1 Barack Obama is a stuttering clusterf*ck of a miserable failure.

2
Replace it with tort reform and fewer regs.

3 What choices?  What table?

4 which I understand has become some kind of dirty word among some conservatives, who insist, contrary to the evidence, that almost nothing needs to be done in the area of health care.

I'm not sure what you mean by this, ace.  Are you saying that there are mountains of evidence that healthcare needs fundamental changes, or that Obamacare needs fundamental changes?  Because one is right, and the other is wrong.

Obama care needs one fundamental change- it needs to be repealed.

Health Care, on the other hand, ain't so bad as people would have you believe.  I could do a full defense of the Health Care industry, but I won't.  What I will say is that any pricing issues would be much more easily fixed by just getting Government out of the way (and moving the incentive for purchasing insurance from the Employer and to the Individual- which is still undoing previous Government intervention) than by the Government implementing some new Rube Goldberg scheme.

5 A contract made under duress is not a contract ( as the lawyers say )

13 more months and a few days, brothers.   A year and a month and some days

6 Yeah, and that buying insurance across state lines thingy.

7 The law empowers a board of 15 unelected officials – the Independent Payment Advisory Board, or IPAB – to hold the growth of Medicare spending to GDP plus 1 percent by reducing reimbursements to health-care providers.

Now who was the one that got slammed by the left, the media (but I repeat myself), and the easily excitable on the putative right for calling it correctly for what it is; a death panel?

8

I think conservatives are worried when they hear the word "replace" because they assume it'll be just another social engineering attempt.

However, our health system is messed up. It costs too much because the market is distorted. Many people can't afford insurance and many people than can barely afford it don't get it because it would eat up most of their budget.

There are a bunch of legtimate fixes out there. Tort reform, open interstate competition, less focus on third party payers.  If a third party is paying then you won't shop around. If people shopped around for MRI's like they do for cars or groceries then they would get the same service for a lower price and it would force hospitals to cut prices in order to compete.

There are a bunch of good ideas out there. So I'm for repeal and replace, assuming replace involved free market ideas and not social engineering from the right.

9 stop whining and take a pill.

10 Oh and my insurance has gone up 13.25% since Obamacare passed.  So it didn't bend the cost curve down.

11 Oh, the sort of doctors who can't otherwise attract a clientele will treat them; but the sort of doctors willing to work for the government's cost-controlled cut-rate reimbursements are not, let us say, top shelf.

Case in point: Who really likes going to the Dentist (or Doctor) who advertises in big, bold letters "Medicaid Accepted Here?"

12 Of ObamaCare he says "Repeal & Replace," which I understand has become some kind of dirty word among some conservatives

What conservatives would those be?

13 Health care is currently a weird blend of socialism and waste. Costs continue going up 2 or 3 times faster than GDP. There is something screwed up on a fundamental level here.

What's screwed up is that government covers health care costs for anyone who isn't a vital employee. No one ever wants to hear it, but the only ways to lower the cost are the same that they are in any other situation-increase supply (not really an option, there are only so many people smart enough to be effective doctors and society would be better off if more of them were tospend their time productively) or reduce demand (end the socialism and accompanying waste).

There are no other possibilities. Not that it matters anyway, seeing as how D.C. is fully committed to destroying the world's economy through spending on every damn thing they can find.

14 when Obama said take a pill ,  everyone thought they were getting all their pills for free!

15 By all that is holy, we are being pulled into the depths by the great mass of ineducable voters and gubmint hangers-on.

16 Case in point: Who really likes going to the Dentist (or Doctor) who advertises in big, bold letters "Medicaid Accepted Here?"

where else would i get my gold grills at the right price?

17

>>>Oh, the sort of doctors who can't otherwise attract a clientele will treat them; but the sort of doctors willing to work for the government's cost-controlled cut-rate reimbursements are not, let us say, top shelf.

 

Reminds me of this quote:

'Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything--except the desires of the doctors. Men considered only the "welfare" of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only "to serve." . . . I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind--yet what is it that they expect to depend on, when they lie on an operating table under my hands?'

 

18 A single-payer system will save healthcare.

Single-payer for lawyers.

19 By encouraging medical providers to turn away seniors, we're also fixing the Social Security problem. You'd think they'd be thanking me.

20 Posted by: Methos at September 27, 2011 02:00 PM (sOXQX)

I can think of several things that would "increase supply."  For one, allow PAs and NPs to run their own practices.  Right now, they have to "support" a "real" doctor- even though they're capable of doing anything you'd go to an Urgent Care Clinic for, and almost anything you'd go to the ER for.

Let them do that- there is a much, much lower barrier to entry, and such locations (especially Urgent Care clinics) tend to be very, very good about "I can't help you with that.  This should tide you over, but you need to call your doctor first thing in the morning.  If you don't have one, I can refer you."

21 oh and the Deadskins lost last night.  Suck it, D.C.   Everything about that city is shit

22 I like the Robot's approach on the "Lost In Space" TV show.

CRUSH!
KILL!
DESTROY!

23 19 By encouraging medical providers to turn away seniors, we're also fixing the Social Security problem. You'd think they'd be thanking me.

Posted by: Comrade Barry at September 27, 2011 02:03 PM (D5hxK)

The Logan's Run solution.

24

A gefilte fish in every pot !!!!!!

25 Posted by: SantaRosaStan, Yid Janitor emeritus at September 27, 2011 02:03 PM (UqKQV)

They didn't so much lose as...  wait, who am I kidding.  Dallas can't exactly take credit for that win.  Any game you "win" on field goals is a game the other team actively lost.

26 But, AARP said President Obama was on my side.  They would never lie.  And Paul Ryan pushed that old woman off a cliff.  I saw it on TV.

