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Thread: How's That Obamacare Doing...

  1. #21
    Senior Member Buzz's Avatar
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    Quote Originally Posted by YardleyLabs View Post
    The best thing that could happen in this country to control health care costs and to improve our economic competitiveness is to get employers completely out of the business of financing health care. I find it interesting that those who complain about "ObamaCare" are almost invariably covered by insurance paid for by someone else. I don't see anyone out there fighting to pay the bills themselves.

    I find it unbelievable that those who think you should never tax rich people and businesses, hate the minimum wage, hate regulation, and think that labor makes too much money, are just fine that employers should pay their healthcare bills. Don't they realize that these folks just pass the cost on to the rest of us in the price of their goods? Don't they realize that foreign goods have a competitive advantage because they don't have to pay healthcare costs?
    "For everyone to whom much is given, of him shall much be required." -- Luke 12:48

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  2. #22

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    Since Yardley is a wealth of statistics I am sure he can address the issue of fraud and waste in the medicaid and medicare system and give some insight on how increasing the governments involvement will be a better use of our medical dollars. Sincerely a medical professional for 20 years dealing with the public in which some get "free medicine".

  3. #23
    Senior Member YardleyLabs's Avatar
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    Quote Originally Posted by ppro View Post
    Since Yardley is a wealth of statistics I am sure he can address the issue of fraud and waste in the medicaid and medicare system and give some insight on how increasing the governments involvement will be a better use of our medical dollars. Sincerely a medical professional for 20 years dealing with the public in which some get "free medicine".
    My knowledge on the specific data is somewhat dated but also relevant. In a prior life, I ran Medicaid in NYC. We were under intense pressure because of payment errors and implements a wide range of improvements. We had an advisory board that included the CEO of one of the largest health insurors in the country and he offered assistance fro his staff. A team came down to review our procedures to control errors and fraud. After few weeks they tripled the number of people involved. It turned out that we wee successfully doing things they had been unable to do in their own operations and they were mining us for ideas. The biggest problems we had with fraud were actually the direct result of legal provisions created at the behest of providers -- particularly clinical labs -- to protect their business interests. Specifically, these prevented us from using our buying power to negotiate pricing or to encourage competition for services (e.g. by contracting out blocks of services or prohibiting kickbacks from labs to physicians for referrals). After I left government, one of the services I offered in the private sector were management reviews of payments by commercial health insurance companies and third party payers.

    My first major project was to review the management of a 250,000 employee plan administered by the same insurance company that had assisted us in NYC. The company had its own internal quality control programs that estimated gross errors of under 2% of claims processed with no net payment error. When I did my review, I found a gross error rate exceeding 50% of claims processed with a net overpayment of 5.2%. Almost 70% of the errors were "systematic". That is, they resulted from errors that were built into their payment procedures and happened consistently. The rest were largely attributable to processes that made mistakes all but inevitable. In the first three weeks of the study, my client estimated that they saved $3 million. At the conclusion of the study, the insurance company, with the approval of my client, hired us to work with them over a four year period to assist and monitor their internal quality improvement programs. Over the next four years we were successful in helping the company to reduce its gross error rate to under 2% with no net payment error

    In any complex system -- whether publicly or privately managed -- there will be errors. Those errors tend to be easier to conceal in the private sector, but that does not mean they are not there. Wide variability in plan design from plan to plan are one of the major reasons for mistakes. The simpler the plan, the fewer mistakes. If you have universal eligibility for coverage, the primary source of error disappears altogether.

  4. #24
    Senior Member tom's Avatar
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    Quote Originally Posted by M&K's Retrievers View Post
    So it's OK to have insurance for your life, income replacement, home, auto, boat, airplane, ATV, UTV, D&O coverage, E&O coverage, malpractice insurance, liability coverage for a hunt test, hole in one coverage, business interruption insurance, flood insurance, etc but health coverage should be "free" and provided by the government.

    Get real regards,
    OK, let's get real

    You PAY for your health care one way or another! THERE IS NO FREE ICE (government run health care is NOT free health care)
    So the real question is what costs less, and what are the choices.
    Does insurance cost our society less than government run health care?
    Sorry but what I see happening in other countries leads me to believe that maybe we have our collective heads stuck in the sand, and are being taken to the cleaners in the process.

    Thinking that big business is the only solution to every problem in America is just plain stupid in my opinion. All that does is insure that the rich will get richer, and YOU will become poorer.

    I owned my own business for many years, so I am not anti business by any means. But, as a (small) business owner I found out the hard way just what our current health care system actually costs! (thinking that you are getting a "good deal" because your boss is picking up part of the tab for your health insurance is idiotic!) THERE IS NO FREE ICE!
    Last edited by tom; 10-06-2010 at 10:27 AM.
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  5. #25
    Senior Member Buzz's Avatar
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    Quote Originally Posted by tom View Post
    OK, let's get real

    You PAY for your health care one way or another! THERE IS NO FREE ICE
    So the real question is what costs less, and what are the choices.
    Does insurance cost our society less than government run health care?
    Sorry but what I see happening in other countries leads me to believe that maybe we have our collective heads stuck in the sand, and are being taken to the cleaners in the process.

