The Future of US Healthcare

[Zippicus]

Originally Posted by Kamui4356

That works fine as long as the scale of business is small. Say there's a small privately owned store that's the only game in town for that product and is over charging the customers. Unless there's some corruption going on, it's not that hard to start your own store offering a competing product. The first store will either have to match your prices, offer a convincing reason why people should pay more for thee stuff sold there, or go out of business. Everyone wins, except the guy that was ripping people off, but if he's smart and adapts, he'll still make out ok too.

The problem is that doesn't work as well as businesses get larger. Larger industries have a much higher cost of entry. If you think health insurance companies are ripping people off and want to start your own, good luck with that. You'll need massive funding just to get on the playing field, and even then you'll likely be absorbed by one of the existing companies. Plus there's the nature of how health insurance is bought. Most times the people don't have a choice on their insurance plans. They get what their company offers. They could try to buy an individual plan, but individual plans are vastly more expensive than the group plans they get through their jobs and may have less coverage on top of that.

As for not using the service, a lot of times there isn't a choice. If it's a service people need and there's a huge cost of entry into the market for new companies, you're pretty much stuck with the existing ones.



Yet every other nation with such a system pays less for healthcare. Further the US is by no means at the top of the list for coverage. Right now, under the current private system, we're paying more money for less coverage. Why would the US be more incompetent than other governments here?

I was speaking philosophically in regards to private owned vs state owned. Too many private institutions are already in bed with the government (like big insurance companies). This is what causes those results you mentioned, and quite likely one of the root causes for our current dilemma.

As far as the health care costs, they're not going to magically go down just by changing who handles the insurance. At best that would reduce some of the administrative overhead which isn't really all that much in terms of overall spending. It might be enough to pay for the bureaucracy that's going to be needed to manage a system like that but I have my doubts there as well.

Something big that they could do that would improve things regardless of whether we end up private, public, or hybrid (which is what we really currently are) is Tort reform. Medical malpractice claims are way out of control and a huge factor in health care cost increases.

[Vexx]

Aye, tort reform (or at least standardization of damages and grievance protocol) is a must-have. The we could shake a stick at the prices of malpractice and liability insurance that takes a good chunk of doctor income (those two being another accelerator of costs).

To give a specific example on exploding costs directly due to the current insurance system, the mail-order specialty drugs pharmacy my wife works employs about 130 people -- over 70 of those are non-medical staff whose sole purpose is to deal with the several hundred insurance companies who all have different: forms, formularies, rates of automatic rejection on first submittal (yeah, her facility tracks that), coverage or not for a treatment, protocols for claim handling, etc.

Oh and the formularies (what drugs they'll cover) and "treatments recommended by accountants" (who stand between you and your doctor since the bottom line is their profit) can change every single month or faster. There's a fair amount of labor spent helping patients who get dumped by their carrier and have to choose between bankrupting their family or dying -- so the facility tries to help by connecting them to foundations (or their congressman). Sometimes the drug companies themselves have special reserves set up for patients who have been dumped with no other recourse... sometimes.

With a single payer system - those costs would be dramatically reduced. If "single payer" is too hard to stomache, then at least standardization of forms, processes, controls, and regulation. Let the carriers compete on who delivers those standardized services most effectively.

[Vexx]

Addressing the "front end problem" of healthcare -- 4 critical steps to reducing societal costs no matter what system we adopt.

Ken Dychtwald Ph.D. Psychologist, Gerontologist and Author
The Biggest Problem With U.S. Health Care -- And How To Fix It!

