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« Worse than it appears | Main | AMT »

Feb 16, 2007

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jc

"Doctor's compensations are also problematic: We overpay here by $58 billion."

Do you know any doctors that would be willing to cut their salaries?

I doubt it. Everyone in the system thinks what they charge or make is justifiable.

How do you get everyone to accept less?

Bubba


"Either eliminating the excess administrative costs of private health insurers......."

Translation: Put a cap on physicians and surgeons fees.

Great idea.

Let's be sure to do it when we institute meaningful medical tort reform and cap trial lawyers' fees.

Roch101

Only in Bubbaworld could "Either eliminating the excess administrative costs of private health insurers, or paying what the rest of the world pays for drugs and medical devices..." be interpreted not as eliminating excess administrative costs or lowering the cost of medical devices and drugs, but as a proposal to cap doctors' fees.

Paranoia, the destroyer.

Dr. Mary Johnson

JC, not all doctors are rich. It's one of the "quantifiables" that deserves discussion, but you won't see it here. It's easier to damn us all.

And in the GSO blogosphere, when a doctor comes to (what Fec calls) "the A list" with a story speaking to some of those "excess administrative health costs" . . . criminal greed and corruption worthy of Jim Black . . . she is blown off and ridiculed.

Bubba was responding to JC, Roch. And he's right. Doctors, especially primary care doctors, have been bled dry. The "quantifiables" in health care costs include ("but are not limited to") an out-of-control tort system predominantly driven NOT by rational medical reasoning, but unresaonable expectations, greed and (of course) lawyerly compensation.

Ain't nothing "paranoid" about it.

Roch101

Dr. J. Please read for comprehension.

Dr. Mary Johnson

Roch, I wish to God you would GROW UP and try to have a civilized conversation without insulting somebody.

The way that private health insurers have "decreased administrative costs" for years is to chip away at physician reimbursement (as they stuffed their own pockets). Never mind that the physician is also running a business and paying employees based on that reimbursement. Bubba's "translation" is therefore fairly accurate.

I comprehend a great deal . . . perhaps because I've lived it (as opposed to reading about it).

Sven

The "quantifiables" in health care costs include ("but are not limited to") an out-of-control tort system

And these "quantifiables" in the out-of-control tort system include "administrative expenses" such as insurance industry executive salaries and advertising costs.

Robert P.

Mary,
If you read the articles or the study, you will see that it says we overpay our specialists compared to the rate of pay for generalists.

Doctors, especially primary care doctors, have been bled dry.

So, while lawsuits are a problem, so is overcompensation of "specialists". As are all the other things listed in this very good study. But, instead of looking at it and saying "Yeah, there are enough problems that we can fix them and have single-payer for all, AND save money", the first response of people like Bubba and yourself is to deny those findings and focus on your pet-peeve.

Look, I like John Edwards, I support John Edwards, but medical malpractice lawsuits are A problem. Not THE problem, but A problem. See how easy it is to take into account ALL the problems and not just those that are in your own self-interest?

BTW,JC, that is a great question. If we had Medicare for all we might HAVE to increase costs for certain tasks. On the other hand, those making 150% of the Medicare payments NOW will scream bloody-murder if we say we are cutting them to 100% and lowering the disparity between what we pay our specialists and what other countries pay their specialists.

Bubba

"Roch, I wish to God you would GROW UP and try to have a civilized conversation without insulting somebody."

No chance, Dr. J.

He's afflicted with the Peter Pan Syndrome.

Plus, it's the only way he knows to react to a logical interpretation of evidence that doesn't support one of his cherished aganda points.

Bubba

"On the other hand, those making 150% of the Medicare payments NOW will scream bloody-murder if we say we are cutting them to 100% and lowering the disparity between what we pay our specialists and what other countries pay their specialists."


Translation: Put a cap on physicians and surgeons fees.

Did someone but out a talking points memo to the Usual Suspects regarding this thread?

Bubba

And by the way, there is NO WAY any "single payor" or "universal health care", "natioanl insurance" or any other scheme will make our health system "better" or "more affordable".

The precedent for that not to happen is etched in stone.

"Focus on my pet peeve"!

PotatoStew

Roch: "Please read for comprehension."

Dr. J: "I wish to God you would GROW UP and try to have a civilized conversation without insulting somebody."

Bubba: "No chance, Dr. J. He's afflicted with the Peter Pan Syndrome. Plus, it's the only way he knows to react to a logical interpretation of evidence that doesn't support one of his cherished agenda points."

Compare and contrast with Bubba, in a recent thread: "That's the second time on this thread you've proven you don't bother to read what people are posting. Read the mises link again, friend.....this time, for comprehension."