27 The law empowers a board of 15 unelected officials – the Independent Payment Advisory Board, or IPAB – to hold the growth of Medicare spending to GDP plus 1 percent by reducing reimbursements to health-care providers. Unless overturned by a supermajority in Congress, the recommended cuts dictated by this board become law. This is why I continue to counsel skepticism about repeal. We will need supermajorities of Republican politicians unafraid of the MFM. Tall order, that. Very. A single-payer system will save healthcare. Single-payer for lawyers. Oh, how sweet that would be. Poetic justice.

28 Pretty much the only non-VP pick thing John McCain got right in that disastrous campaign was his idea to get the US off employer-based health care.

29 Another speech by Ryan....meh

30 Another speech by Ryan....meh

Well, there's only so much the man can do.  And, in his defense: He's right.

31 If you like your doctor, you can keep your doctor.

That's becoming a similar phrase to "hold my beer; watch this".....

32 Single-payer for lawyers.

Oh, how sweet that would be. Poetic justice.

Posted by: George Orwell what knows Obama is a stuttering clusterfuck of a miserable failure at September 27, 2011 02:04 PM (AZGON)

You do know that nobody has been on the national Democrat party ticket since 1980 who did not go to law school.

33 1. Repeal BambiCare 2. Put tort reform in place 3. Eliminate the tax deduction for employer health care 4. Allow interstate competition 5. Give health care vouchers for children under 18 6. Set up high-risk pools for people with pre-existing conditions 7. Make it easier to set up urgent care-type businesses 8. Separate insurance -- which should be for catastrophic care -- from health care, which should be paid for in cash or vouchers

34 I would just like to say ... I don't give a sh*t!

35 10 Oh and my insurance has gone up 13.25% since Obamacare passed. So it didn't bend the cost curve down. Posted by: Ben at September 27, 2011 01:59 PM (wuv1c) My coverage from 2010-2011 was changed as my plan was dropped. We had 3 choices in 2010, 2 in 2011. The change led to a 40% increase in just the monthly premium, in addition to 25-50% on pill co-pays, and the introduction of a deductible. Memo just arrived in my mailbox this morning, another 4% increase in monthly premiums for 2012. Not as bad, but it's now just under $150/mo for just me, just for the premium. And I spend another $100 or so/mo on maintenance drugs.

36 True to the ethos of D.C. the Deadskin DL was calling out signals when the Cowboys were in the shotgun ( imitating Romo )

deceit, dishonesty, disruption, disgusting; degrading............Democrats

37 You do know that nobody has been on the national Democrat party ticket since 1980 who did not go to law school. I'm surprised the Demotards haven't proposed a COTUS amendment requiring Preznits be lawyers first. But that would be gilding the lily, I suppose.

38

You do know that nobody has been on the national Democrat party ticket since 1980 who did not go to law school.

Posted by: AmishDude at September 27, 2011 02:07 PM (T0NGe)

You know, I suspect if someone wanted to catch AmishDude in a trap, all he'd have to do is set a snare with a tape recorder simply playing the words "Lawyer, lawyer, lawyer" over and over in the middle as bait.

39

The problem with healthcare is the lack of a connection between the person getting treated and the person paying the bill.

Nobody has to ask themselves, do I really need this, is it really worth the cost I will have to pay.  Hell, nobody even asks for a price quote.

40 I'm surprised the Demotards haven't proposed a COTUS amendment requiring Preznits be lawyers first. But that would be gilding the lily, I suppose.

Posted by: George Orwell what knows Obama is a stuttering clusterfuck of a miserable failure at September 27, 2011 02:08 PM (AZGON)

For the record, Gore went but flunked out.

Which is a pretty neat trick.

41 We'll continue to be screwed until we start treating healthcare services like any other consumer good and get insurance completely out of the mix for routine transactions.

What we do now for an enormous amount of healthcare costs is akin to filing an auto insurance claim for an oil change or a homeowner's claim for a light bulb replacement.

Pushing all this paper around adds serious overhead and, worse, short-circuits pricing signals in the marketplace.

In this regard, the Ryan plan simply continues the status quo and doesn't really fix the underlying problem. But it's a damned sight better than Obamacare.

42 Dreidel, dreidel, dreidel ...

43 Posted by: AllenG (Dedicated Tenther) is tired beyond tired of the trolls at September 27, 2011 02:03 PM (8y9MW)

Fair enough. Decreasing dumb regulations increases the supply of health care time the existing doctors (and folks who are eventually going to be doctors anyway) have available. Tort reform would tend to make their resources stretch farther, too. So it's not impossible to get some improvement on the supply side, I'm just not sure how much of the problem it alleviates.

44

You know, I suspect if someone wanted to catch AmishDude in a trap, all he'd have to do is set a snare with a tape recorder simply playing the words "Lawyer, lawyer, lawyer" over and over in the middle as bait.

Posted by: AllenG (Dedicated Tenther) is tired beyond tired of the trolls at September 27, 2011 02:09 PM (8y9MW)

Wouldn't be such a problem if half of the Senate, a third of the House and a whole bunch of the appointed administration had no other credential than the world's easiest postgraduate degree.

45 Nobody has to ask themselves, do I really need this, is it really worth the cost I will have to pay.  Hell, nobody even asks for a price quote.

Well, "Nobody" may be a bit of a generalization, there, but it's largely true.  And it was the first step to turning Health Care into a "right."

Say it with me, folks: You have no right to what someone else must produce (or provide).

46 This is one of the ideas he is supporting:

“With regard to health insurance for working Americans, patient-centered reform means replacing the inefficient tax treatment of employer-provided health care with a portable, refundable tax credit. You can take [the credit] with you from job to job, allowing you to hang onto your insurance even during those tough times when a job might be hard to find.”

47 Health care is currently a weird blend of socialism and waste. I don't see the problem.

48 Set up some system wherein health care savings accounts are tax free. Allow employers to contribute what they would have spent on employee health care into such an account.

49

Nobody has to ask themselves, do I really need this, is it really worth the cost I will have to pay.  Hell, nobody even asks for a price quote.

Posted by: AndrewsDad at September 27, 2011 02:09 PM (C2//T)

Price quotes are racist.