While most of the current healthcare debate has focused on how to cover the tens of millions of uninsured Americans and who should pay (granted, these are critically important issues), after thirty-five years working at the intersection of gerontology and healthcare, I'm convinced that we have the WRONG healthcare system for our aging nation. If your train is headed in the wrong direction, it doesn't help to give everyone a seat. And, since the U.S. currently spends nearly twice as much per capita on healthcare as all the other modernized nations, while our national life expectancy ranks a humiliating 33rd worldwide, it's not that we throw too little money at the problem, but that we may not be spending it in the wisest ways.
The Age Wave is Coming
Until recently, most people died relatively young of infectious diseases, accidents, or in childbirth. When the first US census was taken in 1790, half the population was under the age of 16 and less than 2 percent of the 4 million Americans were 65 and older. As a result, society rarely concerned itself about the needs of its aging citizens. The elderly were too few to matter.
However, during the past century, advances in medical diagnostics, pharmaceuticals, surgical techniques, and nutrition have eliminated many of the problems that once caused most people to die young. And so, the irony is that our medical successes have produced tens of millions of long-lived men and women who now struggle for decades with debilitating chronic illnesses such as heart disease, cancer, arthritis, osteoporosis, COPD and Alzheimer's -- that our system is absolutely NOT prepared to handle -- causing immeasurable suffering and trillions of misspent tax dollars.
With the average life expectancy having vaulted to 78 (and rising), the 13% of our population over 65 now accounts for: 44% of hospital care, 38% of all emergency medical services responses, 35% of all prescriptions, 26% of all physician office visits and 90% of all nursing home use. And, the first of the 78 million boomers will become eligible for Medicare in only 18 months!
The Four-Part Solution
#1: Multiply the amount of scientific research needed to delay or eliminate the diseases of aging.
In May 1961, President John F. Kennedy looked to the sky and stated, "I believe this nation should commit itself, before this decade is out, to landing a man on the moon and returning him safely to earth." In response, we mobilized all of our science and energy to realize that dream a short eight years later.
Similarly, in order to avert the costly chronic disease pandemics looming in our future, we must bring about a commitment of sufficient intelligence, creativity and resources to replace unhealthy aging with healthy aging.
The dollars that have been committed to the life sciences to battle the diseases of aging, however, are woefully inadequate to get the job done. For each tax dollar we currently spend on treating disease, only about one cent goes to fund the scientific research that could delay or prevent some of these dread pandemics in the first place. For example, it is estimated that if we could postpone the onset of Alzheimer's disease by five years, half of all the nursing-home beds in America would empty.
#2: Make disease prevention and self-care a national priority.
Let's be honest....we've become a nation of gluttons. We eat too much, exercise too little and then get angry at the healthcare system when we're sick. This lack of proper prevention, self-care and disease management winds up being a key factor in many of our eventual struggles with illness. This is even true among the elderly. For example, 9% of the 65+ population remain chronic smokers, 85% don't exercise regularly, 41% are overweight and 23% are considered obese.
According to the Centers for Disease Control, more than 50 percent of our potential for lifelong health is determined by our personal behaviors. Maintaining a healthy lifestyle can reduce heart disease, hypertension, non-insulin-dependent diabetes mellitus, colon cancer, and osteoporotic fractures -- most of the most common diseases of aging.
Our healthcare system should be focused on helping and motivating us all to compress the various diseases of old age into the shortest possible time at the very end of life - and thereby raise the odds of living long and well (which would please both Mr. Spock and Dr. Spock). (I wonder why Michael Moore neglected to mention self-care in his otherwise provocative documentary Sicko? Was it because it's far easier to "blame the system" than it is to take responsibility for one's own role in the problem?)
#3: Replace medical incompetence with aging-ready healthcare professionals.
When the leading edge of the baby boom arrived in the mid-1940's, America and its institutions were totally unprepared. Waiting lists and long lines developed at hospitals across the country, apartments and homes didn't have enough bedrooms for boomer kids and there was a shortage of baby food and diapers.
With the coming age wave, we should be preparing armies of "aging-ready" healthcare professionals. We aren't. Less than two percent of all the physicians in America have been trained and certified as geriatricians. However well-intentioned they may be, most primary-care physicians have received little or no continuing education in geriatrics. The same holds true in nursing, allied health, and pharmacology.
Every medical school in the United Kingdom has a department of geriatrics. But with 126 medical schools, there are, amazingly, only eleven such departments in the entire United States. Because of limited geriatric competency, every week our physicians make millions of costly mistakes: misdiagnoses, inappropriate surgeries and punishing complications due to faulty medication management (polypharmacy).
If AARP, the AMA, the Centers for Medicare and Medicaid Services and all health insurers required physicians, nurses, and other health professionals to attain basic geriatric competencies in order to be eligible for reimbursement, mistakes and do-overs would shrink, and we'd have better-cared-for older adults at a far lower cost.
#4: Palliative care: death with dignity.
A century ago, 75 to 80 percent of all deaths took place at home with family and friends on hand. Roughly the same percentage of all deaths now occur in institutions -- hospitals, extended care facilities, and nursing homes.
In fact, Medicare spends approximately 28 percent of its total budget on patients in their last year of life -- sometimes when the attempt to prolong life merely means an expensive, inhumane, high-tech death. And something that no one seems willing to talk about is the fact that the extension of dying in this fashion all too often becomes a capitalist feast as some medical companies see their profits grow, the longer the dying process is extended.
We'd be wise to shift the emphasis for the dying patient to "palliative care" or hospice care -- which focuses on the relief of symptoms, controlling pain, and the provision of emotional and spiritual support for the patient and their family. Such treatment requires relatively little apparatus and technology, is much less costly than the procedures currently in place in most hospitals and provides for a far more humane and dignified last stage of life.
The Challenge Ahead
On January 1, 2011, the first baby boomer will turn 65. Whether we grow old sick, frail, and dependent -- or vital, active, and productive -- will depend on our ability to dramatically alter the orientation, strategies, skills, and financial incentives of our current healthcare system. And so, while we're focusing now on the coverage and financing of our damaged healthcare system, we should also focus on re-visioning healthcare's purpose -- to create long-lived, productive and healthy men and women.

