claims; and,
• Denying or procrastinating the payment of claims.

Exactly, claims adjusters have one and only one goal – maximize profits. Ever know one for a health insurance company? I do, was married to one for a while actually. They are rated on the number of claims they deny, not the number they approve. Approval rate getting to high – 10 demerits. Quality of care isn’t even part of the equation.

 

(Hey, didn’t I say a few post back I was going to stay out of this discussion? Shit.)

 

[Selden]

The whole premise of insurance is to spread the risk among as large a group as possible

No, no, Nannette. Private health insurance as practiced in the US is a combination of:

• Excluding applicants who are likely to make claims; and,
• Denying or procrastinating the payment of claims.

Exactly, claims adjusters have one and only one goal – maximize profits. Ever know one for a health insurance company? I do, was married to one for a while actually. They are rated on the number of claims they deny, not the number they approve. Approval rate getting to high – 10 demerits. Quality of care isn’t even part of the equation.

 

(Hey, didn’t I say a few post back I was going to stay out of this discussion? Shit.)

All right, I should have written "The whole point of insurance should be to spread the risk..."

 

Not a second or third hand report, last week I heard a woman on radio whose insurance was canceled on the Friday before a mastectomy scheduled for the following Monday. Why? Because she hadn't disclosed that she her health history included acne and a rapid heartbeat. Fortunately, her congressman, Rep. Joe Barton (R-TX) interceded.

 

http://www.npr.org/templates/story/story.php?storyId=105680875

 

That said, if health insurance were universally required, with effective government oversight and regulation, I still believe that premiums would go down, and rescission would be much less of a problem.

 

This has been an entertaining thread, but it's about as pointless as the even longer discussion on global warming, so this is my last comment. Really. This is supposed to be a motorcycle forum.

[Dave McReynolds]

Here's a hypothetical and I'd like your response.

 

You take your bike into your dealer for service. You agree with the service manager

as to the work to be done and the cost before leaving. Later, the tech spots a condition

that needs attention that, if fixed, will incur both parts and labor costs.

 

If you're the owner, you want the tech to make any repair he deems necessary, regardless

of final cost. Yes ___ No ___

 

If you're the service manager, you want your tech make the repair without checking with

him or you, incurring costs to which you, the customer, might object. Yes ___ No ___

 

If both answers are "no", you want the tech to CYA by calling before fixing. How can

that be a bad thing?

 

In your world, you tell a client a job will take 10 hours and quote a fee based on those

hours. You find the job will take 20.

 

Do you call the client before expending the hours? Yes ___ No ___

 

If "yes", aren't you just covering your ass?

 

Commercial pilots are in a steady-state of CYA. The entirety of the job is to make sure

nothing goes wrong; or conversely, to make sure everything goes correctly. It's the reason

pilots echo the controller's instruction; and, it's the reason why some employees leave

meetings and immediately send emails to meeting attendees trying to clarify exactly what

they are to do.

 

Thank God (or god for the atheists and agnostics) for CYA. Cherish it for it keeps us

safe in more ways than we can count.

 

 

Sorry John, I stepped out for a while, or I would have answered you sooner. Meanwhile, I also agree with Greg's post on this.

 

I suppose it's just semantics, but I don't agree that any of the situations you describe above fall under the definition of CYA, because nobody, doctor, lawyer, accountant, or motorcycle mechanic, has a right to spend my money without my authorization first. Getting the customer's authorization before doing the work is integral to doing the work and getting paid for it.

 

An example of CYA in my own work would be if I decide that a certain transaction puts a client into a risky tax position. As a CPA, I have an obligation to discuss this with my client, and identify the risks. For some clients, I would do this over the phone. So far I don't consider this CYA. For other clients, I would worry that they might conveniently forget our phone conversation if the risky tax position comes back to bite them. For those clients, I would follow up the phone call by sending them an email describing the risks, and would ask for a confirmation email before proceeding. That I would consider CYA.

 

Why? Because, assuming the client had the intellectual capacity to understand the risks over the phone, I am not rendering any more service to the client by the emails. The time spent does not benefit the client; all it does is give me peace of mind, in the event of a future malpractice claim.