50 If Obama really wanted to stick it to the rich, he'd get rid of employer-based health care and repeal ObamaCare.

Which proves that his class warfare rhetoric is BS

51 But does it cover cobra bites??? I don't give a sh*t, but my friend wants to know...

52 True to the ethos of D.C. the Deadskin DL was calling out signals when the Cowboys were in the shotgun ( imitating Romo )

deceit, dishonesty, disruption, disgusting; degrading............Democrats

Posted by: SantaRosaStan, Yid Janitor emeritus at September 27, 2011 02:08 PM (UqKQV)

True, but that's where Romo needed to change the keyword.

Ok, guys.  On Cochise....READY BREAK!!!!

It's a copycat league.  Belichick has been cheating for years and winning, so why not?

53 50 If Obama really wanted to stick it to the rich, he'd get rid of employer-based health care and repeal ObamaCare.

He just wants to stick it to the rich who earn it on their own.  The fact is that the politically-connected politically-donating rich are just fine.  The Democrats have always been the party of Tammany Hall. Always.

54 So it's not impossible to get some improvement on the supply side, I'm just not sure how much of the problem it alleviates.

Well, you're probably right that it will take "both" to "fix" the cost of healthcare.  But I'll really point out the problem is with our perception that the cost of health care is "too high." 

It is distorted (to an unknowable, but probably very large) extent by government regulation and intervention, but the fact is that people are willing to pay what people are willing to pay.  If my insurance company is willing to pay 1000.00 for some procedure, that's their business.  The only time it "hurts" is when someone who is uninsured needs the same procedure- why should the doctor lower his rate for that person?

And, I think, that's what we should be talking about- price distortion, not "exploding costs."  It takes the discussion back out of the realm of hyperbole and emotion and back into the realm of economics and empiricism.

55 Very nasty for seniors, eay?  This is indeed bad news.   If the MFM ever starts reporting this and the left gets wind of it...  I shudder to think!
Our hegemony on killing old people will come to an end!
They'll start setting bag limits on old people!  They may allow killing of old people only in season!

We have to mobilize!  Don't let the MFM report this!

56 He just wants to stick it to the rich who earn it on their own.  The fact is that the politically-connected politically-donating rich are just fine.  The Democrats have always been the party of Tammany Hall. Always.

Posted by: AmishDude at September 27, 2011 02:14 PM (T0NGe)

But, NO ONE has gotten rich on their own.,......NO ONE!!!!!!!!

57 And, I think, that's what we should be talking about- price distortion, not "exploding costs." 
Posted by: AllenG

But you repeat yourself.

58

has the Perry-mania past yet?

 

is it safe for people with brains to speak again?

59 I don't see what's wrong with Obama's math. High health care costs are driven by high demand combined with insufficient supply. By lowering payments to doctors, less elderly will be treated. Then there will be less elderly, which will drive demand down. I don't know for sure, but I think I'm detecting hints of that genius in Obama everyone's been telling us about.

60 Paging Mr. President-elect Ryan, to the White House, your country needs you.

61

In a perfect world, the "replacement" for Obamacare AND Medicare AND Medicaid would be Pure Capitalism.

I'll tell you what ultimately is driving runaway medical costs, beyond the simply unavoidable fact the population is aging and therefore requires more medical attention: Government Involvement.

Here is something to consider, though... the Medical sector is at heart a Service Industry.  Well, we've said for years that ours is an increasingly Service Based Economy, right?  So if there is increasing demand for medical services, isn't that a good thing?  I mean, why should increasing demand for medical services be bad, but increasing demand for... I don't know, 3D Porn or something, be "good"?  I'm just saying that Obama's argument that too much growth in the medical services field will "bankrupt" us is as a society is wrongheaded... unless the government insists on being the payor and more and more of its budget gets sucked into it.  But that is an argument for less government involvement, NOT for efforts to somehow cripple the growth of the medical services sector.

 

 

 

62 But, NO ONE has gotten rich on their own.,......NO ONE!!!!!!!!

Posted by: © Sponge at September 27, 2011 02:16 PM (UK9cE)

They believe it.  The whole world is a big country club to them.  You have to get your certificate, you have to make contacts, you have to get your man on the inside of the clique.  They see the world as it was in ancient Rome.

63

OhÂ…  I thought I should warn you.  Sheila Jackson Lee is on to us.

64

and... if people would get it thur their thick skulls that it isn't the government's job to provide you with healthcare the system would right itself, as long as the government is involved things will only get worse.

 

65 59

You should see his plan to deal with the food shortages created by ethanol production.

66 High health care costs are driven by high demand combined with insufficient supply. By lowering payments to doctors, less elderly will be treated. Then there will be less elderly, which will drive demand down.

I don't know for sure, but I think I'm detecting hints of that genius in Obama everyone's been telling us about.

Posted by: Empire of Jeff at September 27, 2011 02:16 PM (z/Mo

In other words, if you remake the commercial and just have Obama pushing the old lady off the cliff and keeping the wheelchair, you've got ObamaCare?  Well, why didn't they just say so?!?  They're right.  Americans DIDN'T understand what they were saying.

67
Health care is currently a weird blend form of socialism and waste.

FIFY.  Socialism is inherently wasteful, full of graft and corruption.

68 We have been ass raped by the inside the beltway Republican establishment too many times.  When we hear "repeal and replace" we assume it means repeal the part that Obama's name on it and pile some more socialism on.

69 I think conservatives are worried when they hear the word "replace" because they assume it'll be just another social engineering attempt.

I think they're smarter than that, and they don't "assume it'll be just another," but instead they know, based on historical precedent and shit (and, especially, based on the fact that "replace" is the mantra of giant-government-forever scumfucks like Ryan), that it'll be the same but worse.

"Replace" means "rebrand." As conservative. As free-market. To make actual conservative or free-market reform impossible. Because "we tried that and look what happened."

Like always happens.

70 68We have been ass raped by the inside the beltway Republican establishment too many times. When we hear "repeal and replace" we assume it means repeal the part that Obama's name on it and pile some more socialism on.