[Reckoner]

So I thought I would bump this thread for discussion now that health reform is about to come crashing down into the U.S.

What I would like to ask is... What information is right, what information is wrong? It seems that many different sources are throwing many different ideas and numbers out there.

Could this be the end of the Democratic congress?

And is there a well explained summary of Obama's plan out there? I seem to be out of the loop here .

The comments out there that have been pissing me off the most out there are things like "It's going to Canadian-style health care!" (This largely being just a scare tactic where people don't have any factual basis or real experience to draw from when talking about Canada's health care) or "the government is going to control what how they treat you!" (This is when the health insurance companies pretty much already do this for you, and they probably care less about you.)

[yezhanquan]

Politics-wise, the Republicans aren't all that wrong in seeing health-care as Obama's D-Day. The thing is: will they fare better than the Germans?

If we go by the mantra "If it ain't broke, don't fix it.", then it is time to fix something, for the system is broken.

[Vexx]

Its pretty clear to anyone paying attention that the health insurance industry is pouring pressure to retain, if not the status quo, something so watered-down in terms of a result that it will be almost worthless in terms of reducing overall costs (reducing costs directly equals reducing profits to the insurance lobby). Its becoming less and less likely that many of the things like:
1) health insurance not dependent on an employer
2) freeing small business of needing to worry about benefits
3) developing large pools of insured who can bargain down price
4) being one medical problem away from bankruptcy
5) being uninsurable because of pre-existing condition (like diabetes, high blood pressure, etc)
.... oh whatever, I could list a dozen things that don't seem to be happening.

Basically, whether Dem or Repub - a large cadre of both parties swear fealty to the insurance lobby against the interests of their citizens. Corporate rule and the ultra-wealthy end up keeping most of the tax avoidance they got in over the last 30 years in the largest shift of money into the smallest number of hands the US has ever seen.

[TinyRedLeaf]

Originally Posted by Kamui4356

Personally I think there's a few reasons for it. One, it's a relic of the cold war. Since the Soviet Union was "communist" anything communist or socialist was portrayed as evil, while anything capitalist was portrayed as good. As a result, socialist style programs meet a lot more resistance just on the fact that they're socialist, rather than considering if they're a good idea. This also leads to the "free hand of the market will solve everything" thinking. Sure, the free market might be able to produce a cheap TV, but there are other industries that the free market simply doesn't work for. Health insurance is one of them.

Two, there's an idea that anyone can get ahead if they just have the right oppertunity. As such they don't like programs designed to help th poor at tax payer's expense, because that's accepting that they need it and won't get become rich or see it as blocking their chance to make money.

Three, there's always been a strong libertarian trend in the US. Such people basicly see governments as inheirantly oppressive, thus they must be kept as small as possible. Of course those same people seem to overlook the fact that private corporations can be just as oppresive in their drive to maximize profits.

Four, it's because most people get their news from the talking heads on fox and cnn and simply don't bother to look any further than that. They just accept what the media is spoon feeding them as the complete truth.

Originally Posted by Kamui4356

Plus there's the nature of how health insurance is bought. Most times the people don't have a choice on their insurance plans. They get what their company offers. They could try to buy an individual plan, but individual plans are vastly more expensive than the group plans they get through their jobs and may have less coverage on top of that.