[russell_bynum]

The whole premise of insurance is to spread the risk among as large a group as possible

No, no, Nannette. Private health insurance as practiced in the US is a combination of:

• Excluding applicants who are likely to make claims; and,
• Denying or procrastinating the payment of claims.

Exactly, claims adjusters have one and only one goal – maximize profits. Ever know one for a health insurance company? I do, was married to one for a while actually. They are rated on the number of claims they deny, not the number they approve. Approval rate getting to high – 10 demerits. Quality of care isn’t even part of the equation.

 

(Hey, didn’t I say a few post back I was going to stay out of this discussion? Shit.)

 

This simply has not been my experience. Keep in mind that there IS competition in our healthcare system. My employer has two or three choices. Employees talk to each other and other folk's experience plays a role in which company we select. We also complain to HR, who selects the plans to begin with. If people aren't happy, things change. Therefore...even though the insurance companies do want to control costs by limiting claims, if they go too far. I'm sure they're also worried about litigation due to failing to approve necessary care.

 

BUT....even if that's true, wouldn't that be the same (or worse?) with the govt making those decisions? If not, then how are they going to control costs to keep premiums (taxes) from going through the roof?

[russell_bynum]

What I find quite amazing, astonishing even, is that the USA has the most expensive by far, but yet sub-standard just about any way you can measure it healthcare system in the world. Yet some (many even) US Americans tolerate it, defend it even, to their last breath.

 

If we were talking about any other product or service you would be total up in arms. And what single thing could be more important than your health?

 

What is it? Is it lack of vison about what could be? lack of knowledge about what works in the rest of the world? Stubborn US American pride?

 

Ignoring for a second the 46 million there without healthcare coverage, even those of you who can afford it are getting totally ripped off. But yet you resist every effort decade after decade to improve the situation. I just don’t get it...

 

It's quite simple.

 

1. I've got coverage I'm happy with at a cost I'm OK with.

2. I do see room for improvement with the current system (even just looking at it from my selfish perspective), but:

3. I'm exceedingly leery of ANYTHING the govt wants to do. The govt has a long history of mucking things up, taking away our rights, raising taxes and then pissing the money away, corruption, inefficiency, and generally being miserable to work with. In short, I don't have any faith that they'd make anything better, and I'm fairly certain that they'd make it worse for those of us (most of the country) who have it pretty good.

[Lets_Play_Two]

I am not sure how these prove your point since we have different policies and different life styles that affect all of these. Leading the world in abortions is a political result and infant mortality can also be argued to be greatky affected by political policies. Percent obese has nothing to so with the health care unless you believe that we should mandate calories or Big Macs consumed. Teen birth rate? What does medical care have to do with this.

These things and more have everything to do with healthcare. “Healthcare” is not just about fixing people once they are ‘broken’, it’s about preventing people from ‘breaking’ in the first place.

 

AHHH, it takes a village. What do you see as government's responsibility when it comes to the use of plastic surgery. How about the health care needed to protect young women from making the mistake of early pregnancy, or what about the need to stop some women who may be at risk from becoming pregnant? Does "health care" extend to weeding out people whose personality will cause them to be high risk takers when riding a motorcycle? When do you want the tax on fast food to start?

[MikeRC]

EB:

A huge portion of the claims for malpractice is for medical expenses arising out of the malpractice. With universal coverage, those costs get shifted out of the tort system into the health care system. It will reduce the number of malpractice lawsuits (and arguably the number of personal injury lawsuits in general) if the fighting over who pays the medical bills (and the lawyers' fees) is eliminated.

 

Unfortunately that isn't true in Canada. The provincial gov't comes in and reclaims the medical expenses first from any successful malpractice suit or settlement. That and ongoing care considerations still result in multi-million dollar awards. But the Supreme Court of Canada has put limits on pain and suffering and punitive damages.