Posted by: Bob Saget at September 27, 2011 02:21 PM (F/4zf)

 

 

hey! don't be spillin' the beans!

 

the rubes aren't supposed to catch on...

71 Government entitlement programs certainly need reform.  They need to be eliminated, but you cannot simply pull the plug.  They need  to be phased out - probably over a long period of time; and the phase-out needs to be done intelligently so the society doesn't collapse.

Well and good.  But the fundamental problem, IMO, is what it always is in economics: supply and demand.  Today, demand is artificially high because there is too much insurance - which means people can go to the doc any time they have the sniffles, and there is no cost.  That should change; however, the limit is that privately provided insurance (on whatever terms are agreeable to both parties) ought always to be available to private purchasers.

What about supply?  That, IMO, is where we really need to look at government.  I believe the supply of providers is kept artificially low by over-cautious regulation.  Both with respect to actual medical people, and pharmaceuticals.  There are plenty of EMTs, PAs and Nurse Practitioners (and maybe others) who are fully capable of handling cases they are not presently, legally able to handle.  That should change.  If nurses could treat cases of sniffles, docs could spend their time on more serious cases.

The caveat is disclosure.  A free market's efficient operation is dependent upon information.  If a provider has limited qualifications - don't keep him/her out of the supply - but provide that the limitations be disclosed.  Patients willing to lower their costs by patronizing a lower qualified provider ought to be able to do that.

Is it riskier?  Of course, and so I suppose it will never happen.  As a society, we are not willing to take risks pertaining to our own safety - we must be forced to wear helmets to walk across the street.  But I think we're not going to solve the underlying problems until we really tackle supply and demand at its roots.

Obviously, this is more complex than can be set forth in a Breitbart-comment.  But you get the idea.

72 It is distorted (to an unknowable, but probably very large) extent by government regulation and intervention, but the fact is that people are willing to pay what people are willing to pay.  If my insurance company is willing to pay 1000.00 for some procedure, that's their business.  The only time it "hurts" is when someone who is uninsured needs the same procedure- why should the doctor lower his rate for that person?

Posted by: AllenG
............
You don't understand health care pricing...

The insurance company only pays $300 for that $1000 procedure.  The schmuck with no insurance gets stuck paying the full price.

Insurance companies always have a pool of "preferred providers" with whom they have made pricing agreements.  it is beneficial to both parties.

The government has nothing to do with this arrangement.  Although the government does have separate arrangements similar to the above.. except they are not two sided "agreements", they are simply published payout amounts.

73 Of ObamaCare he says "Repeal & Replace," which I understand has become some kind of dirty word among some conservatives, who insist, contrary to the evidence, that almost nothing needs to be done in the area of health care.

I don't know anyone personally who says nothing should be done. Tort reform, allow states to op-in on national plans, ease up on taxes and other regulations with regard to medical technology and equipment (did that tax on toothbrushes as medical devices ever go into effect?) are a good start for change

74 61I'm just saying that Obama's argument that too much growth in the medical services field will "bankrupt" us is as a society is wrongheaded... unless the government insists on being the payor and more and more of its budget gets sucked into it.  But that is an argument for less government involvement, NOT for efforts to somehow cripple the growth of the medical services sector.
Posted by: CoolCzech at September 27, 2011 02:18 PM (Iaxlk)

Well put. I'd add that the question, "Why is the federal government involved in paying for medical care in the first place?" needs to be asked -- by everyone (as if!) ...

75 As long as we think of medicine or health care as a "right," we will end up where we are now. As long as we believe society must steal from some to pay for the healthcare of others, the scope of the theft will grow. The need of "others" is elastic yet never shrinks. It is as inevitable as old age. So if we are lucky, we dial the theft back a bit, maybe rearrange the paperwork and the bureaucracy. Nevertheless the inescapable problem and argument from the Left will always return, as it always does, to "What about the poor? You'll let them die?" Or starve? Or go without clothing? Or education? Or access to the internet? One way or another, we will have to argue for government spending less on "medicine." That is a very tough sell.

76

OhÂ…  I thought I should warn you.  Sheila Jackson Lee is on to us.

Posted by: Hussein the Plumber at September 27, 2011 02:19 PM (jx2j9)

When you sum Jackass-Lee's and Tavis Smiley's IQs, do you hit double digits?

77 When you sum Jackass-Lee's and Tavis Smiley's IQs, do you hit double digits? Yes, preceded by a negative sign.

78 Costs continue going up 2 or 3 times faster than GDP. There is something screwed up on a fundamental level here.

After reading this horse puckey, there was no reason to go on.
Anyone who spouts this garbage should be horsewhipped.
Of course health care costs increase at faster rates than other consumer goods and services.  It ain't hard to understand.  People live longer.  They therefore suffer from more chronic conditions for a longer period of time.  New medical technology means more tests and more therapy that costs ... take a wild guess ... more money.

To end on a positive note, I'm sure Michael Moore would be happy to post this load of fertilizer on his site.

79 I need to amend what I typed in anger.  When I said "inside the beltway Republican establishment"  I did not in any way mean to imply that the socialist Republican establishment outside the beltway was any better.

That is all.

80

Not very many people understand how actuaries calculate future health care liabilities.   They assume that health care costs in the next year will go up about what they've done given recent experience, then they assume that health care cost increases year-over-year will go down for several years, until they reach a "terminal" trend rate.   So that a typical health care trend rate actuaries might use would be:  12% in Year 1, 11% in Year 2, 10% in Year 3, and so forth, down to 5% or so in Year 8 and all years after that.

Oddly artificial, isn't it?   It reminds me of the chapter in the book "The Black Swan," called "The Scandal of Prediction," in which the author lambastes so-called professionals who pretend to be able to predict the future.   Nobody really believes that health care trends will look like that.   So why do they do it that way?

