Posted on 07/18/2010 6:59:12 AM PDT by Oldeconomybuyer
Under President Obama’s new health-care law, regulators gained a radical power: the ability to define “unreasonable” premiums and reject them on state-level insurance exchanges.
Massachusetts, which has already been the model for the national health-care overhaul, recently gave its regulators the authority to strike down excessive rate hikes—and the result was a nearly 90 percent rejection rate.
If the same blunt approach is applied nationally, insurers may pull out to focus on more profitable market segments—and the promise of universal access could crumble.
(Excerpt) Read more at newsweek.com ...
Nonsense. Do you have any concept what the costs are for health care, e.g., a heart bypass, kidney transplant, etc.? We need insurance and shared risk because of the costs involved in providing that health care from the hospitals to the doctors, nurses, etc. to the medical equipment.
If they do not have the funds to pay for what they want or need they will not get what they want or need. They may get part of what they want or need from a government system - but they will not get all of it, unless they are willing to pay for it.
LOL. Please cut the sophistry. What if someone has a heart attack? Do we check their ability to pay or ask if they wish the care or not? Do we turn away people who need dialysis?
No, the preferred solution is for people to pay for the health care they want.
That is just plain stupid. You seem to have no understanding what it costs to provide health care in this country. Most people could never afford to purchase any significant health care if they had to depend on their personal finances. There is a reason people must have insurance whether it comes from the private sector or the government. My daughter spent one night in the emergency room and the costs were approximately $10 K.
“You seem to have no understanding what it costs to provide health care in this country”
You seem to have no understanding how it came to cost so much to provide health care in this country.
“We need insurance and shared risk “
We can do this without socialism and politics. The present route has more to do with those than it’s original focus of shared risk. That starts with people paying for their health care. Shared risk for catastrophic events only is the only way insurance will work.
“LOL. Please cut the sophistry. What if someone has a heart attack? Do we check their ability to pay or ask if they wish the care or not? Do we turn away people who need dialysis? “
What if someone has a heart attack and their hospital is closed like will happen under socialized medicine? Who goes to the head of the line for dialysis in a government-centralized system, you or a registered democrat?
Why do you think the delivery of health care costs so much in the US, yet costs so much less in other countries?
“My daughter spent one night in the emergency room and the costs were approximately $10 K.”
Why do you think this emergency visit costs $10k?
“You seem to have no understanding what it costs to provide health care in this country”
You seem to have no understanding how it came to cost so much to provide health care in this country.
“We need insurance and shared risk “
We can do this without socialism and politics. The present route has more to do with those than it’s original focus of shared risk. That starts with people paying for their health care. Shared risk for catastrophic events only is the only way insurance will work.
“LOL. Please cut the sophistry. What if someone has a heart attack? Do we check their ability to pay or ask if they wish the care or not? Do we turn away people who need dialysis? “
What if someone has a heart attack and their hospital is closed like will happen under socialized medicine? Who goes to the head of the line for dialysis in a government-centralized system, you or a registered democrat?
Why do you think the delivery of health care costs so much in the US, yet costs so much less in other countries?
“My daughter spent one night in the emergency room and the costs were approximately $10 K.”
Why do you think this emergency visit costs $10k?
I do. Before Obamacare, the government still controlled about 50% of the health care dollars in this country. Programs like Medicare and Medicaid plus an aging population and more and more benefits have driven costs up. Also, medical advances in technology and drugs have added to the costs. I am 67 years old. I have witnessed tremendous advancements in health care.
And third party insurance for health care tied to the employer that emerged after WWII, have removed patients from the cost equation. We need to move the control over health care expenditures back to the patient and that can be done in a variety of ways using the private sector and limiting government's involvement. It can be done through insurance, vouchers and allowances.
"Preserves the existing Medicare program for those currently enrolled or becoming eligible in the next 10 years (those 55 and older today) - So Americans can receive the benefits they planned for throughout their working lives. For those currently under 55 – as they become Medicare-eligible – it creates a Medicare payment, initially averaging $11,000, to be used to purchase a Medicare certified plan. The payment is adjusted to reflect medical inflation, and pegged to income, with low-income individuals receiving greater support. The plan also provides risk adjustment, so those with greater medical needs receive a higher payment."
What if someone has a heart attack and their hospital is closed like will happen under socialized medicine? Who goes to the head of the line for dialysis in a government-centralized system, you or a registered democrat?
