Obama-Care based on inaccuracies

[dnf777]

Isn't this inevitable in a system that depends upon employers to provide healthcare insurance?

Yes, in a way it does, but I'm not sure why. Who pays the premiums shouldn't matter in regards to coverage policy.

Morris Fishbein (JAMA editor and very influential medical administrator of the 30s and 40s) warned against employer provided coverage, and his warnings have proven true. Back then, a day is the hospital was $5, and it was more of an enticement to employment that actual significant benefits.

Providing healthcare to a population (or deciding to let it provide for itself) is probably one of the MOST complex social/governmental issues that has faced modern man. Anyone who claims to have all the answers, or even thinks its a single-faceted solution is crazy, or trying to push an agenda! One this is for sure....when there's this much money at stake, there WILL be corruption involved.

[TXduckdog]

That is true. But remember, we all tend to consume more health care dollars as we age. (LIFE is a pre-existing medical condition!) As it is now, we all bring that condition to medicare, as we hit 65. The private insurance companies are no dummies, and have decided "we'll take you premiums and dole out very few precious claim dollars to young, healthy people, but we know that won't last...so when you hit 65, let Uncle Sam pick up the tag....we're done....you're no longer profitable for us"

the whole concept of insurance, spreading the risk/cost goes out the window. We know "risk" increases with age, and they have concocted the ultimate cherry-picking scenario.

NO easy answers here. But the current system is unsustainable. In the end, we're probably ALL going to pay more. Whether a little more or a lot more depends on the plan put in place, and obviously, nobody has the answer right now.

Avoid the Western Diet and live healthier regards,
Dave

Dole out precious claim dollars= rationed health care
All are going to pay more= in more ways than we know and not all in $$$$

Fascinating discussion.....thats why its so damn important to get this health care thing right.

[Gerry Clinchy]

That is true. But remember, we all tend to consume more health care dollars as we age. (LIFE is a pre-existing medical condition!) As it is now, we all bring that condition to medicare, as we hit 65. The private insurance companies are no dummies, and have decided "we'll take you premiums and dole out very few precious claim dollars to young, healthy people, but we know that won't last...so when you hit 65, let Uncle Sam pick up the tag....we're done....you're no longer profitable for us"

I totally agree, Dave. The elderly, logically, become the most expensive patients. The premiums to cover their health care become unsustainable.

the whole concept of insurance, spreading the risk/cost goes out the window. We know "risk" increases with age, and they have concocted the ultimate cherry-picking scenario.

Under a public option, the private insurors will still be able to cherry-pick the "gap" coverage, as they do with Medicare. They may have to provide a policy specified by law, but will they have to charge the same premium as the public option? If not, then the govt plan would have the same problem it has with Medicare. The high-maintenance patients will opt for the the lowest cost program, which is likely to be the govt plan.

I think the Medicare situation developed precisely as a result of the premise of spreading/risk cost. In order to cover the elderly, the premiums had to get very high, even though they had lower-risk insureds to help spread the risk/cost.

I think the resulting care denials stem from the fact that even with the higher premiums we all have experienced, even though many low-cost insureds are present in the insurors' overall insured populations, the impact of just a few high-cost insureds blow everything out of the water actuarily.

That is rooted in the costs of the care as a result of medical advances (which few of us would want to give up).

NO easy answers here. But the current system is unsustainable. In the end, we're probably ALL going to pay more. Whether a little more or a lot more depends on the plan put in place, and obviously, nobody has the answer right now.

Absolutely agree. There ARE no easy answers. But there could be some logical steps to take. If tests are ordered to protect the doctor/hospital from litigation, then there needs to be tort reform & truly medically-driven "best practices". Fraud in the system (private, Medicare, Medicaid) has to be forcefully addressed. The medical profession has to effectively find a way to get the really "bad" doctors out of practicing medicine. That would mean addressing the licensing nightmare with common sense, a combined effort of govt & the profession. The legal profession could also benefit from some similar reforms

If the legislators attacked some of these issues with issue-specific legislation, then I think that the voters might have more faith in govt's ability to do something fiscally responsible and useful to the overall situation. These individual issues could certainly attract bi-partisan support. If a public program is inevitable, then these issues have to be "fixed" before it could deliver care any better than what we have.

I'm not in favor of sticking it to doctors and hospitals that do a good job. There is a lower limit to what costs are/will be for the care from dedicated, gifted professionals.