Originally Posted by Vexx

Most people don't actually get any real choice in their insurance plans. Since for some cock-eyed reason we tie it to the employer - the employee gets to choose between what plans the employer could afford its part of. As companies are absorbed by other companies, the benefits usually decay (in order to make their expenditure pay back faster). And of course, if you lose your job and have any sort of chronic condition --- forget any other insurance company picking you up.

I've been taking note of this thread for a while, but have not ventured in because, as a non-American, I don't really have much in the way of insight to offer.

I am, however, very curious how the American health-care system ended up in this situation. Is it really a case of capitalism run amok? And how is it that companies ended up shouldering the responsibility for their employees health insurance?

Is anyone aware of any paper out there that explains the history behind this mess? In the meantime, I could probably do some research to explain Singapore's approach to health care. The gist of it is easy enough to describe, but the devil is in the details and it's not quite as straightforward to elaborate.

For a start, all Singapore citizens and permanent residents (PR) are covered under a public health insurance scheme. This insurance is funded by the Medisave portion of each individual's Central Provident Fund account, which is, in effect, a government pension scheme funded by monthly contributions by each citizen/PR and his employer. The exact rate of contribution varies according to age and income level, but it works like how a progressive tax rate would (in fact, it works a bit too much like income tax, something which many Singaporeans complain bitterly about).

However, it is a universally accepted fact that Medisave alone will not cover all hospitalisation and medical bills. Singaporeans, in general, are aware of the need to buy personal health insurance plans to cover such eventualities and we have become generally more savvy about the various kinds of insurance we need for adequate coverage. (Many companies do provide insurance for their employees, but the payout from these schemes usually amount to no more than a token sum. Most people here don't rely on company insurance as a result.)

Life insurance is the worst possible kind of coverage you can get with respect to health insurance -- the payout comes after you die. It's comforting to know that you'd be leaving something behind for your loved ones after you bite the dust. It's not so comforting, however, if you end up with a debilitating disease that destroys your ability to work but doesn't, at the same time, kill you.

That's why an individual also needs to buy hospitalisation, critical-illness and accident plans on top of plain old life insurance. And, yes, the premium costs do add up, although it helps that we can claim tax subsidies against the premiums paid. And, yes, the ugly truth also remains that there is a significant minority of Singaporeans who can't afford private insurance and are also too poor to have had much cash stashed away in their Medisave accounts. Hence the grim observation by many Singaporeans that we can afford to die, but we can't afford to fall sick. Make no mistake, the Singapore Government is well aware that this is a political hot potato. It therefore does its best to keep the issue out of mainstream media.

Nonetheless, both health-care and insurance costs are very low here compared to the United States. The Government claims that it's the result of careful management. I haven't studied the issue closely enough to say otherwise. Meanwhile, a random search of the Internet threw up a couple of glowing observations by foreigners about Singapore's health-care system: Oxford's Journal of Public Health and another from the Library of Economics & Liberty.

For a more contrarian view, there is this article ("Medisave, Medishield...Medi-crisis?", Jan 2008) re-printed by the Ministry of Health on its website. The Government's reply is printed at the bottom.

EDIT
Found another article which, in my opinion, does a fairly good job at explaining the pros and cons of the Singapore health-care system: Health Care in Singapore.

It's not a bed of roses and, moreover, what works in Singapore is unlikely to work in the whole of the United States, since there are obvious differences in geographical size, demographics, genetics and socio-cultural backgrounds. But our model does certainly provide a good example of how government intervention can go a long way towards ensuring health care for as many citizens as possible.

[mg1942]

What's your measure of success?

If your measure of success has any notion of diversity of choice, self determinism, and right to privacy, then NO existing single payer system is successful.

If your measure of success is restraining costs in a sustainable manner, then no model offered by current planners is successful (not medicaid, not the Massachusetts plan, not the Hawaiian plan that only lasted 7 months).

If your measure of success is hi tech/quality health care quickly available to all, then no current model is successful, not Canada, not any in Europe. These all depend heavily on government rationing. They also heavily depend on the US health care system providing a majority of the research and pharm breakthroughs, as they do not happen in tightly rationed environs.

Here's what we need to be able to do:

Write into any legislation specific metrics that define the desired outcomes of the legislation and what constitutes success or failure. These metrics should have time frames associated with them. If those outcomes are not realized within the time frames, the legislation becomes invalid. Would you go for something like that?