For a simple reason:  if they don't assume that something happens to lower health care cost trends long-term, health-care costs will eat all of our GDP within a couple of decades.    What that "something" is, no one knows.   But something has to happen.  

What can't be sustained, won't be.

 

81 Now, now y'all need to settle down and stop clinging to your guns and your religion and just accept that our good President Obama has got all of our best interests in mind.  Now be good crackers.  Good crackers.

82 The IPAB's purpose and function is price-fixing.

Price-fixing causes shortages and a decline in quality of the thing that is price-fixed.

This is so patently obvious and true that it's a wonder that the people who say otherwise can tie their own shoelaces. 

83 In business school they laughed at my idea for a mail-order leech business. Look who's laughing now assholes!

84 >> The insurance company only pays $300 for that $1000 procedure.  The schmuck with no insurance gets stuck paying the full price.

Rarely. The schmuck with no insurance is usually on Medicaid or some other public assistance program and we taxpayers get the joy of picking up the tab.

85 86 >> The insurance company only pays $300 for that $1000 procedure.  The schmuck with no insurance gets stuck paying the full price.

Rarely. The schmuck with no insurance is usually on Medicaid or some other public assistance program and we taxpayers get the joy of picking up the tab.


Actually, a lot of providers have a much-discounted rate for uninsured patients.  Ask sometime.  Most people don't realize that because they have insurance.

86

Last time I checked, there was no constitutional requirement that you had to be a lawyer to run. The fact that so many do (and win) may be more telling about other professions than lawyers. You want more doctors, business people, whatever to get elected........get them to run and win.

Posted by: Mallamutt, RINO President for Life at September 27, 2011 02:25 PM (OWjjx)

Actually, in many states it is a requirement to be a member of a third of the government -- the judiciary -- even though state (and federal) constitutions aren't long, aren't complicated and are written in English. So there is no a priori reason that someone who is subject enough to the law that he's expected to follow it should have to be a member of a fundamentally corrupt profession in order to determine the constitutionality of a law.

It's not a formal requirement at the federal level but, if they weren't corrupt, any discrimination lawyer should be able to win a discrimination suit against the judiciary for excluding non-lawyers from government.

Also, such requirements violate Article IV, Section 4 of the US Constitution.

The profession itself is government-created, government-fed and government-dependent.  A lawyer taking elective office is engaging in a huge conflict of interest and the result can be seen among the Ivy League lawyers in the corrupt Obama administration.

87 Here's my solution:

Universal Catastrophic Coverage

Let's have a program that takes no income tax dollars. It is funded by a new payrol tax, let's say 2% (just like the current Medicare contribution).

We pool those contributions and pay for all "major medical" procedures above a set amount.  That could be $15,000 per year.. or maybe higher..

This is administered by private insurers who would then try to sell you (but you would not be forced to buy) insurance to cover the gap between $0 and the where the catastrophic amount kicks in.

You would have the choice to not get any gap cvoverage - many young healthy people would choose to do that.  Or you might choose to get a high deductible gap coverage to keep premiums down.

Employers who feel generous may purchase a no co-pay coverage for their employees..or anything in between.

The bottom line here is that the gap coverage would be dirt cheap.  There is no high-end risk for the private insurers.

So, what we've done is created a pool of 300 million people for high end catastrophic illnesses only.  And we've put management of low-end day-to-day medical treatments back in the hands of the consumer.

The really poor can have gap coverage subsidized by the government.. but here's the cool part.. we are now subsidizing only that cheap gap coverage.. and perhaps on a sliding scale.. with co-pays maybe!

The low-end treatment will likely move to managed care organizations with the insurers partnering with care givers.. idea: go to Wal-Mart Insta-Care for your initial visit and pay no co-pay!

It's a hybrid system that conforms to the American desire to be in charge of their own health care, while still providing a safety net in case of catastrophic, unforeseen illnesses and accidents.

88 The IPAB's purpose and function is price-fixing. Price-fixing causes shortages and a decline in quality of the thing that is price-fixed. Feature, not bug.

89 Of course health care costs increase at faster rates than other consumer goods and services.  It ain't hard to understand.  People live longer.  They therefore suffer from more chronic conditions for a longer period of time.

There's that, there's the third-party payments and there's the fact that "health care" is a hell of a lot better now than it was before, even for lower cost.  But if you want the latest medicine and procedures, you have to pay.

If you want 1950s healthcare -- which was just fine for 1950s people -- you pay a hell of a lot less.

90 If you want 1950s healthcare -- which was just fine for 1950s people -- you pay a hell of a lot less. That is seriously the plan. I mean it like a heart attack. The Left would rather see the rabble (not themselves, naturally) all equal with half-century old medicinal practices than a society with disparity in treatment. Again, the elite Left knows, like the Politburo, they plan to be immune to this.

91 @92 Sock won't come off.

92 Chi-Town Jerry, So, essentially you've invented... Social Security. Only its purported use is for health care, not living expenses. And why would Congress keep their dickbeaters off of this pool of money, replacing it with non-marketable treasuries, just like Social Security?

93 My insurance premiums have gone up by about 15% this year, so I'm looking to cut back, since in this crappy job market, the only work I can get is contract work with no benefits, so I have to pay out of pocket for all of it. And the govt just significantly raised my expected payment for my student loans, so frankly I'm not sure I should even bother paying for insurance anymore. But then I'd be one of those "uninsureds" and subject to an eventual penalty. F--- the government.

/rant off

94 That is seriously the plan. I mean it like a heart attack.

Oh, yes.  In Great Britain, anybody in the upper middle class has private health insurance and goes to private hospitals. It's only the warm fuzzy knowledge of wretched (but universal) healthcare that keeps the whole thing going.

95 It's almost as if everyone is dancing around the fact that nothing is free, not even medicine. And if you can't pay for it, then you force someone else to pay... unfortunately someone else eventually runs out of money too.

96 This is what he had to say about prices:

"Health care providers have no incentive to provide transparent prices to their patients, because their patients don’t pay directly – it’s the government bureaucrat or the insurance company bureaucrat who pays the bills."