[YardleyLabs]

The primary source of the cherry picking problem now is actually that portion of the population that bets that it will not require significant care and therefore chooses not to obtain appropriate coverage. When these people do become seriously ill, they become public charges either by qualifying for Medicaid or by becoming part of that group of uninsured who do not pay their bills. Most insurance companies would be happy to provide universal coverage for any group that guaranteed 100% participation. In the absence of that guarantee, the companies worry about the "moral hazard" effect (insurance jargon) under which people only buy coverage when they believe they are likely to need it. That dramatically increases the risk of insurance for the carrier.

The other gamesmanship involved in coverage decisions is deciding who gets stuck with the bill. While much of the population is uninsured, a large percentage are actually covered under more than one plan. This also makes rating decisions more difficult and plans expend a significant effort arguing over which plan is responsible for which costs.

Finally, plans compete for providers but in a manner that is sometimes perverse. One one hand, every plan wants to have enough providers in the most common specialties to make their plans attractive. However, they do not necessarily want to have a wide selection of providers in the most expensive specialties and they can benefit from provider turnover. For example, if I have a chronic ailment such as asthma, and my insurer convinces the provider the stop accepting payment, the service becomes an out of network service. The insurance company still only pays the amount they would have paid for an in network physician. However, the care is now subject to much higher deductibles and co-payments. While this type of behavior is not very common from the biggest insurers, such as the Blues, it is found among those with smaller market shares. Under a plan that I offered through my company for a period of three years, it became apparent that primary care providers were being flipped almost annually by the insurer (HealthNet).

Decisions on ways to legitimately reduce health care costs are difficult. However, one of the advantages of universal coverage and minimum plan requirements is that they would reduce the incidence of some forms of "gotcha" coverage. Individuals would not be able to play the odds on purchasing coverage making rating decisions easier. Insurers would not be able to discriminate against individuals or groups based on health need, making that type of gamesmanship less prevalent. Smaller employers would be grouped together for rating purposes, reducing risk for insurers and costs for employers.

The problem with a piecemeal approach is that it will tend to increase the opportunities for "gotcha" coverage by leaving gaps for exploitation. If there is going to be anything piecemeal, I would prefer to see a less comprehensive minimum coverage requirement while retaining universal coverage. In my mind, I do not think any significant reform is possible without universal coverage.

[txbadger]

"• We need to implement "best practices." Mr. Obama and his advisers believe in implementing "best practices" that physicians and hospitals should follow. A federal commission would identify these practices. "

The devil is in the details which would be determined after passage.

Bottom lne is 85% of the people have health insurance and the attempted power grab with limited details, no real proof of how to fund it nor what'll be covered was doomed to fail.

My solution of open enrollment into the Federal employees plans with the enrollee paying the gross cost. Pick the plan you want, which for record are private insurance plans, pay the premium and enjoy. Then We may have the same coverage as Our employees.

[Gerry Clinchy]

The problem with a piecemeal approach is that it will tend to increase the opportunities for "gotcha" coverage by leaving gaps for exploitation. If there is going to be anything piecemeal, I would prefer to see a less comprehensive minimum coverage requirement while retaining universal coverage. In my mind, I do not think any significant reform is possible without universal coverage.

Just for clarity, I am not suggesting a piecemeal approach to health care coverage.

However, I fail to see how tort reform in advance would interfere with a universal coverage package, if the latter does result. Tort reform encompasses many fields, like product liability.

I don't see how correcting the licensing nightmare would interfere either. Or seeking out fraud and abuse, and doing something really meaningful about that.

Even when someone might come up with a universal coverage idea that is promising, these other issues could be addressed now.

Just saw that Massachusetts is having to temporarily cut back on its med coverage for legal (that is legal) immigrants (with green cards for less than 5 years). This is to help their budget deficit problems.

[YardleyLabs]

Just for clarity, I am not suggesting a piecemeal approach to health care coverage.

However, I fail to see how tort reform in advance would interfere with a universal coverage package, if the latter does result. Tort reform encompasses many fields, like product liability.

I don't see how correcting the licensing nightmare would interfere either. Or seeking out fraud and abuse, and doing something really meaningful about that.

Even when someone might come up with a universal coverage idea that is promising, these other issues could be addressed now.

Just saw that Massachusetts is having to temporarily cut back on its med coverage for legal (that is legal) immigrants (with green cards for less than 5 years). This is to help their budget deficit problems.