Answering a question with a question doesn't work. You failed to answer my question. And what you propose, patients paying from their own resources for care, will close more hospitals than socialized medicine.
Why do you think this emergency visit costs $10k?
Lots of factors, some general and some pertaining to the illness of the patient. First, there are the administrative costs of maintaining an ER facility that includes 24 hour a day staffing including lab techs, facility costs such as utilities, state of the art equipment like CAT scans, X-Rays, sonograms, etc. plus whatever tests are needed for the patient. Then there are just the overhead costs from hospital administration to the treatment of illegals and the uninsured.
The point is to formulate policies where even those at the lowest rung can have all the basics (food, shelter, medical care) and have a life (savings, transportation, church), and to have this with a minimum of government involvement (no medicare).
And if we can take care of little ol’ granny living on one SS check, then the rest of us can be no worse; things can only be better.
And what I speak of is not new, it is the way America society was decades ago, until the growth of government wrecked the economy by making life so complex and expensive.
Yeah the $275 that should be budgeted could be used for non-medical items such as cell phones and internet.
But I don’t favor ‘an everybody must pay’ universal health law to get around that.
Instead I favor pre-existing condition portability as long as monthly retainer payments are not in arrears by more than say 60 days and are brought current within a year unless the retained MD agrees to continue care otherwise.
This puts the onus of payment and responsibility directly on the individual.
The FairTax would rebate monthly federal retail sales taxes by $207 to individuals and more to familes with children. That rebate alone can be used to retain an MD.
If the retainer is not purchased, a person can purchase a less expensive catastrophic policy. Those that choose to ignore their health will find it difficult to get treatment if they have no coverage.
If people with a preexisting condition fail to pay for more than 2 months and their MD dismisses them, they are out of luck unless they find a charitable organization willing to cover the cost or a bank willing to loan them what is needed, just as it is now.
For those with preexisting conditions that fall out of portable continuing coverage, I don’t know what can be done. I would think and hope that the society around them will pressure them to get portable continuing coverage and keep it, especially in light of them receiving a monthly $207 retail tax rebate.
But I would never never allow government to mandate they use the monthly retail tax rebate for health coverage because I believe ultimately that government is the problem.
LOL my clock is sure ticking I feel something else not working right every month...I figure since I've never been this old before, that probably the way its suppose to be..I just keep wearing out my parts...I am fine with that..
“Instead I favor pre-existing condition portability as long as monthly retainer payments are not in arrears by more than say 60 days and are brought current within a year unless the retained MD agrees to continue care otherwise.”
Here is where you lose me.
The MD should be free to charge whatever they want, and they should be able to have as many (or few) patients as they want.
One would hope that networks of MD’s would form that could handle various pre-existing conditions as you mentioned, but it should be at their choosing.
As for folks with chronic and serious illness - society will have to handle this in some way - but it should be limited to the specific condition at hand.
The key is that MD’s can work as hard as they want, make as much money as they wish, and patients can do as they please as well.
The beauty of this is that everyone has the freedom to do as they wish and the government need not be involved in any way.
“Programs like Medicare and Medicaid plus an aging population and more and more benefits have driven costs up.”
Since you are so experienced, you know that Medicare and Medicaid do not fully reimburse all medical care and reimbursements in general are subject to political whims.
“We need to move the control over health care expenditures back to the patient and that can be done in a variety of ways using the private sector and limiting government’s involvement. It can be done through insurance, vouchers and allowances.”
No - it can be done when people freely choose whatever care they need and want - and choose insurance or choose not to have insurance. No vouchers, no government, no regulation.
Short of that it will be too expensive and/or less available.
“it creates a Medicare payment, initially averaging $11,000, to be used to purchase a Medicare certified plan. “
No, no, no. Medicare is broke already. let people choose their care by paying for what they want. Let the rest stand in line for the government-run care if they can stand it.
“And what you propose, patients paying from their own resources for care, will close more hospitals than socialized medicine. “
What I propose - having patients pay only for the care they actually use will make hospitals more profitable. Let folks who can’t or won’t pay go to the government facility or not receive care at all. It will make medical care more available and cheaper for everyone - everyone that is willing to pay.
I agree with you but if we can push to get government out of Medicare/Medicaid altogether, then we will need some transition laws regarding all the sick persons with preexisting conditions (pxc).
Portability allows pxc patients to be plugged in to a retainer doc who also pays an extended coverage on behalf of their patients to a specialist group.