[yezhanquan]

Today, the trend in Congress and the Senate is the inability to kill programs that are inefficient. Why do you think the Senate's vote to stop building the F-22s was hailed? It's an exception, rather than the norm. I don't think a bill containing such metrics would be passed.

While you do need rocket science for certain illnesses, the vast majority of illnesses can be prevented if people bothered to take care of themselves. You don't need expensive drugs, at least not all the time.

[Autumn Demon]

During the presidential election John Edwards often said he wanted to give all Americans the same health insurance members of Congress receive. That idea would obviously be extremely expensive.

An op-ed in the New York Times suggests that idea is possible if the care Congress receives is made more affordable, so the plan could be extended to the poorest of Americans.

The article suggests having different types of insurance for primary care and emergency care, which would combine the Democratic goal of extending coverage to all with Republican goals of creating cost saving incentives with competition.

http://www.nytimes.com/2009/07/22/op...36f&ei=5087%0A

An alternative strategy for Congress would be the new “fitness club” model offered by some doctors, in which members pay $65 a month for same-day or next-day access to primary care services. This would involve no insurance companies, so it would save administrative expenses.

We could then pair one of these primary care plans with high-deductible insurance coverage for catastrophic care, but limit total annual out-of-pocket payments to, say, 15 percent of family income. For a member of Congress whose family had no other income, that limit would be $26,000. If this kind of plan were extended to other Americans, a family earning $25,000 a year would have a limit of $3,750.

This kind of hybrid plan would honor the values of both parties even as it cut the cost of covering each politician by perhaps one-third. It would give members the incentive to shop for less expensive health services, thus encouraging doctors and other providers to compete to offer better value. At the same time, members would know they are protected in the event of a costly illness. Those who wanted greater coverage could pay for it out of their own pocket.

[Solace]

Originally Posted by TinyRedLeaf

Is it really a case of capitalism run amok? And how is it that companies ended up shouldering the responsibility for their employees health insurance?

It's insurance. You need insurance for pretty much anything in America. If you drive, you need car insurance (this is enforced by law even). You need house insurance, health insurance, life insurance, depending on other factors you may need to supplement or spend more for different policies as well.

Essentially, if one considers the cost of insurance to be too high, the cost of not having it is higher. You can't afford to *not* have insurance, because you will pay heavily (most likely bankrupting) and/or you will go to jail when something goes wrong.

Insurance companies use this power to tell you what is and is not acceptable according to them. There are many problems of abuse, and companies are not bound by contract to keep you in your policy. Private insurance is expensive and most employees take their companies policies because it is better than nothing.

The government solution appears to be "more insurance", and they want in on the action. The real solution should be "insurance is a way to hedge your bets, but you should only require it when the chips are down". For normal situations (you have a cold, you dinged someones car door, you got your teeth cleaned, etc.) you shouldn't *require* insurance just to cut the costs.

So in other words, insurance became the consumers way to subsidize the rising costs of living, and in turn propelled insurance from a "good idea" to a mandated institution that only encourages rising costs in a spiraling cycle.

This is the same issue with college. Most students cannot afford tuition costs, so they are forced into taking loans and finding grants to cover as much as possible, automatically going into debt for years on the hope that their education will pay off and increase their personal living standards. Hopefully their chosen field of study will have jobs ready or they will run into problems.

Instead of easing the burden on citizens by trying to reduce the costs of living, companies and government have only increased their power over society under the disguise of protection. It's not all that different from the old days of mob protection, where you were forced to pay them a fee in exchange for them not destroying your life. Hooray for feudal policies!

There's more profit in treatment than there is in prevention or curing.

[mg1942]

Originally Posted by Vexx

Its pretty clear to anyone paying attention that the health insurance industry is pouring pressure to retain, if not the status quo, something so watered-down in terms of a result that it will be almost worthless in terms of reducing overall costs (reducing costs directly equals reducing profits to the insurance lobby). Its becoming less and less likely that many of the things like:
1) health insurance not dependent on an employer
2) freeing small business of needing to worry about benefits
3) developing large pools of insured who can bargain down price
4) being one medical problem away from bankruptcy
5) being uninsurable because of pre-existing condition (like diabetes, high blood pressure, etc)
.... oh whatever, I could list a dozen things that don't seem to be happening.

