I could live without healthcare reform! How about you?

[Fish Elvis]

"Forced participation in abortions" is the new "death panels".

Wow, that text from Michael Connelly would be laughable if so many people didn't take it seriously.  I just wrote and then deleted a bunch of stuff because it's not worth it.  

Another thank you to Crash for his response.  I'm generally on the other side, but this country will be a lot better off if it's conservative/right side is rigorously honest and intellectually sharp.  Keep showing people there's another way to do it, or we're all in trouble.

It's interesting to see this usually non-partisan tax-and-budget guy get fed up:
"One of the ... offensive ... aspects of the Republicans' hateful lying about death panels and the like is that they are actually the ones who want to provide less treatment."
http://danshaviro.blogspot.com/2009/08/healthcare-reform.html

This account from the former PR head for Cigna is gripping:
http://www.guernicamag.com/spotlight/1207/the_last_temptation_of_wendell/

[FishFarmer]

There is nothing inherently wrong with the idea of making a profit from providing health care -- except it doesn't work well socially. Profit models always push towards selling more of your product and pressing your pricing upwards in the market. Not a good thing when it eats up 16% of GDP and *still* leaves 40 million folks uninsured. And if you don't think Brian's point doesn't come into play you've got to be kidding yourself.

Ben

[Eric B]

Well I can see that medical professionals should be compensated fairly for their hard work.

But do we need new afflictions and drugs to treat them advertised on TV, like hamburgers?

I feel a bout restless leg syndrome coming on, accompanied by irritated bowel syndrome...  but I'm too ADD to care.

[Lost Mojo]

Eric you bring up one of my greatest angers....why in the hell is it legal to advertise PRESCRIPTION medication?

-Brian G

[Eric B]

Cuz there is HUGE money to be made. 

[promethean_spark]

>Profit models always push towards selling more of your product and pressing your pricing upwards in the market.

Tell that to Wal-Mart...

There are some areas where there isn't competition in health insurance, which gives companies more freedom to take profits (maybe 6.6% instead of 3.3%), but I seem to recall that we already have anti-trust laws on the books to deal with such situations...  It's not like 10 years ago the government told Microsoft "You've got a monopoly, so we're going to make a public software company that sells operating systems and word processors to make the market fair!"

[littoral]

Tell that to Wal-Mart...

This is what I refer to as a zombie meme. It refuses all reality and never dies.

Being self employed and often traveling on business leaves me with exactly one option where I live, Anthem. These regional monopolies are quite common, especially in rural areas, and plainly undermine any claims of a competitive market.

Health care is rife with de facto monopolies. Pharmaceutical companies hold monopolies in the form of patents for decades. And the same is true for the medical device industry. These monopolies are routinely extended indefinitely through "evergreening" and the use of "patent thickets". The ideas that competition in health care keeps prices low in a free marketplace are absurd as free market competition largely does not exist, and this is by design.

If you need proof of their non competitive nature look no further than the Medicare Advantage program. Private insurers freaked, they couldn’t possibly compete with government administrative costs when this program was proposed. They bitched and whined then quickly funneled money into legislation that granted them subsidies. And they receive these subsidies to this very day... because they can’t do it as efficiently as government administrators.

[Lost Mojo]

Where is there no competition in the market? I didn't check facts but I believe there is at least 3 competitors in all states. In a few very outlying areas this may be the case but we are talking probably less than 5% of the populace.

-Brian G

[FishFarmer]

maybe 6.6% instead of 3.3%

Where are these numbers coming from?

we already have anti-trust laws on the books to deal with such situations...

Anti-trust laws only come into play when you abuse the competition by virtue of your monopoly. In other words, it is not illegal to be a monopoly. It is also not illegal to charge outrageous prices because you are a monopoly. It is only illegal to compete "unfairly".  That's why you see so few anti-trust suits.

Again, France covers it's entire population at a cost of 11% of GDP and provides world class care. We spend 16%+, don't cover ~20% of adults and have poorer results. Might be worth looking into.

Ben

[promethean_spark]

http://biz.yahoo.com/p/sum_qpmd.html
under 'health care plans'
Note their dividend yield is also 0.1%, not like shareholders are raking it in there...

[littoral]

Where is there no competition in the market? I didn't check facts but I believe there is at least 3 competitors in all states. In a few very outlying areas this may be the case but we are talking probably less than 5% of the populace.

-Brian G

Brian see:

AMA healthcare competition study

Marketwatch regarding the health care industry exemption from the anti-trust laws.

And one of my favorite quotes regarding California specifically

Health insurance premiums for California working families have increased 96 percent from 2000 to 2007. At the same time, the median earnings of California workers increased 19 percent from $25,740 to $30,702. That means health insurance premiums for California working families have risen five times faster than wages

Believe me, I wish it weren't true. My wife and I are healthy yet because we are self employed, and because we need insurance that travels we had exactly one option. That is hardly competition.