    Thinking that big business is the only solution to every problem in America is just plain stupid in my opinion. All that does is insure that the rich will get richer, and YOU will become poorer.

    I owned my own business for many years, so I am not anti business by any means. But, as a (small) business owner I found out the hard way just what our current health care system actually costs!

    You're wasting your breath on M&K, he works in the insurance business. So, it's his ox that would be gored if we had socialized insurance. Notice that I didn't call it socialized medicine.
    "For everyone to whom much is given, of him shall much be required." -- Luke 12:48

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  6. #26
    Senior Member tom's Avatar
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    Notice that I didn't call it socialized medicine.
    Good point!

    As a "senior citizen", maybe we should start a new thread on part A, part B, part -- oh hell, how is a senile old fart suppose to figure all this crap out!
    Everyone has this dilemma in their future, and as it is set up now, there is no correct answer because circumstances will change!
    Haven't met an insurance agent yet that doesn't say "my product is the best one".
    Last edited by tom; 10-06-2010 at 10:46 AM.
    "there is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance --- that principle is contempt prior to investigation."
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  7. #27
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    I find it unbelievable that those who think you should never tax rich people and businesses, hate the minimum wage, hate regulation, and think that labor makes too much money, are just fine that employers should pay their healthcare bills.
    Broad generalizations here ...

    1) I do not espouse that we never tax rich people. FWIW, I'm not one of those rich people.

    2) I've been paying for my own health insurance since 1992, as a self-employed person.

    I had employer health insurance for about two or three years. In fact, I was responsible for choosing the insuror. I chose a non-profit for two reasons: the price was good, and if anyone lost their job (and all of us eventually did!) everyone would have the option to convert to individual coverage without a pre-existing condition problem.

    For MANY years those who paid for their own health insurance received ZERO consideration from a Federal Income Tax standpoint ... so everyone who received employer health coverage tax-free was WAY ahead of those who were self-employed. Someone FINALLY realized that people who paid for their own health insurance were actually saving the govt money by NOT using govt-subsidized care (Medicaid) ... and agreed to consider that in taxation.

    Don't they realize that these folks just pass the cost on to the rest of us in the price of their goods? Don't they realize that foreign goods have a competitive advantage because they don't have to pay healthcare costs?
    I absolutely realize that the cost of doing business for any business is passed along to the consumer.

    It actually DID make some sense to give employees the choice of taking $ in lieu of their health insurance; and also allowing them a tax deduction as the self-employed now receive (but for MANY years did not receive). The health insurance deduction goes on Schedule A, so the deduction only applies to over 7% (?) of adjusted income. One asks why has health insurance, a valuable compensation, has never been taxable? According to tax law such things as bartered services are taxable. Why has health insurance, when provided by an employer always been tax-free? Was it our govt (IRS Code) that came up with that idea? It seems that unions would have had the most interest in lobbying for this kind of tax treatment.

    I don't think we disagree greatly, Buzz ... our difference may be about the best way to deliver the product (health insurance/health care). And, I also believe Jeff is correct in that people don't pay attention to the cost if it is a "gift" from their employer. Actually, will that change greatly if many people who are presently uninsured receive substantial subsidies to get the care they need? Sort of like the food stamps thing when recipients use the food stamps for food that others, without food stamps, would not buy due to the cost of those items.

    Yes, those folks making $20,000 a month are living hand to mouth...
    I'd say between SS, Medicare deduction, and 35% FIT tax, the amount remaining is about 1/2 the gross. Might be more depending on the size of the household, and deductions allowed on Schedule A (like property taxes and mortgage interest). That doesn't include local and state income tax. Where I live those come to over 4% of gross ... a flat tax with VERY few deductions on the State tax & none on the local tax.

    Those income levels generally don't qualify for "assistance" in such things as college tuition. I recently read that private college tuition & room & board is running around $30,000 to $40,000 a year. Those people taking home $10,000/mo better be good savers because when the kids go to college they'll need it. Even state institutions are not cheap anymore.


    They spend about 9% of GDP on health care while we spend 17%. Like most countries, they have resisted spending more. As it happens, the total tax burden in the UK is about 5% of GDP higher than in the US.
    Their taxes might be higher if they had to spend more on military stuff that the US spends. Some may argue that some of our military stuff is not needed (the two wars in the mid-east, of course) ... but the US also expends a great deal on other stuff militarily. So, one would also have to assess how other portions of the GDP are spent to compare those #s fairly to what the US spends.