Too funny.

jc

Mary, I never said all doctors are rich. I would say most are, though.

I'm not complaining about anyone making money, as I am a capitalist. I just threw that out there for discussion.

My point was that NO one wants to reduce their income, salary, or revenue if you are on the supply side. In fact, most want to keep increasing.

That is the crux of the problem because most people cannot afford health insurance now, much less when the premiums increase 10-20% per year.

The system is broke and needs to be fixed so healthcare is affordable for all.

Bubba

Alright Stew, lets talk about that.

Tell us all why you think it's "too funny."

Make it good.

PotatoStew

Read the quotes Bubba. For comprehension, if you'd like. You'll figure it out.

Bubba

"Read the quotes Bubba. For comprehension, if you'd like. You'll figure it out."


Now why did I know I'd get an answer like that from you?

You're back in the "Ignore" category, where you belong.

Robert P.

Bubba,
Care to back this up with facts and a repudiation of: the VA turn around, Medicare cost-effectiveness and satisfaction of 80-90%, the per capita cost of single-payer care in countries with comparable wait times as the US ($2.957 vs. $5,635), and, the health rankings of those same countries versus the US (1,9,10,16,20,21,25 vs. 37)

Dr. Mary Johnson

Before we deteriorate into the pissing contest:

No argument, Sven. In fact I used to have this discussion (with insurance executives & lawyers who were not brave enough to sign their names) over on the "ProCare" site. But that site (developed to publicly challenge the garbage going on over at NCBCBS) was shut down by litigation.

And the discussion (such as it was . . . often peppered with insults and slams worthy of Roch & company) stopped.

I've certainly addressed the executive compensation issue on my website: http://www.awhitewall.com/Salaries.htm

But hey (speaking of "reading comprehension"), nothing I've been saying for over a year in this blogosphere is "relevant" to anything.

JC, THE VERY FIRST THING that is ALWAYS thrown out any time any one of these studies comes out is physician compensation. It does not matter what the study acutally says (thank you Robert, but I did read it - just like I read the one that Sue threw in our faces last week . . . with her very agendized interpretation about "doctors withholding care"), but the public discussion always turns on what we pay doctors . . . especially the specialists that our tort system would have the generalists rely on for everything.

There is always a chicken and egg (what comes first?) quality to these arguments.

There also seems to be an incredible amount of resentment amongst the general public directed at doctors related to their compensation. Some of it is warranted, but a lot of it is not. Doctors go to school FOREVER to learn how to do what we do. We go through hell during our educations always looking to the point where we can just practice medicine, do what we love and BREATHE. Yet when we "get there", we are beseiged on all sides by outside interests (solely in it for the money) that mostly hinder the patient-physician relationship and actually often impede good care.

Again, on what PLANET is it OKAY for me to have been fired by two clueless, over-paid 9-5 hospital executives for saving a baby's life? I'll tell you. It's the planet North Carolina . . . where our Speaker of the House (as captain of the starship "Bad Enterprise") will shortly be marched off to a Klingon prison (after he enjoys a sunny vacation somewhere).

There is NO WAY, after the cluster-screw I endured IN GOVERNMENT SERVICE (and in the legal system after), that you can convince me a "single-payer" system mananged by that same government would be anything but a fiscal disaster.

Robert P., the VA had nowhere to go but up. Most of the physicians there are in some kind of military or public service and their malpractice is covered by the Federal Tort Claims Act.

Jim Caserta

Just wondering...has anyone commenting read all of the full McKinsey report?

Bubba

Try something a little less old than 12 years regarding "satisfaction", Robert.

Dr. J covered the VA aspect.

And the rest of your information proves........exactly what?

Robert P.

satisfaction. Unlike the reports churned out by the Bush administration, real science takes time.

The VA aspect as coverd by Dr. J was that they had nowhere to go but up? Oh, that is such a cop-out and you know it. They provide fantastic care in a single-payer, "socialized" medicine setting.

The rest of the information proves that we could have better healthcare cheaper with single-payer. Once again, where are your facts that back up "The precedent for that not to happen is etched in stone." You seem pretty sure of yourself for someone who has no data to back up that position.

Bubba

"You seem pretty sure of yourself for someone who has no data to back up that position."

Given the level of your contribution, it's a cinch.

If you think you can keep up with the material, try reading this.

Then try again to make whatever point you have about Medicare.

Bubba

Let's take a look at what Professor Friedman had to say about this issue.