Here’s an example breakdown at a very affordable cost basis of only $275 per month per patient for a dual physician clinic having panels of only 2000 patients (pts) each (laid back practice). Keep in mind that many retainer docs can charge much more for example $500 per patient and maintain a panel of between 3000 and 5000 patients each. In other words for the ambitious doc there is plenty of money to be made.
(2000 + 2000 pts) x $275 = $1.1 Million gross revenue,
National Retail Sales Tax (NRST) 23% = $253,000,
Post Tax Revenue = $847,000,
Extended Specialist Coverage Payments $60 per pt. x 4000 pts = $240,000,
Physicians $175,000 x 2 = $350,000,
Clinical Staff = $150,000
Net for operations $107,000.
The pxc pts will be seen by a specialist (e.g. endocrinologist, oncologist, neurologist, etc.). Each specialist group of say 6 specialists can support say about 25 dual physician retainer doc clinics for a minimum 4000 pt premiums of $60 each; total = $240,000 x 25 clinics = $6 million gross of which the specialists will take about 40% leaving the remaining 60% for staff, facilities and hospital services. There is no NRST at the specialist level because they are B2B (business to business).
The above are minimal numbers so that the actual economics will likely be greatly richer. If the numbers work at these demand and cost levels, they will survive and thrive under most other conditions. The savings that accrue from eliminating government regulation and poor reimbursement and eliminating insurance companies are dramatic.
Portability is vital to competition and makes a market. Without it the medical provider part of the market wields too much market power. Let the patients find a retainer doc and when their demands drive up referrals to specialist care, market pricing will adjust up according to supply and demand. Too many former medicare pts (elderly) in one region will drive up costs to the point that more specialists will need to be recruited or more elderly will need to relocate to regions of lower cost.
No government involvement is required to administer portability. Its existence merely signals to MDs to service the population at large and not a cherry picked subset. Of course retainer docs can just pass on the costs. The monthly $275 per patient may become $325 and $350 and so on if there is an increase in referrals to specialists. But increasing monthly retainers can cause a patient to go shopping for a more affordable retainer doc who in turn has a specialist group that is hungry for business. The market adjusts but the law of the land must always be to promote competition in markets.
The frame and intent of the bill is an economic sabbotage of the current payers, the insurance companies. They are sacrificing the engine on which this plane flies. They have been vilified publicly, and they are now legislatively leveraged to fail.
Consider the analogy: Banks - legislatively mandated to make bad loans - compelled via fair housing legislation. Do not worry about bad derivatives; those will be easily assumed by Fannie Mae and Freddie mac.
Similarly now, the insurance companies are being compelled to underwrite bad polcies, much like a bank underwriting a bad loan. Cannot exclude pre-existing conditions. Just that alone, ignoring the ability to raise premiums, is a business model that is not sustainable. Add to that the back up (derivative plan -public option) looming as the catch net for a failed insurance system, and a DSHS secretary that can decide they cannot raise their premiums, how can anyone not conclude that this bill is precisely designed to kill private insurance companies.
But be careful what is wished for. Consider the fallout and the necessary consequences.
Do not forget, these insurance companies pay the delivery systems which keeps them in business.
While gov patients pay at a rate which equals a loss to the delivery systems, the insurance companies make up the difference and are therefor the lifeblood to the current system and its providers.
No private insurance compaines, no private delivery systems. The nature of delivery systems are high volume, high overhead, but very low margin, typically have ~ 2-3 weeks of reserved revenue to continue to remain in business if payment ceases before "out of business" signs are posted.
No amount of changes or appeals or repeals is going to change the formula. Its notoriously brilliant in its concept. Because just like the bank collapse, not many people are going to blame the goverment.
Oh no, as soon as the insurance companies go bankrupt many will rejoice, many will say good riddance and many will simply look forward to the government "alternative". It’ll come off as if just another greedy industry that couldnt manage their own books, and bonuses will pointed at to the CEOs as the reason for failure, but few will acknowledge the Tomahawk missile.
But the greater point is this: THE EXACT SAME FATE IS THEN SEALED FOR THE DELIVERY SYSTEMS. Every Hospital, Clinic, Doctor's group, Nursing Home, Pharmacy etc - every single piece of the entire delivery system that currently depends on the private insurance companies - are subject to rapid bankruptcy.
They’ll will be maligned for being too caught up in the insurance companies pockets. Mis-management -overspending -poor use of resources and a need for an efficient fair public system will ushered in on the “crisis” of the medical system collapse.