97 Posted by: Empire of Jeff
.........
No.. nothing at all like Social Security. 

First off, all funds are used up each year unless you have a "healthy" year.. the unused funds remain in the fund for the next year.. these things should average out over several years.

Second, you are not paying for someone else.. because it is just as likely that you may need to use the funds as someone else.

A few "features".. this would not replace Medicare necessarily.  This would be for everyone else.  Medicare's high-risk patients need to be in their own plan.

Also, this would have to be out of touch of politicians wishing to raid it.  Untouchable.  Or, yes, it would fail almost immediately.

The point is, it brings down health care costs (insurance premiums, government-paid insurance and real health care costs) in short order.

98 Look, here's the thing. A majority of the current gov mission performs so poorly that a secondary market develops for those who want something better performing. Education Mail Transportation Food Medicine Law And that means you pay twice, once for the shit that is not satisfactory, and again to fill your real requirement. This will not go away, so better to stop whining and develop a skill that will be appreciated by the upscale marketplace. It is not difficult to provide a service that is superior to the gov product. And the people who don't see the difference will be shitty clients anyway.

99 Posted by: Miss80sBaby
........
That's just plain wrong.. I get a "Statement of Benefits" every time my insurance company pays a bill.  It shows how much the doctor billed, how much the insurance company discounted, and how much they paid.  And sometime how much my portion is if I have not met my deductible.

How much more transparent can you make it????

100

The Democratic plan is to do no reforms to the system at all, and just cut the amount of money paid to health-service providers -- who, let me be clear, will simply stop treating Medicare patients. Oh, the sort of doctors who can't otherwise attract a clientele will treat them; but the sort of doctors willing to work for the government's cost-controlled cut-rate reimbursements are not, let us say, top shelf.

You miss the obvious - the next obvious step is for Congress to pass a law that requires doctors to take every medicare patient that comes along.

You scoff and say it won't happen now that the GOP controls the house?  What do you think will happen if Obamacare survives SCOTUS and the next administration doesn't repeal?

First, as Obamacare takes affect, seniors start to lose their doctors.  then, we have night after night of stories about seniors who can't get any doctor to see them.

then, the GOP caves and agrees to pass a law requiring doctors to treat medicare patients b/c not doing so is "discrmination".

I guarantee you that will happen regardless of who has congress. 

101 That's just plain wrong.. I get a "Statement of Benefits" every time my insurance company pays a bill.  It shows how much the doctor billed, how much the insurance company discounted, and how much they paid.  And sometime how much my portion is if I have not met my deductible.

How much more transparent can you make it????

Posted by: Chi-Town Jerry at September 27, 2011 02:51 PM (f9c2L)

It doesn't matter whether an individual can see the costs - as long as they aren't paying directly, they don't care.  That is the 3rd-party payer problem. 

102 First, as Obamacare takes affect, seniors start to lose their doctors. then, we have night after night of stories about seniors who can't get any doctor to see them. then, the GOP caves and agrees to pass a law requiring doctors to treat medicare patients b/c not doing so is "discrmination". That is a disturbingly realistic scenario. Already many doctors have stopped taking Medicare patients as it is now.

103 Some of his ideas sound good but I would like more specifics, especially when it comes to incentives.

104

Supply and demand, folks.

If something costs too much, there ain't enough supply.

The AMA has a chokehold over American medical schools. They keep the doctor supply low, on purpose, by refusing to accredit med schools that don't play by their class limit rules and by gaming the licensing systems.

And universities have a good reason to comply - money. Med schools are expensive to establish and run. Law schools aren't. Just stick another chair at the end of the row and collect the tuition in law schools.  Med schools have to have labs and expensive facilities.

There are thousands upon thousands of people both here and abroad who are perfectly qualified to hand out Z packs and diagnose strep throat. I went to college with at least ten very bright folks who didn't get in to med school (all white guys) who would have made wonderful doctors. The AMA and the bureaucrats just need to get out of the way and the med schools need to educate these people, then they need to have an incentive (making enough money to pay off their student loans before they're 50) to set up a clinic on every corner and take the pressure off the ERs.

BTW anybody recently looked at photos of an old hospital ward from 50-60 years ago? That's how hospitals kept costs down.... 12 people to a room, with 1-2 nurses who actually cared about their patients roaming around.

105

Wow, if only we had a system where a non-lawyer could, oh, I don't know, gather up signatures on a piece of paper and get himself or herself on the ballot, something like a petition.

A lawyer would challenge it.  Bring it to a judge.  The judge (also a lawyer) would strike it down to help his lawyer buddies. (This is not hypothetical, Obama did just this.)

But you haven't addressed my issue of the judiciary and the Article IV, Section 4 violations.

I do agree with you.  I think there has to be a fundamental coordinated anti-lawyer campaign to educate the populace on the foolishness of introducing the endemically corrupt legal profession into the legislature.  That way we can get some real reform.

If we don't have such a campaign, people will keep electing lawyers as if lawyers are real human beings.

a tacit admission that your rantings were nothing more than another sign of your utter disdain for lawyers devoid of any factual basis .

Lawyers are, by definition corrupt.  There aren't any theorems to be proven, it's axiomatic.  Lawyers are to corruption what ants are to a picnic.  Follow the lawyers and you'll see where the rancid meat and spoiled milk are.

Lawyers are the lubricant by which corruption enters the body politic.  We have to make it unprofitable to do so.

Your obvious answer seems to be to continue to rant and rave about the number of lawyers to little avail.

Lawyers are very good liars.  It takes some effort to dislodge them.  They have infested the system for a very long time. That's why we need to shine light on them.

Or, in math terms (I seem to recall you were a math professor) your formula is

x+y=z

Yeah...don't try that.  Seriously, leave it to the experts.  In fact, let's do what the lawyers do.  Let's make it illegal for anybody but certified mathematicians to engage in arithmetic.  Then, anytime you have to do so much as add two numbers, you have to pay me.