Excerpts:

"Employer financing of medical care has caused the term insurance to acquire a rather different meaning in medicine than in most other contexts. We generally rely on insurance to protect us against events that are highly unlikely to occur but that involve large losses if they do occur—major catastrophes, not minor, regularly recurring expenses. We insure our houses against loss from fire, not against the cost of having to cut the lawn. We insure our cars against liability to others or major damage, not against having to pay for gasoline. Yet in medicine, it has become common to rely on insurance to pay for regular medical examinations and often for prescriptions."


"Third-party payment has required the bureaucratization of medical care and, in the process, has changed the character of the relation between physicians (or other caregivers) and patients. A medical transaction is not simply between a caregiver and a patient; it has to be approved as "covered" by a bureaucrat and the appropriate payment authorized. The patient—the recipient of the medical care—has little or no incentive to be concerned about the cost since it’s somebody else’s money. The caregiver has become, in effect, an employee of the insurance company or, in the case of Medicare and Medicaid, of the government. The patient is no longer the one, and the only one, the caregiver has to serve. An inescapable result is that the interest of the patient is often in direct conflict with the interest of the caregiver’s ultimate employer.*** That has been manifest in public dissatisfaction with the increasingly impersonal character of medical care.***"

"In terms of holding down cost, one-payer directly administered government systems, such as exist in Canada and Great Britain, have a real advantage over our mixed system. As the direct purchaser of all or nearly all medical services, they are in a monopoly position in hiring physicians ***and can hold down their remuneration, so that physicians earn much less in those countries than in the United States***. In addition, they can ration care more directly—at the cost of long waiting lists and much dissatisfaction."

(Imagine that!)

"The first question asked of a patient entering a hospital might once again become 'What’s wrong?' not "What’s your insurance?"

Roch101

Bubba, what's your assessment of VA healthcare? Are you content with it or would you rather it be changed to some sort of market-driven system?

Robert P.

I give you science-based, hard-facts and you give me data from this group? That is just like a conservative, backing up your position with bullshit data from partisan groups.

Who We Are

The Council for Affordable Health Insurance (CAHI) is a research and advocacy association of insurance carriers active in the individual, small group, HSA and senior markets. CAHI's membership includes insurance companies, small businesses, providers, nonprofit associations, actuaries, insurance brokers and individuals. Since 1992, CAHI has been an active advocate for market-oriented solutions to the problems in America's health care system.

Well, lordy, imagine that, they financed and published a study that shows....shocker....private insurance does a better job than public insurance. Of course, that goes against every NON-PARTISAN study NOT financed by "insurance companies".

THIS is why liberals hate conservatives, because you don't look at the facts. From evolution to health care, you base all your decisions on "your gut" and not on facts and reality. Or, you pay people to make reality look the way you want. Don't forget that front organizations just like this were paid by the cigarette industry to turn out paper after paper saying that they weren't causing cancer. And, those reports were backed by conservatives to the HILT, just like you are doing with this report.

Facts, not fiction.

Bubba

"Bubba, what's your assessment of VA healthcare? Are you content with it or would you rather it be changed to some sort of market-driven system?"

No opinion.

I don't access it personally.

From clients and people I know or correspond with, the opinions are widely varying.

Bubba

"Facts, not fiction."

That's what was provided. Too bad you chose not to comment on the material itself.

Where were they wrong?

P.S.-- Stop using "scientific consensus" on "global warming" tactics. They don't work.

I notice you totally ignored Professor Friedman's comments too.

Why am I not surprised?

Bubba

Since our pal Robert didn't like the last set of facts that were a little inconvenient to his cherished beliefs, let's see how he likes this information.

Conclusion:

"Medicare has no equivalent. And this highlights the point that a part of the insurance industry's administrative costs are not because the private sector is inefficient, but because government is taxing it and imposing regulations and unfunded mandates (it tells the private sector to do something, but doesn't reimburse its costs).

There is something a little disingenuous about imposing unwanted taxes and regulations on an industry and then criticizing it because its administrative costs are higher than the untaxed government program."

Brenda Bowers

Dear Lord but I do love to read threads like this one! Everyone is yelling "fix the system" but they know nothing about the system they are yelling to have "fixed". People the bottom line is that the system is unfixable! The big mistake was made in 1965 when Congress decided to give all the elderly Free medical care regardless of income and ability to carry their own health insurance. In fact, one half of the elderly did have their own medical insurance in 1965 and had no need for the government largess from the pockets of the tax payers. Now this largess is an ENTITLEMENT for all who have the bad manners to grow old and there is no way the young who are working and paying taxes are going to get the elderly off of their backs.