Basically, whether Dem or Repub - a large cadre of both parties swear fealty to the insurance lobby against the interests of their citizens. Corporate rule and the ultra-wealthy end up keeping most of the tax avoidance they got in over the last 30 years in the largest shift of money into the smallest number of hands the US has ever seen.

I guess the Congressional Budget Office is in the pocket of the health insurance industry?

Because even they say the Obama's plan will not bring costs down but rather cause them to skyrocket.

[Vexx]

Obama .... doesn't really have a plan - he hasn't proposed anything more than a mission statement or outline. What we have are a cavalcade of competing plans circulating around Congress that make it difficult to even isolate just what the hell who is talking about what when they don't even use the same terms to describe the same thing.

The plan the CBO analyzed, frankly, isn't the plan most progressives were thinking of when they voted the Democrats in -- because it basically guts most everything that would actually reduce costs. The Democrats are pwnzored by the status quo goblins -- aka the big money machines currently pouring millions of dollars per day to derail any substantial changes to the status quo.

[Theowne]

The comments out there that have been pissing me off the most out there are things like "It's going to Canadian-style health care!"

Yeah, that's an interesting statement that these politicians make.

I live in Canada. I've had multiple surgeries growing up. I want to know what is so bad about this Canadian health care system that the Americans like to get worked up over. There's never been a single moment where I've ever thought "this darn Canadian health care!".

[yezhanquan]

Well, the US doesn't really have a model to emulate. The sheer size of the US population (300 million and counting. Largest population with democracy>150 years and second largest democracy on this planet) means that the US can only take other countries' models as references, at best. They need to come up with a plan which is theirs, and with lobbies in the way, some have simply given up and went with the status quo.

[Alleluia_Cone]

I wonder if health care is ultimately the issue that fosters greater understanding by the American public at large (or, to be more realistic, the subset that gives a damn about politics) that Barrack Obama is frightfully devoid of the ability to craft legislation. He is a spokesman. Nothing more. And if you think that reality slightly uncomfortably, consider that he is actually the spokesman for legislative initiatives brought to fruition by Nancy Pelosi, Harry Reid, and their respective minions. In short, Barrack Obama is Billy Mays in a suit, except he is not selling us OxiClean, rather, billion dollar programs that defy explanation. And this is coming from a registered Democrat; imagine what someone in Topeka, Kansas thinks?

[mg1942]

John Stossel on 20/20 last night on government controlled health care.

This is what the Obama's minions, aided by the Brawndo swillers want to shove up your ass.

Of course, this is from that wildly right-wing network, ABC.

An informative 6 minutes for those of you that haven't allowed the Brawndo to shorten your attention span to less than that.

http://abcnews.go.com/video/playerIndex?id=8227482

[Vexx]

Why change anything? .... "everything is just fine the way it is"
http://www.newsweek.com/id/209817
Newsweek is also considered a right-leaning news source by most.

Spoiler for text of Newsweek editorial report:

Go ahead, shoot me. I like the status quo on health care in the United States. I've got health insurance and I don't give a damn about the 47 million suckers who don't. Obama and Congress must be stopped. No bill! I'm better off the way things are.
I'm with that woman who wrote the president complaining about "socialized medicine" and added: "Now keep your hands off my Medicare." That's the spirit!
Why should I be entitled to the same insurance that members of Congress get? Blue Dogs need a lot of medical attention to treat their blueness. I'm just a regular guy and definitely deserve less.

I had cancer a few years ago. I like the fact that if I lose my job, I won't be able to get any insurance because of my illness. It reminds me of my homeowners' insurance, which gets canceled after a break-in. I like the choice I'd face if, God forbid, the cancer recurs—sell my house to pay for the hundreds of thousands of dollars in treatment, or die. That's what you call a "post-existing condition."