I actually have no problems with the theory of tort reform. It's the reality that makes me hesitate. Right now I believe that managed care companies and pharmaceutical companies get too much of a free pass and that doctors and hospitals are left holding the bag. In some areas we have entire classes of care that are financed largely if not primarily through legal settlements. An example of this is care for children with cerebral palsy. Much of the lobbying for tort reform comes from the drug companies and managed care companies seeking to preserve their protected status. With respect to physician malpractice, tort reformers tend to want to limit the payout even when costs are real. Neither of these approaches addresses the real issues. Universal health coverage would actually take some of these issues off the table. Health insurance programs should not be able to limit coverage for items such as birth defects that may require lifelong care. By requiring everyone to be covered, the cost is spread widely. That would reduce the scope of damage awards in a manner that would make stricter adherence to demonstration of gross negligence more feasible and would also limit attorney fees paid for recovery of direct care costs.

In cases where gross negligence is involved, I believe patients deserve their day in court. My ex was involved in a case where a quadriplegic who had enough mobility in a few of his fingers and in his head to be able to to control a variety of equipment. That allowed him to, among other things, attend college. While being transported, his chair was not secured, the doors of the vehicle were not fully closed, and the driver drove with rapid starts and stops. Finally, his chair flew out the back the back of the vehicle and his neck was broken again. He lost all the movement that had previously permitted him to live his life. The insurance company argued that he was a quadriplegic before the accident and a quadriplegic afterward so there was no real injury other than medical bills that were paid by Medicare. Happily, the jury did not agree.

[Gerry Clinchy]

his chair flew out the back the back of the vehicle and his neck was broken again. He lost all the movement that had previously permitted him to live his life. The insurance company argued that he was a quadriplegic before the accident and a quadriplegic afterward so there was no real injury other than medical bills that were paid by Medicare. Happily, the jury did not agree.

This does not sound like a medical malpractice suit, which would have been part of the health care coverage topic.

I don't think that anyone would be against removing all tort options for people, but there is surely a need for laws to prevent frivolous suits.

In the real world, defending oneself against even a frivolous suit is so costly, that the defendant just "settles". The attorneys have to be the worst at policing their own in the matter of frivolous lawsuits. Even though Pennsylvania has such a law, it doesn't get used much because of the cost of pursuing such a suit.

That would reduce the scope of damage awards in a manner that would make stricter adherence to demonstration of gross negligence more feasible and would also limit attorney fees paid for recovery of direct care costs.

That may be more of a "guess" than fact. Until the attorneys are penalized directly for bringing the frivolous suits, they will continue to throw their hats in the ring ... they have nothing to lose.

Was involved in my first and only real estate suit a couple of years ago. Generated about $60,000+ in legal fees. End result: the complainant was dead wrong. Took a year and a half to get in front of a judge. The judge saw the truth very quickly. There was a "settlement". The compainant's attorney actually made the legal error himself! He collected about $25,000 of those fees. Cost the complainant total $40,000 or more for his attorney's error. Unconscionable!

[YardleyLabs]

This does not sound like a medical malpractice suit, which would have been part of the health care coverage topic.

I don't think that anyone would be against removing all tort options for people, but there is surely a need for laws to prevent frivolous suits.

In the real world, defending oneself against even a frivolous suit is so costly, that the defendant just "settles". The attorneys have to be the worst at policing their own in the matter of frivolous lawsuits. Even though Pennsylvania has such a law, it doesn't get used much because of the cost of pursuing such a suit.



That may be more of a "guess" than fact. Until the attorneys are penalized directly for bringing the frivolous suits, they will continue to throw their hats in the ring ... they have nothing to lose.

Was involved in my first and only real estate suit a couple of years ago. Generated about $60,000+ in legal fees. End result: the complainant was dead wrong. Took a year and a half to get in front of a judge. The judge saw the truth very quickly. There was a "settlement". The compainant's attorney actually made the legal error himself! He collected about $25,000 of those fees. Cost the complainant total $40,000 or more for his attorney's error. Unconscionable!

It was medical malpractice because the ambulance company was providing a medical service paid through health insurance. The defendant ws a company, not a doctor.

Been there, done that on frivolous lawsuits. In my case it was a wrongful termination suit with violation of "liberty" rights and due process with a personal potential liability of $1 million. The case lasted five years, ending with a jury trial. In that case the judge posed more than 50 questions to the jury with respect to the facts and in every case the jury found in my favor. In this case the plaintiff had actually been ordered to pay legal costs of an employer when she had filed a similarly frivolous employment suit ten years earlier. We were not allowed to introduce that into evidence because it was deemed prejudicial and not germane. In that case the judge wrote that in his entire career he had never witnessed a more perjurious individual or a more abusive use of the courts.

[Buzz]

It was medical malpractice because the ambulance company was providing a medical service paid through health insurance. The defendant ws a company, not a doctor.

I didn't see that it was an ambulance company in the original post.