The "crises" will inevitably lead to an urgent 'spending / recapitalization' package. They will say: "we cannot let these companies fail. We need to infuse money into the infrastructure to keep it alive."
And then all at once, you have dissolution of the insurance companies, followed rapidly by bankruptcy of the private health care system, followed by the governmnets recapitalization plan. In one fell swoop the payers become the "public option" , and the owners of the delivery system becomes the federal government.
This is Obamacare. It is the hostile takeover of our curent medical system.
These people are treasonous private industry wrecking balls. And there was no revolutions after the banking takeover and redistribution and no revolution after the auto fiasco. And there may be some bemoaning, but like sheep in a pen, there will be no revolution resulting from the medical industry collapse as they once again will be able to pull the wool over people's eyes stating how it was the industry's own fault, and the government is simply there as the good guy to pick up the pieces.
No, only God can help us now. This thing is over as we speak unless some 1-10,000 chance that some constitutional challange can be won and a large section of the law can get dismantled. But I am not holding my breath.
imo, we have just witnessed the beginning of the end of the soverignty of this nation.
The collapse of our healthcare system, the extraordinary loss of real capital in our markets, and the newly printed paper borrowed to bailout an enormous percentage of the healthcare infrastructure (which will make the banking bailouts look like chump change), combined with the most repressive taxes we have ever seen will be the final blow. Healthcare is their coup de grace.
They knew it when they signed.
"This is a big f**king deal", said the jester. This legislation will be our undoing - and purposefully so imo -economically, socially and nationally- and perhaps the cracks in the walls of our sovereignty will become wide door mats.
There are two issues of reimbursement. Generally the government reimbursements don't cover all of the costs to the doctor and hospital, which is why 12% of the doctors don't accept Medicare patients and 40% don't accept Medicaid patients. Since the states fund about 50% of the Medicaid costs, they have established different standards as to what they will cover and who will be covered because they can't afford their portion of the bill.
Medicaid: Biggest insurer is a budget buster
No - it can be done when people freely choose whatever care they need and want - and choose insurance or choose not to have insurance. No vouchers, no government, no regulation. Short of that it will be too expensive and/or less available.
I suggest you read the Ryan roadmap as well as the Coburn-Ryan health care proposal. I am not against people choosing or not choosing to have health insurance, but the vast majority of people will choose to have it just like they do car insurance. As far as government involvement is concerned, that train left the station a long time ago and it is not coming back. Ryan is proposing privatizing Medicare, which I support.
No, no, no. Medicare is broke already. let people choose their care by paying for what they want. Let the rest stand in line for the government-run care if they can stand it.
LOL. And who pays for the government run care? The idea is to put control back into the hands of the patient. Let the patient purchase the kind of insurance they want, need, and can afford. There is no way most of the people in this country can fund their own health care from their own finances without any insurance. The more people you force into government run care, the higher the costs to the taxpayers.
What I propose - having patients pay only for the care they actually use will make hospitals more profitable.
That is a nonsensical statement. What do you mean by actually use? Aren't they billed now for services?
Let folks who can’t or won’t pay go to the government facility or not receive care at all. It will make medical care more available and cheaper for everyone - everyone that is willing to pay.
Are you nuts? Forcing more people into government facilities will increase costs, not decrease them. What exactly do you mean by afford? Are you against private insurance? And by government facilities, do you mean totally owned government hospitals, doctors on the USG payroll, etc. Are you proposing the elimination of Medicaid and Medicare, which provide the funding and care for over 100 million people?
You live in a fantasy world. Unfortunately, reality is what counts.
“LOL. And who pays for the government run care? The idea is to put control back into the hands of the patient. Let the patient purchase the kind of insurance they want, need, and can afford. There is no way most of the people in this country can fund their own health care from their own finances without any insurance. The more people you force into government run care, the higher the costs to the taxpayers. “
Government care - as is already provided extensively - is funded and budgeted and debated. It is also not very good. We will have it whether we like it or not.
The only way to put the people in charge of their health care is to get them to pay for it.
How can you make a statement like “There is no way most of the people in this country can fund their own health care from their own finances without any insurance.” with a straight face? For most folks, they’ll pay MORE for insurance than they will pay for general medical care - until they get a catastrophic illness.
“What do you mean by actually use? Aren’t they billed now for services?”
I mean they pay for what THEY use not for what everyone else who does not pay uses wrapped into a bill that they are responsible for.
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