Yeah.

Post #311,420 by jake123 7/21/09 2:18:41 PM Reply	Yeah. It's called the experimental method. Something's not working... you try something else and see if it works. Lather, rinse, repeat.
Post #311,429 by beepster 7/21/09 4:52:02 PM Reply	Super lets experiment with 20% of the GDP. If we screw it up...how bad can it really be? I will choose a path that's clear. I will choose freewill.
Post #311,430 by jake123 7/21/09 5:03:59 PM Reply	Judging by other country's experiences with public health care, a whole lot better than what you've got.
Post #311,436 by folkert 7/21/09 8:37:01 PM Reply	DING DING DING! EFFING... crap HDHP, savior to the Corporate world... Screws the covered. Basically it makes it an "umbrella" policy, nothing else. Sucks down $333/month in Deductible and 20% after that (20% of 1200/month in prescriptions is still $240) so total == about $600/month Beep, do you really want to know what CRAP HDHP is... its the ONLY thing companies are becoming able to afford. Gone are the days of "full coverage" health care. Here is a REAL IN FORCE HDPD "Deluxe" plan at right about $1300/month from the company and about $333/month for scheduled deductible. All "in network" amounts (I'd fall in that Family plan) Plan Features: Cal Year Deduct Indiv/Family: $2000/$4000 Coinsurance (employee planned part): 20% Annual Out-Of-Pocket Max Indiv/Family: $3500/$7000 Lifetime Max: unlimited Primary Care Phys: 20% after deductible Specialist Visit: 20% after deductible Preventitive Care: Routine Physical: 0% deductible waived (age/freq schedule) Well Child Care: 0% deductible waived (age/freq schedule) Ded. waived till age 17 OB/GYN: 0% deductible waived, ONE OB/GYN exam plus PAP smear per year Allergy Testing: 20% after deductible Allergy Injections: 20% after deductible Prescription Drugs: Day Supply: 30-day supply Formulary Generic: $15 Copay after deductible (annual must be met) Formulary Brand: $25 Copay after deductible (annual must be met) Non-formulary: $40 Copay after deductible (annual must be met) Self-Injectables: %30% coinsurance, $150 max (no deductible) Mail-Order Prescription Drugs Day Supply: 90-day supply Formulary Generic: $30 Copay after deductible (annual must be met) Formulary Brand: $50 Copay after deductible (annual must be met) Non-formulary: $80 Copay after deductible (annual must be met) Hospital Services: Inpatient: 20% after deductible Inpatient Physician Services: Included under Inpatient Hospital Outpatient Services at a hospital: 20% after deductible Outpatient: 20% after deductible Surgical Facility: Outpatient: 20% after deductible Emergency Care: Emergency Care: 20% after deductible Ambulance: 20% after deductible Urgent Care Facility: 20% after deductible Lab and Radiology: Lab services: 20% after deductible Radiology: 20% after deductible Complex Imaging (MRI etc); $250 Copay Preventative Mammograms: 0%, deductible waived, age/frequency schedules apply Maternity Care: Inpatient: 20% after deductible Office Visits: 20% after deductible Mental Health Services: Inpatient: 20% after deductible Outpatient: 20% after deductible Substance Abuse: Inpatient: 20% after deductible Outpatient: 20% after deductible Other Services: Chiropractic Care: 20% after deductible Durable Medical Equipment: 20% after deductible Home Health Care: 20% after deductible Skilled Nursing Facility: 20% after deductible Now, given how much things cost... a single unexpected 3 day Hospital Stay will max out your deductible, plus cost and average of $300-400/day at 20%. My, that heart attack sure does look expensive. I am glad you had it under a good medical plan. Its not good you had it, but still.
Post #311,453 by beepster 7/21/09 11:33:40 PM Reply	And tell me where... ..in ANY presented plan those costs are addressed in a positive manner? Nowhere. So you expect it to get better...and you're willing to blow up the entire system to get everyone mediocre coverage with no addressing the cost...making it simply another entitlement program that will break this country in about 35 years. I will choose a path that's clear. I will choose freewill.
Post #311,459 by folkert 7/22/09 8:18:36 AM Reply	Those costs... are being driven by the Pharma Companies, the Medical Equipment "suppliers". Think about those "ATMs" in the banks. How were they originally billed? What was the point? Now lets think about the cost saving devices for speeding up the taking of Blood Pressure, Pulse and Oxygen levels... reducing the amount of time and skill needed... Oh but wait, they've never been shown to actually do that, in reality its kept the same amount of time required for checking this stuff AND it still requires exactly one person to administer the machine or checks. So, one Stethoscope and an... mumble... (pressure band... hell can't remember the name) are WAY cheaper and are very easy to use. Vs the cost of those auto-mated checkers and the service contracts. This is just one simple thing to reduce a $5K/year per piece of equipment contract, times perhaps 300 (in a large hospital) or even 1500 across as "metropolitan" health group with outpatient and "combined" doctors offices. Multiply that by the number of those thing in the US... say 800 (conservative)... $5000 x 1200 machines x 800 "systems"... a measly $4.8B saved on the service contracts alone. Feh... sometimes automation doesn't work. There are many places in the Health Care industry it just doesn't and actually has the opposite effect and costs MORE.