A lot.

Well, I might work pro bono for people whose political positions I like, but I'll just use my other clients to subsidize those.

106 Meantime, HHS Secretary Shecantbeserious refuses to even crack down on Medicare waste. I just interviewed a gentleman who's filed a Whistleblower lawsuit against a lab, because HHS won't do its job properly.

107 101 Look, here's the thing. A majority of the current gov mission performs so poorly that a secondary market develops for those who want something better performing.
Education
Mail
Transportation
Food
Medicine
Law
And that means you pay twice, once for the shit that is not satisfactory, and again to fill your real requirement.

Posted by: dr kill at September 27, 2011 02:48 PM (le5qc)

God, that's a brilliant point.

108 ChiTown - those things are extraneous info, Adam Smith's pimp hand hits when you pay the bill, not a month later when the small print comes

109 Exactly dr kill, the first step in going galt is sending your kids to private school, the second step comes when you get the property tax bill for schools you arent using.

110 Shakespeare described that "fundemental, anti-lawyer campaign" a long time ago - revolution.

111 >>>which I understand has become some kind of dirty word among some conservatives, who insist, contrary to the evidence, that almost nothing needs to be done in the area of health care. That's not true at all. Of course the old system needed fixing. But a topic you've lectured us on time and time again, the difference between a recall and a normal election, that when faced with a or not a the argument is a lot easier than arguing for b in an a and b situation. Why people love generic republican but any specific republican has trouble. Instead as a first step of losing support while arguing over the merits of the conservative replacement which would as a necessity skewer some sacred trial lawyer cows, keep the focus on how much O care sucks. Once we can get support to get rid of it, and we do get rid of it, then build a consensus for a new plan. I personally don't want to see a new plan until ocare is gone, that way I can actually debate the new plan instead of having to defacto defend it as is just to get rid of ocare.

112 ChiTown - those things are extraneous info, Adam Smith's pimp hand hits when you pay the bill, not a month later when the small print comes Posted by: Jean
..........
Ok.. but you assume no one wants to insure themselves - or, even worse, your ideal is not to allow anyone to insure themselves.  That's almost more intrusive than the cockamamie schemes the libs come up with.

113 Am I the only one who believes ObamaCare's ultimate goal is to do away with Medicare and put everyone on the exchange?  Why don't seniors see this?  Medicaid for EVERYONE: what could go wrong?

114 117 Am I the only one who believes ObamaCare's ultimate goal is to do away with Medicare and put everyone on the exchange?  Why don't seniors see this?  Medicaid for EVERYONE: what could go wrong?

One example of that is the IPAB, which was introduced for Medicare but will be used in ObamaCare and everywhere else.

115 Re: conscription for medical doctors. When doctor buds come over for dinner, I always plug in Dr. Zhivago. Always a big hit.

116

Look, spill your guts, we are all friends. We are here to help.

Posted by: Mallamutt, RINO President for Life at September 27, 2011 03:20 PM (OWjjx)

I've said this many times before.  In 2008, Barack Obama had exactly one credential for running for the presidency: He was President of the Harvard Law Review.

That's it.  That's the list.

Look.  If I were to have a full frontal lobotomy, the piece of my brain that they take out could graduate from Harvard Law.  I might even write something that would be published in the HLR.  Granted, I would be bored out of my mind at the tedious simplicity of it all and the fact that my fellow students would not have the intellect to compete in a real graduate program against, you know, foreigners.

Yale Law graduate (and hence supergenius) Hillary Clinton said, essentially, that math was too hard for her and seemed to think that didn't diminish her in the least.

Trust me, ain't no math majors quaking in their boots about the difficulty of a Con Law course.

I also realized just how easy the profession is but how much power having all those connections gives.  They set up barriers to entry and get rich off of hard-working honest people, particularly in moments of misfortune.

I began to realize that law school teaches all the wrong lessons: Life is a zero-sum game, you don't earn a living from exchanging goods and services voluntarily, a ruling by a judge settles everything, lawyers are smart enough to make our decisions for us, etc., etc.

They are exactly the wrong people to be our ubermensches. In large part, they have absolutely no problem-solving skills, that's why they major in polisci or English or worse. That's why math is too hard for (most of) them.

Of course, I've noticed you're using the typical lawyer trick.  When you can't argue the facts, resort to ad hominem.  Or something.

Why I or my personal psychology is important, I have no idea.  I just chalk it up to being important.

117 Actually, a lot of providers have a much-discounted rate for uninsured patients.  Ask sometime.  Most people don't realize that because they have insurance.

Posted by: Roger at September 27, 2011 02:34 PM (tAwhy)

I went to a Doctor in Texas for knee surgery (and/ or rehabilitation).  My insurer told me to pick three Docs that would be the cheapest.  I chose the more expensive Doc, because I found he was the premier knee Doc for rodeo injuries.  I was denied by my insurer.  I told my Doc this and he said no problem and gave me a $900.00 "discount".  I asked why.  He said it was because the insurance company hiked up the payment so much, he had to chose to make up for the lack of payments that he did because of mediscare, medicaid  and such.  I had excellent surgery and care, before and after. 

I went to Doc in N.Y., for a flu bug.  I was told it would be $75.00 for the office visit.  When the visit was over, and told the front desk I would be paying in cash, they looked at me as like I had lost my mind!  They weren't even sure they had change on hand, luckily I did, but I told them I would run next door and get some if they didn't.  My charge for the office visit?  $42.00.

Go figure!

118 http://tinyurl.com/mrghrq

The link above is to one of the best articles I've seen on this subject.

Like so much in this administration, a lot of the problems come from the FDR administrations. The whole idea of employer provided health insurance took root then as a reaction to the wage controls imposed during the war. We know well today that wage and price controls are a very bad idea and only lead to a situation worse than what they try to correct. Worse because they substitution of benefits like health insurance for higher wages lead to the growth of a massive market distorting parasite that should never have existence for non-catastrophic situations.