    Would also be interesting to know what items are the root of their deficit, as those would be the items that would need cutting to reduce the deficit. Or that 5% difference in taxes paid is going to be higher in the coming years. This is also going to be true for the US since we're presently living on "credit" as well.
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  8. #28

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    I must say I do not have the experience of sitting behind a desk and looking through many reports as you Yardley but I have the limited knowledge of working in various retail pharmacy settings and also as director of pharmacy of a charity now teaching hospital. In my immediate family I have 11 siblings or spouses that work in various settings varying from clinic physician to hospital ceo to nurses. It always gives me pause to think of the differences of opinion to those that have boots on the ground as those that read reports and summarize. I acknowledge that I have a narrow view but from ground level it seems that there is a significant amount of people that get "free" services that should not. My wife works as a nurse surveyor for DHH and she sees a large amount of this in nursing home and PCA(personal care assistant) programs funded by various government entities. My faith in the government being able to efficiently run such a large undertaking as healthcare in such broad terms is non existent. We have train generations of people to rely on help from the government as a way of life that we must not let more personal responsibility leave the individual. I will say that my siblings and I were raised in a home that would have have been considered below poverty and never got assistance. We learned to live without things such as BMW's,Mercedes,Cadilacs,Luis Vutton,Blacberrys, and other such niceties that I see some of these government receivers on a daily basis. I am a little upset to continue to work to pay for other peoples children after I have done so without government help while these same people will come to get free medicine after they come back from "the club". I wonder what reports are out there that show the percentage of people that are milking the system. I doubt it is accurate.

  9. #29
    Senior Member tom's Avatar
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    Quote Originally Posted by ppro View Post
    I must say I do not have the experience of sitting behind a desk and looking through many reports as you Yardley but I have the limited knowledge of working in various retail pharmacy settings and also as director of pharmacy of a charity now teaching hospital. In my immediate family I have 11 siblings or spouses that work in various settings varying from clinic physician to hospital ceo to nurses. It always gives me pause to think of the differences of opinion to those that have boots on the ground as those that read reports and summarize. I acknowledge that I have a narrow view but from ground level it seems that there is a significant amount of people that get "free" services that should not. My wife works as a nurse surveyor for DHH and she sees a large amount of this in nursing home and PCA(personal care assistant) programs funded by various government entities. My faith in the government being able to efficiently run such a large undertaking as healthcare in such broad terms is non existent. We have train generations of people to rely on help from the government as a way of life that we must not let more personal responsibility leave the individual. I will say that my siblings and I were raised in a home that would have have been considered below poverty and never got assistance. We learned to live without things such as BMW's,Mercedes,Cadilacs,Luis Vutton,Blacberrys, and other such niceties that I see some of these government receivers on a daily basis. I am a little upset to continue to work to pay for other peoples children after I have done so without government help while these same people will come to get free medicine after they come back from "the club". I wonder what reports are out there that show the percentage of people that are milking the system. I doubt it is accurate.
    So you are saying that the system we have been using isn't working all that well. Welcome to the club!! Why not try to see if we can fix it!!!!!!!!

    Kinda like saying "someone has to pay the bills", "so lets lower taxes".
    Last edited by tom; 10-06-2010 at 12:44 PM.
    "there is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance --- that principle is contempt prior to investigation."
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  10. #30
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    Quote Originally Posted by ppro View Post
    Since Yardley is a wealth of statistics I am sure he can address the issue of fraud and waste in the medicaid and medicare system and give some insight on how increasing the governments involvement will be a better use of our medical dollars. Sincerely a medical professional for 20 years dealing with the public in which some get "free medicine".
    We have a bit of a dilema here in Florida on which crook to vote for in the race for Governor. Has somewhat to do with Medicare.

    On the Republican side is Rick Scott
    One questioned Scott's decision to plead the Fifth Amendment 75 times in a lawsuit involving one of his companies.

    After months of being tarred for mammoth fraud at the hospital company he founded, Republican gubernatorial nominee Rick Scott is launching his own hard-hitting ad, accusing Democrat Alex Sink of bilking investors as the Florida president of NationsBank in the 1990s.
    Scott has said repeatedly he "takes responsibility" for the billions of dollars in illegal Medicare and Medicaid reimbursements Columbia/HCA collected under his watch. Scott was forced out of the company in the late 1990s after the U.S. Justice Department announced its Medicare fraud investigation.

    And on the Democratic side Alex Sink

    One claims that as president of NationsBank Florida she was responsible for questionable sales practices conducted by a separate securities company that reported to NationsBank Corp.
    The other ad echoes one from Scott's Republican allies that singles out Sink for blame over state pension fund losses she, along with Gov. Charlie Crist and Attorney General Bill McCollum, was one of three members of the board administering the trust fund.

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