Post #311,461 by beepster 7/22/09 8:39:40 AM Reply	Re: Those costs... Much of what you are attributing to "big bad companies" is pass through costs of massive (and promised future massive growth) of the regulatory environment. Companies in NJ, for example, wanting to sell private insurance are forced to cover procedures like acupuncture and other marginal procedures...making the difference in policy cost between lighter regulated states (Kentucky, among others) nearly 6 times. Those machines, also, allow for a lesser trained person to administer those same tests...so instead of needing an RN at 80k per year (conservative), you can run the same tests in the same time with a med assistant at 25...meaning the machine AND maintenance pays for itself in under 1 year (with your numbers). The biggest single problem in healthcare is lack of visibility of the true expense. There is very little competition in insurance...because companies are passing through increases, the government is passing through increases...noone is forcing the system to task. The proposed bills are more of the same, not less...its just switching who pays. And tell me...if the issue is coverage of 45 million americans...how does it make sense to spend 1 Trillion, when you could offer each one a 10k per year policy (better than most any policy out there) for 450 billion? I will choose a path that's clear. I will choose freewill.
Post #311,464 by Another Scott 7/22/09 10:02:25 AM Reply	You didn't look at the numbers carefully. And tell me...if the issue is coverage of 45 million americans...how does it make sense to spend 1 Trillion, when you could offer each one a 10k per year policy (better than most any policy out there) for 450 billion? Um, the estimated 10 year cost is $1T. $1E12 / 10 = $100E9/yr $100E9 / 45E6 = $2222/yr. HTH. Cheers, Scott.
Post #311,471 by beepster 7/22/09 10:44:50 AM 7/22/09 10:47:05 AM Reply	And neither did you because most policies for individuals on that scale would be under 3k, not 10...so its still a third. Individual coverage under no organized plan is under 300/month full blown..and catastrophic coverage can be had for under 1000/yr. What they are proposing is approximately 2250 per person per year for coverage. If the government is sooo good at running this, they should easily be able to beat private insurers...and this way they aren't creating any new infrastructure that will necessarily add cost and drag to an already costly and slow process (ask a doctor about medicare billing sometime). I will choose a path that's clear. I will choose freewill. Edited by beepster July 22, 2009, 10:47:05 AM EDT Expand All History
Post #311,475 by Another Scott 7/22/09 10:57:19 AM Reply	Evidence, please. And you're changing the subject again. The cost of the HELP plan and similar legislation is ~$1T over 10 years, not per year. Your example of spending $10k/yr for 45E6 people would cost $4.5T. Cheers, Scott.
Post #311,482 by beepster 7/22/09 11:59:04 AM Reply	Look up plan costs semi relevant article http://www.americanp...3/cost_shift.html Those are averages for full service plans. Assume the article is correct in that there is a 10% min shift because of uninsured (which goes away). You are then average just over 4k for full med coverage (not the basic that is being promised). Further assume that there must be some benefit associated with insuring 45M people at one go...or even that an 11k family policy will cover and average of 4 ppl and you get miraculously close to that mid 2k range....which means you could simply insure everybody and spend the same amount without changing a thing. Add in the fact that Washington has probably NEVER hit a spending target...so they say 1T...what does it really end up at? Probably closer to 1.5T. Your faith in the fed is commendable...but likely horribly misplaced...especially considering the artificial deadline being imposed. Look at all the shining examples of huge, rushed legislation we have in the past 10 years or so...Patriot, TARP...sure lets do that to healthcare too. I'm not against fixing the system and providing base coverage for all...we're a rich enough country that we should be able to pull that off. The proposals in current form don't address key issues...it just creates another entitlement. I will choose a path that's clear. I will choose freewill.