But once again, because it was too unseemly to put up a real fight, the left kept moving the definition of normal farther and farther in their preferred direction, to the point where hardly anyone living can remember we didn't do things this way and hasn't necessarily been an improvement.

The idea that 1950s prices deliver 1950s health care is nonsense. By that logic, the device you're using to read this should be valued in the millions of dollars instead of being affordable to anyone in the middle-class. Improved and new technologies can introduce new costs but just as often drastically lower the cost of doing some things. (The downside is that technology enables the existence of the bureaucratic behemoth of the health insurance industry.) Diagnostics are ultimately lowering many costs by virtue of early detection and improving accuracy. I can recall when there were just seven locations in the entire US performing MRI services. Now there are thousands and the price of setting up a new facility is a fraction of what it once was, even though the newer systems are much better. We're also seeing the advent of cheap mass produced diagnostic devices that give results in minutes that formerly took days.

We can do vastly more today and that means we can spend vastly more but it also means we can do much of it far better and cheaper. The day when you go to your local drug store and buy a little box that takes a blood sample, determines you have a cancer still so small that surgeon couldn't see if viewing the organ directly, and injects you with a drug to kill the rogue cells and only them, is still a long, long way off. But the potential is there and getting closer.

In terms of technological advancement of medicine, we should be very pleased with our progress since WWII. But in terms of how we've nearly destroyed the business of medicine we should only feel shame.

119 My charge for the office visit?  $42.00.

It would be that -- or lower -- if everybody paid cash.

It's simplistic, of course, but those with insurance pay $75 to make up for those that pay $0 or those who, with their insurance, pay $30 for that negotiated rate.

Think about it.  You have the flu, you shouldn't need to see a doctor, a PA would be better, in fact.  In that case, and in most cases, doctors are "prescription-writing machines".

120 The idea that 1950s prices deliver 1950s health care is nonsense. By that logic, the device you're using to read this should be valued in the millions of dollars instead of being affordable to anyone in the middle-class. Improved and new technologies can introduce new costs but just as often drastically lower the cost of doing some things.

You're right, of course. (Although an office visit would probably be more expensive today even in a truly free market.)

121 In my experience, as we always pay for our office visits, we NEVER get a cut rate. I have asked, and the staff looks at me like I am a nut job. I guess MI doctor's offices don't need to give a cash-rate.

122 125 In my experience, as we always pay for our office visits, we NEVER get a cut rate. I have asked, and the staff looks at me like I am a nut job. I guess MI doctor's offices don't need to give a cash-rate.

Posted by: Lonelyconservativeinmi at September 27, 2011 04:49 PM (rZZA3)

You should call around. Could just be your doc.

123 Think about it.  You have the flu, you shouldn't need to see a doctor, a PA would be better, in fact.  In that case, and in most cases, doctors are "prescription-writing machines".

Posted by: AmishDude at September 27, 2011 04:45 PM (T0NGe)

I agree AmishDude.  I guess what I was trying to get across was that at that point and time my flu was so bad as the threat to be hospitalized for it.  A nurse or PA could have done the same as the Doc did.  The knee thing was "out-patient", even though I spent all day in their "outpatient" clinic.  The other doctors for the knee surgery wanted me in the hospital for 3 days, plus the weeks of rehab, which (the rehab) I was able to do just fine on my own, due to the expertise of the knee Doc and his staff.

I got my moneys worth from both of them, though.

124 jwm, the point I should have made is that PAs are better not just from a cost perspective but from experience.  PAs see that kind of thing all the time.  The knee thing really requires some specialized knowledge and experience.

125 @128 AmishDude,

Yes, I understand that.  That's why I went with knee specialist.  If I had a PA to go to for the flu, I would have done that.  The knee specialist was in Texas.  The GP Doc was in N.Y.  Just goes to show ya how things are different all the hell over.  *grins*

126 #124

But is it an acceptable cost? If the typical office visit, by virtue of improved technology, deeper knowledge, and better means to access that knowledge (which takes us back to improved tech) at the doctor's command, allows for detecting a far greater range of ailments and threats, then aren't we potentially getting far greater value that the increase in cost?

In some cases it is correct to say it used to be cheap because there wasn't much on offer. But we've done more than just learn to treat more diseases. Many things we do far better than the same common procedure in past decades.

I had my appendix out when I was six. (1970) I was laid up for several days and it was a couple of weeks before I could move around freely and comfortably. Now, they have techniques to do the same surgery with a hole so small it barely leaves a detectable scar and so much less abdominal  muscle damage the patient is up and around in far less time. This is real progress and if a modern appendectomy costs a bit more after inflation, it's worth it.

It would be preferable if the techniques reduced cost along with the other benefits. I believe that will come but in medicine, like many other fields, finding something that works regardless of cost is step 1. Though I suppose the big win would be if they could actually treat and cure appendicitis rather than yanking it out.

127 Obama is a stuttering clusterf*ck of a miserable failure.

128

Health care is currently a weird blend of socialism and waste. Costs continue going up 2 or 3 times faster than GDP. There is something screwed up on a fundamental level here.

======

Yes, exactly.  A few of the fundamental assumptions of the Law of Supply & Demand are violated with the critical portions of healthcare.  If you understand the assumptions and look at why they are not applying in a clean manner, you can find all the answers and make some good guesses at solutions.

Here's a hint, diminishing marginal valuation does not apply to your liver.  The price is irrelevant, and you will never take the 2-for-1 sale.  When the demand line becomes too steep, the situation is ripe for unethical behavior by those who control supply.

129 we NEVER get a cut rate

Blame Medicare.

If your Doc accepts Medicare, he CAN'T give you a discount.

130 #122 Uh, no.  Whoever wrote that is clueless.

131 Focusing on "replacing" it is like focusing on "fixing immigration:" without stopping the flow of illegals.

Repeal first.  Fix the economy. When jobs are coming on strong, then worry about getting government out of the healthcare business.  (If Ryan's plan doesn't do that, then it's a total waste of time.)