[crash]

Again, in 75% of bankruptcies, where medical costs was the cause, the person filing *had* insurance.

These numbers come from Professor Elizabeth Warren from Harvard.

http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf

David U. Himmelstein, MD, Deborah Thorne, PhD, Elizabeth Warren, JD, Steffie Woolhandler, MD, MPH

"RESULTS: Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors,the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001."

So, if I read this right, a "medical bankruptcy" indeed has medical expenses as the catalyst for the bankruptcy.

With credit to Benjamin Disraeli:  There are three kinds of lies:  lies, damn lies, and statistics.

Controlling for demographics, but not for markedly different national economic conditions and a rather drastic change in the bankruptcy law making bankruptcies far more onerous on exactly the educated, home-owning demographic, makes these stats pretty meaningless.  I would attribute this almost entirely to the BAPCPA.

Personally, I see health care for profit as fundamentally immoral.

...This is the natural conclusion when you hold the view that health care in a 1st world country is a natural right...

I don't think a moral view is necessarily the extension of a political one  

Ben

I should hope that a political view is the extension of a moral one, but I'm probably just a dreamer.

[FishFarmer]

With credit to Benjamin Disraeli:  There are three kinds of lies:  lies, damn lies, and statistics.

The progression has been interesting:
The author is bright, but biased
It's not really about "medical" bankruptcies
Now it's just a lie

You can nit pik, but there is little doubt far too many people face bankruptcy do to medical expenses. And a majority of them had insurance that, I would wager, they would have said they were happy with --- until they needed it. For this we spend 16%+ of GDP.

I would attribute this almost entirely to the BAPCPA.

Well that's an interesting thought.  But the fact is that it's in place and people facing bankruptcy have to deal with it. A few years ago they didn't, that's just the way it is. It's a reflection of the way things are, far from meaningless.

I should hope that a political view is the extension of a moral one, but I'm probably just a dreamer.

Depends on how honest a person is with themselves, doesn't it?


Ben

[crash]

With credit to Benjamin Disraeli:  There are three kinds of lies:  lies, damn lies, and statistics.

The progression has been interesting:
The author is bright, but biased
It's not really about "medical" bankruptcies
Now it's just a lie

You can nit pik, but there is little doubt far too many people face bankruptcy do to medical expenses. And a majority of them had insurance that, I would wager, they would have said they were happy with --- until they needed it. For this we spend 16%+ of GDP.

I would attribute this almost entirely to the BAPCPA.

Well that's an interesting thought.  But the fact is that it's in place and people facing bankruptcy have to deal with it. A few years ago they didn't, that's just the way it is. It's a reflection of the way things are, far from meaningless.

I should hope that a political view is the extension of a moral one, but I'm probably just a dreamer.

Depends on how honest a person is with themselves, doesn't it?


Ben

The point being that the study attributes too much blame to medical bills and by extension the insurance industry, when this was an entirely foreseeable consequence of BAPCPA, which became law on October 17, 2005.

In 2001 there were a total of 1,452,030 non-business bankruptcy filings in the US.  In 2007 there were 822,590.  http://www.uscourts.gov/bnkrpctystats/statistics.htm

Further that with states like California having policies of not allowing exemptions to executions on judgments for medical debts, and it isn't any surprise at all that with a 44% reduction in filings, those that still file have a highly disproportionate number of large medical bills (so-called "medical bankruptcies", to use the term from the Warren study).

Her being a bright capable person and her using statistical slight of hand to support her agenda aren't mutually exclusive.  Sophistry is an art form practiced by all attorneys and politicians.  Don't hate the playa, hate the game.

[FishFarmer]

The point being that the study attributes too much blame to medical bills and by extension the insurance industry

Well, no. Medical bills are what they are. If the insurance was inadequate that stands on it's own. If your argument with the numbers is the ~3 times more likely than (whenever) I get that, but otherwise there is nothing obviously wrong with them.

What I'm saying is that it doesn't really matter how people got there. Blame insurance, blame hospitals, blame big pharma... they all played a role. People themselves, for that matter. The bottom line the whole thing is inefficient (~30% of insurance premiums go to administration, Thailand < 2% for their whole system) and unnecessarily expensive (pharma and hospitals).

Again, 16% of GDP and ~20% of adults are *still* not covered, with examples all over the world of doing better in terms of costs and outcome.

Further that with states like California having policies of not allowing exemptions to executions on judgments for medical debts, and it isn't any surprise at all that with a 44% reduction in filings, those that still file have a highly disproportionate number of large medical bills (so-called "medical bankruptcies", to use the term from the Warren study).

So what you're saying is that, in terms of absolute numbers, a great many people being crushed by medical bills aren't even making it into the calculations?

Sophistry is an art form practiced by all attorneys and politicians.

It's certainly not limited to those venues.


Ben