I like the absence of catastrophic insurance today. It meant that my health-insurance plan (one of the better ones, by the way) only covered about 75 percent of the cost of my cutting-edge treatment. That's as it should be—face cancer and shell out huge amounts of money at the same time. Nice.
I like the "lifetime limits" that many policies have today. Missed the fine print on that one, did you? It means that after you exceed a certain amount of reimbursement, you don't get anything more from the insurance company. That's fair.
Speaking of fair, it seems fair to me that cost-cutting bureaucrats at the insurance companies—not doctors—decide what's reimbursable. After all, the insurance companies know best.
Yes, the insurance company status quo rocks. I learned recently about something called the "loading fees" of insurance companies. That's how much of every health-care dollar gets spent by insurance companies on things other than the medical care—paperwork, marketing, profits, etc. According to a University of Minnesota study, up to 47 percent of all the money going into the health-insurance system is consumed in "loading fees." Even good insurance companies spend close to 30 percent on nonmedical stuff. Sweet.
The good news is that the $8,000 a year per family that Americans pay for their employer-based health insurance is heading up! According to the Council of Economic Advisers, it will hit $25,000 per family by 2025. The sourpusses who want health-care reform say that's "unsustainable." Au contraire.
And how could the supporters of these reform bills believe in anything as stupid as a "public option"? Do they really believe that the health-insurance cartel deserves a little competition to keep them honest? Back in the day, they had a word for competition. A bad word. They called it capitalism. FedEx versus the U.S. Postal Service, CNN versus PBS—just because it's government-backed doesn't mean you can't compete against it. If they believed in capitalism, the insurance companies would join the fray and compete.


I'm glad they don't. I prefer the status quo, where the for-profit insurance companies suck at the teat of the federal government. Corporate welfare's what we've got, and it's a damn good system. Through a wonderful program called Medicare Advantage, the insurance companies receive hundreds of billions of dollars in fees to administer a program that the government is already running. Don't touch that baby. You'd be messing with the handiwork of some fine lobbyists.
You know what part of the status quo I like best? It's a longstanding system for paying doctors called "fee for service." That's where doctors get paid for each procedure they perform, as if my auto dealer got paid separately for the steering wheel, brakes, and horn instead of for the car. Fee-for-service is why the medical care at that doc-in-a-box at my mall is so superior to the Mayo Clinic or Memorial Sloan-Kettering Cancer Center, where the doctors are on salary. Who would want to mess with that?
OK, if you really press me, I'm for one change. It's the one that Republicans trot out to prove they're "reformers," too. We could save our whole system if we just capped malpractice awards. Two of our biggest states—California and Texas—did it a few years ago and nothing has changed there, but who cares? It sounds good.

So tell your congressmen and senators when they're home for the summer recess that it's too soon to address this issue. We've only been debating it for 97 years, since Theodore Roosevelt put national health insurance in the Bull Moose Party platform of 1912. We've only had 745 congressional hearings on the subject (I made that number up, but it's got to be close). That's not enough! Let's study this problem more before we do anything about it.

Did I say "problem"? Who said there was a problem? Not me. I like the status quo.

20/20 is not "Frontline" :P - it has never been much more than tabloid journalism. Another "48 Hours" clone.
ABC is a corporate media outlet owned in part by Disney and other large corporations.
That said, they are revealing some of the garbage sailing under the radar with the Dems that do not really address the problems.

Now.... what the Democrats are actually *doing* is turning the reform into a ball of crap as all the special interests of pharma and insurance patiently gut, delay, subvert whatever the original intent was. This is probably the clearest demonstration that the discussion in the US is between ultra-exteme-right 'fascism' (corporate-directed government) and at best, a corporate influenced 'pragmatic' center. Any thing remotely "left wing" or "progressive" has been effectively put out of the picture.

Small and medium businesses trying to compete against the global market are being eaten alive by benefit costs - that is being totally ignored in this discussion. The siphoning of money by the for-profit insurance industry, their interference with patient treatment, their revealed tactics of claim denial, dropping coverage on trivialities, the impossibility of *getting* coverage once you have a condition and lose it, the lack of portability in insurance --- that's all okay according to the status quo supporters.

[Autumn Demon]

Explanation of how eliminating insurers' ability to discriminate against the sick could do more harm than good.

http://online.wsj.com/article/SB1000...googlenews_wsj

Mr. Obama wants to wave away this reality with new regulations that prohibit "discrimination against the sick"—specifically, by forcing insurers to cover anyone at any time and at nearly uniform rates. But if insurers are forced to sell coverage to everyone at any time, many people will buy insurance only when they need medical care. This raises the cost of insurance for everyone else, in particular those who are responsible enough to buy insurance before they need it; they end up paying even higher premiums. And the more expensive the insurance, the less likely people will buy it before they need it.

[Vexx]

Whee for Murdoch... does the upside-down logic sound that appealing? This is a non-starter complaint that every other country the US considers a competitor seems to have gotten around or not had as an issue to begin with.