Post #311,473 by folkert 7/22/09 10:51:33 AM Reply	The RN ends up taking it again... Anyway with the automated tool. Give me a break, hell, when I was in the Marine Corps, after I took my PFT after getting my wisdom teeth pulled... I was put on "light duty" and sent to the Infirmary. Where the only thing no-one volunteered for was taking Blood Pressure, Pulse and Temperature. They gave me about 5 minutes of training on how to use the the Stehoscope to listen for the noise change when operating the Sphygmomanometer (thanks Another Scott) and within 10 minutes TOPS, I was taking Infirmary Triage readings for the Medic doing the rest of the Triage. It doesn't take a brain-engineer or rocket-surgeon to operate those damn things. In fact, I typically did two at a time, first blood pressure and pulse, switch to temperature and overall condition second. All at the same time, easy, accurate and simple. Sure nobody like to to do Triage, NO ONE. But throwing a machine that breaks so often its stupid... the basics are being lost in the Health care industry driving up costs due to automation and its costs. Using "Oh the machine is broke" as excuses for why something wasn;t done, when they tools are at hand to do the work... PLUS... now here is a biggy... You get to actually talk to the patient. Rather than just walk in wait and leave. Bleah, and I think you missed something... my horrible HDHP casts the COMPANY $1300/month along with MY scheduled costs of about $600/month. $1900/month == $22,800 a year... where the HELL are you coming up with $10K a year being better than MOST. $10K/year == $834/month GOSH you really think with the CURRENT BROKEN system that is doable? And I agree, no one is taking the systems to task EXCEPT THE INSURANCE COMPANIES. Do it both ways... Forcing Providers to take it in the Chin on cost and the Insureds taking it in the Pocket book. Giving the insurance Industry TONs of profits (lately at least). Building a competing Industry for it would be like "Re-Programming" RoboCop, taking the 3(+1 hidden) Rules and adding 2300 other vague and conflicting ones, nobody COULD/WOULD be able to make it right ever. Therefore, the best way is to force changes, small ones first and then bigger and bigger ones until everything works, finishing out with Tweaks... But then it'll get to where current DayCare Regulations for Licensed DayCare providers are spinning out of control... YOU CANNOT REGULATE COMMON SENSE.
Post #311,463 by Another Scott 7/22/09 9:55:55 AM Reply	Sphygmomanometer IME, too many LPNs and others rely on numbers spit out by the automated boxes without really thinking about whether they're right or not. And they don't feel comfortable using the old fashioned sphygmomanometer. Part of it is that they're over-worked (monitoring too many patients). When our oldsters were in the hospital, unless they were in the ICU, they weren't monitored by a pulse-oximeter. We had to bring in our own. So, I'm not sure how much of an impact they have in general health-care inflation. The nursing home might have had one for the whole facility, but it usually didn't work, so RNs had to buy their own if they wanted that information. Automated sphygmomanometers can be found at drugstores for < $50. Pulse-oximeters are more, but we were able to get a good one for $500, IIRC (cheap ones were < $200, but seemed more susceptible to finger shaking (Parkinsons, etc.). I think drug costs are a bigger issue. I still recall spending something like $600 (after federal insurance and supplemental) for some antibiotics for Joe - about 10 pills. Also, whenever someone enters a hospital they get a new batch, and when they return to their nursing home they get a new batch, so there's a huge amount of waste. FWIW. Cheers, Scott.
Post #311,465 by jake123 7/22/09 10:24:29 AM Reply	You do it by bargaining hard with the vendors just like everybody else does. Mind you, you're right... the current plans don't do this because none of your politicians in Congress have the stones to actually shaft the people that need to be shafted (that is, the insurance industry) to fix your country's health care system. Be that as it may, offering a public health insurance plan is very simple; create a wholly government owned non-profit corporation, set up the rules for capital retention for long term requirement, appoint and/or elect a board of directors, and start hiring actuaries to staff it up and figure out what the numbers need to be. Then, let them compete. Simply put, the fact that they DON'T have a legal obligation to maximize return to shareholders means that they will immediately have a huge cost advantage over everyone else, allowing them to provide better coverage for less money. Arms-length relationship with Congress makes itn unamenable to political pressure, and as they pick up customers the other insurance companies lose them... leading to the ability to use their market power to drive down costs. If I were a business owner, and I could buy from them at the price point they should be able to offer it at, I'd be encouraging my employees to use it. Ultimately, the public health insurance corporation should become the dominant if not the only player for the services they cover. This allows other insurance companies to work around the margins covering the "luxuries" (eg - private hospital rooms for the squeamish) but ultimately for any of the necessities the public one should be the only one covering them. Yeah, it's socialism. So what, it works. People who are interested in using empiricism in assessing public policy outcomes should not be afraid of this. The big problem I see is that ideology is being used as cover to convince people not to use empirical methods to help decide what is the best course of action. The best part is that there's lots and lots of empirical evidence all over the world that shows that the US system is the worst among developed nations. Foofawring about "but I don't see a plan that spells it all out for me!" shouldn't stop one from noting that everywhere else uses single-payer non-profit public insurance to control their costs and assure good outcomes, and that they all work far far better than the US system does.
Post #311,469 by boxley 7/22/09 10:39:32 AM Reply	if its the worst why do so many canadians come here for treatment? All of my canadian relatives pays for an insurance plan good for work down here. thanx, bill
Post #311,470 by jake123 7/22/09 10:42:24 AM Reply	Let's see some numbers. Also, where do they live? Finally, when you've got people sent to the US for work when facilities/staff are not available in the time needed, OHIP covers it. That's a separate issue from the one woman who's trying to sue OHIP now and made that ad for the insurance industry down south... she was going to get treatment, just not on the schedule she wanted.
Post #311,474 by folkert 7/22/09 10:54:03 AM Reply	Hey its a "ME FIRST" Society down here... Unless you didn't notice that.

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