 

Other factors contribute to lower medical-legal costs in Canada. The physicians' lawyers NEVER settle a case just because the legal costs will exceed the award or they don't like the publicity around the case. They WILL settle if the review of the case by a panel of legal and medical experts feels that the physician is likely to have a decision against them. This basically eliminates suits getting past the discovery stage as long as the "local standard of care" has been met. Although all physicians belong to one co-operative medical protective association (CMPA), malpractice coverage isn't cheap and there are regional and specialty differences in fees. Worst off? Obstetrics in Ontario at $40,000 per year. But physicians get most of those costs reimbursed at the local level as long as they follow the rules for continuing medical education and practice review.

 

In reply to your other comments, malpractice lawsuits within the medical profession are not seen as a good measurement of physician performance or competence. They usually are decided on legal arguments rather then the quality of medical care. However, the national medical protective association, provincial licensing authorities and regional privilege boards are more effective at identifying and then limiting the practice of or eliminating bad doctors.

 

Mike Cassidy

 

[90%angel]

What I find quite amazing, astonishing even, is that the USA has the most expensive by far, but yet sub-standard just about any way you can measure it healthcare system in the world. Yet some (many even) US Americans tolerate it, defend it even, to their last breath.

 

While some of this is debatable (especially point number one, as evidenced by the voices from Canada and UK on this thread), this article does a pretty good job of giving voice to what we fear. I suppose another reason is: If you don't trust your government, why on earth would you hand them responsibility for your health care?

 

ObamaCare article

 

 

[mbelectric]

What I find quite amazing, astonishing even, is that the USA has the most expensive by far, but yet sub-standard just about any way you can measure it healthcare system in the world. Yet some (many even) US Americans tolerate it, defend it even, to their last breath.

 

While some of this is debatable (especially point number one, as evidenced by the voices from Canada and UK on this thread), this article does a pretty good job of giving voice to what we fear. I suppose another reason is: If you don't trust your government, why on earth would you hand them responsibility for your health care?

 

ObamaCare article

 

 

But.....why would you hand your health care to the government if you had enough money to buy your own??? And you do, don't you?

 

MB>

[Whip]

 

...again

 

$200/month for the best care money can buy.

 

Less than my cell phone bill

 

Less than my cable TV bill.

 

I wonder how many of those mythical 46 million have a cell phone and watch cable every night.

 

Please don't touch our healthcare system just educate the folks.

 

 

$200 per month is not that much.....(it was $300/month)

 

 

Your quote is a little misleading. It should read "$200 per month, which is what I pay living in San Antonio and with my history." The prices vary wildly depending on where you live, and your health history.

 

There is no way you get anywhere close to that number living in the Metro NY area or Florida, for top of the line Blue Cross Blue Shield, especially if you're not working for a company with a number of employees. Even within a large company you're paying multiples of that (adding the costs to you and your employer).

 

While in NY my wife and I paid over $1500/month (combined) for catastrophic coverage only, and I shopped everywhere. My friend, living on Long Island, who recovered from cancer 5 years ago is paying $25 THOUSAND per year for the full boat Blue Cross Blue Shield.

 

To your reference, that's a heck of a lot more than our cell pone, cable bills, and dining out combined.

 

 

 

 

In life we make choices. Where ya live is one of the most important. I choose to work and live here in South Texas. Almost everything about living here is cheaper than in NYC or Florida.

 

Each state has it's own rules on what is covered in "Health Insurance" wouldn't it be better to pick and choose what you want covered.(like auto coverage) Imagine how much cheaper it would be if you didn't have to be insured for tatto removal . ...I would prolly pass on AIDS and tummy tucks too.

 

Give peeps choices and make everyone get some basic insureance.....again like auto liabilty.

 

It ain't that difficult.

 

The solutions are out.....

 

 

Summer classes at the Whip school of common sense and economics will resume after the 4th of July Holiday.

 

I'm gonna celibrate my independence by working the next 5 days.

 

 

 

 

 

 

 

 

 

 

[Shaman97]

Turns out that 62% of all bankruptcies are medically related, and of those, 78% had private insurance. I really had no idea of the percentages - it's worse than I thought.

What's most likely to bankrupt you.