In 1965 the government did make the right move in Medical care and it is known as Medicaid. Medical care for the POOR. If the government would have helped those who could not afford medical insurance to get it then none of the astronomical costs for health care would have happened. The insurance companies would have had to keep costs in check due to competition for customers,. The insurance companies would then have put pressure on the medical establishment to keep cost down wo as not to cut too deeply into their profit. The Free market would have controlled cost in health care just as it has in everything else that the government hasn’t gotten it’s fingers into.

I have blogged repeatedly on this topic with facts and figures and yet the same ignorance of what they are talking about prevails among most people who think they can keep the same level of health care we now have and institute Universal Health Care too. It can not be done! What are you willing to forego because you will give something up I assure you, whether it be higher and higher taxes or the level of health care.

Robert P.

Bubba,
Your take from the Hoover Institute is wrong. They are saying that all Third Party Insurance companies have lead to this problem, not just Medicaid and Medicare. He also makes the mistake of saying public health care pays for 50%, when it is now closer to 66%. Also, he choses to only mention Canada and Britain as examples of single-payer plans, both of which now have public/private insurance plans and long-wait lines, versus the countries that I listed above (none of which is Candada or Britain), which have the same wait times and much less costs-per-capita. I think it is telling what his future view of the best insurance system would look like:

A cure requires reversing course, reprivatizing medical care by eliminating most third-party payment, and restoring the role of insurance to providing protection against major medical catastrophes.

The ideal way to do that would be to reverse past actions: repeal the tax exemption of employer-provided medical care; terminate Medicare and Medicaid; deregulate most insurance; and restrict the role of the government, preferably state and local rather than federal, to financing care for the hard cases.


First, no insurance except anything but major medical catastrophes? Yeah, look how well that works out currently, we already have that, it's called Medicaid and it kicks in once people go bankrupt from being nickel and dimed by insurance. I think you can see his real feelings in that lost sentence "to financing care for the hard cases", the hard cases huh? What about people with schizophrenia? Regular working class people who reach age 25, have a schizophrenic break and then need $1500 a month in medication and care? What about autistic kids who need $1200 a month in occupation, speech, and physical therapy? That isn't a medical catastrophe, so I guess we just throw those kids away. We throw away the working class, too.

The Heartland paper actually makes some good points. I'll keep that in mind and look into it further.

Lastly, a word on Facts vs. Fiction. My facts are mostly published in peer-reviewed journals, where they go through rigorous review for truth and originality. Your facts are published by right-leaning think tanks, whose sole purpose in being is to push those right-leaning ideas. To quote one of my favorite online personalities, there are "Lies, damn Lies, and statistics." You can make numbers say anything you want, only when they have been vetted and analyzed by nonpartisan peers can you believe them. So, no, I am not interested in discussing "papers" published by these think tanks.

Bubba

"First, no insurance except anything but major medical catastrophes? Yeah, look how well that works out currently, we already have that, it's called Medicaid and it kicks in once people go bankrupt from being nickel and dimed by insurance."

Ummm.....ok, sure Robert. Whatever you say.

I think we're done here.

Anyone who makes such a statement like the one you make above about Medicaid shows your lack of understanding about health care issues.

Thanks for playing.

Robert P.

Ah, Bubba, the final solution for losers, to quit.

I'm leaving you behind now Bubba, like "Ogre" before you, and for the same reason - you lack the ability to discuss reality, to provide sources, or to deal with facts because they get in the way of your prejudices.

Bubba

Pay attention, Robert. I will tell you this once, and once only.


Fact:

Medicaid is NOT in any way considered "catastrophic innsurance", particularly in the most common industry definition of that term.

Fact:

Bankruptcy does NOT qualify people for Medicaid.

Fact:

You have no idea what you're talking about.

Robert P.

Pay attention Bubba, you condescending idiot.

Medicaid functions as catastrophic insurance for the working class, who are routinely dropped from their coverage anytime they have a catastrophic illness. You, who have done nothing but spout right-wing talking points, NOW choose to focus on "the most common industry definition"?

Bankruptcy doesn't qualify people for Medicaid, but losing everything they own because of health care costs does, and THAT happens all the time. Note I didnt say "declaring Bankruptcy", I said going bankrupt, as in losing all they own. If you live in some ivory tower, I'd be happy to introduce you to some friends who were normal middle-class people with retirement, college funds, a nice house, two cars, all that good stuff. Until the husband got cancer, lost his job because he couldn't work, lost his insurance, spent the college funds, spent the retirement funds, sold the house and only THEN qualified for Medicare. THAT is what I consider going bankrupt, not some IRS bullshit.

Bubba

You are clueless on this topic.

Buzz off.

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