Healthcare Reform Thread II

[Sava]

Kuci, I don't have the statistics on this at hand, but I can tell that antibiotic use alone is (needlessly) much, much higher here in the US than it is in other industrialized nations. We have giant assloads of waste that our 30% isn't doing a thing to stop.

But without excessive antibiotic use, how will we create the next generation of superbug (which will require bigPharm to give us newer and better drugs!)?

[Dinner]

Hey, Sava. Long time no see.

[Guynemer]

It's a conspiracy! :tinfoilhat:

EDIT: good to have you around, Sava

[Sava]

To say nothing of the similarity to the whole "we must do something NOW!" (as opposed to "we must do something right") meme that led to the PATRIOT Act, Iraq, rendition, etc. etc. etc.

But those were all old plans that were sitting on the shelf. When the time was right, it was easy to dust them off and say EUREKA!

Although, I'm sure pharm and insurance companies have dusty legislation somewhere that they are dying to get passed. Maybe when Sarah Palin becomes President and germs get labeled "terrists", it will happen for them.

[Dinner]

To say nothing of the similarity to the whole "we must do something NOW!" (as opposed to "we must do something right") meme that led to the PATRIOT Act, Iraq, rendition, etc. etc. etc.

I agree that in general the "we must do something now" meme is around in American political thought but everyone has been studying health care for 16 years now and knows exactly what must occur in order to cover everyone and bring down costs. If 16 years isn't long enough then how long would be in your opinion?

Not that the politicians will actually do what all the economists and experts say because the politicians are more interested in maximizing campaign donations then they are in actually getting the job done as efficiently as possible.

[Sava]

thx guys... I drop by now and again... usually just to troll and peaceout

[DirtyMartini]

I'm all for reform. I just want one that actually makes things better.

I agree. Unfortunately the the Medicare strategy for controlling costs is to simply pay less and less for services rendered.

The big problem in health care reimbursement right now is that procedures (x-rays, lab tests, surgeries, etc) are generally adequately (too well?) paid for by private insurers. "Soft" care (clinic visits, preventative care, phone calls, etc) are not reimbursed at a rate that even pays the expenses incurred. Basically, at most hospitals, radiology, pathology and laboratory medicine make a profit since they're 100% procedural. All the other departments lose money hand over fist. Currently, the profits from the one set of departments offset the losses of the other set only barely resulting in operating margins on the order of 1-2% for most hositals. The system is broken, but it's broken in two places so it can still sort of stand up for patients under 65 with private insurance. Unfortunately Medicare's only response to rising costs has been to continually decrease reimbursement, so hospitals lose money on every new Medicare patient they treat.

So, you've got procedures propping up non procedural departments, patients with private insurance propping up those on Medicare ,and the insured propping up the uninsured on the balance sheet. The proposals on the table would all result in more people under the government umbrella -- you can bet the reimbursement in that plan will match Medicare values. Also, most of the proposals have a big target on specifically reducing the focus on procedures, which would be fine if they also increased reimbursement for the nonprocedural bits, but we all know how likely that is to happen. Make those changes and those 1-2% margins disappear in a puff of smoke.

Experts say that if even the step of reducing the Medicare age to 55 is taken, 30% of the hospitals in the country will close within a month.

Single payer is the way to go, but that single payer has to be accountable for the viability of the system -- just continuously decreasing what you'll pay isn't a viable strategy. The only reform that I think would actually work would be to essentially massively extend the VA system -- if you want the goverment to pay for your health care, you must go to clinics and hospitals that it owns and see doctors that it controls and pays-- that way the government is actually responsible for the costs of the system instead of just unilaterally decreasing what it is willing to pay to a third party. Those who can still get private heath insurance would be able to go to the private hospital/clinic of their choice.

[Kuciwalker]

Kuci, I don't have the statistics on this at hand, but I can tell that antibiotic use alone is (needlessly) much, much higher here in the US than it is in other industrialized nations. We have giant assloads of waste that our 30% isn't doing a thing to stop.

Aren't antibiotics really cheap? Wouldn't the meat of preventable expenses be more in the range of expensive surgeries?

Anyway, I wasn't claiming to know what the answer is in either direction; I was just pointing out that Zkribbler's conclusion was in no way justified by his "arguments" (actually, they're just the old Democratic talking points).

[KrazyHorse]

More importantly, why is he comparing the cost-control measures applied by US health insurance providers to those applied by other countries when the administrative cost comparison was between private US health insurance providers and US governmental health insurance providers?

[Sava]

Prolonged antibiotic use has both short term and long term side effects that people seek further medical treatment for. While it is a popular treatment for acne, the use of broad spectrum antibiotics will deplete beneficial bacteria in the gut, creating an imbalance, which can complicate skin problems and cause gastrointestinal issues. A 30 day supply of tetracycline or keflex may only cost $15. But if one then goes to the doctor for topical creams or other issues, the visits and subsequent costs in medication can add up.

This isn't just with antibiotics, mind you. You take a blood pressure med, but then get headaches as a side effect. You take meds for the headache, but get diarrhea . You take meds for that, it messes with your cholesterol. The real issue may just require balancing nutritional needs or correcting a vitamin deficiency. But medical professionals nowadays are trained to treat symptoms by prescribing medications. The common practice should be to look at the individual as a whole, but that is not the case.

[rah]

As long as the pacs are dumping millions and millions of dollars in politicians war chests, there will be no REAL reform.
Right after that is addresed the next thing I would do is take away all those politicians current great health plans. Give them some incentive to actually do something.

[Sava]

As long as the pacs are dumping millions and millions of dollars in politicians war chests, there will be no REAL reform.

If only we could use THAT money to pay for health care.

[Ogie Oglethorpe]

Charles slicing like a hammer

Why Obamacare Is Sinking

By Charles Krauthammer
Friday, July 24, 2009

What happened to Obamacare? Rhetoric met reality. As both candidate and president, the master rhetorician could conjure a world in which he bestows upon you health-care nirvana: more coverage, less cost.

But you can't fake it in legislation. Once you commit your fantasies to words and numbers, the Congressional Budget Office comes along and declares that the emperor has no clothes.

President Obama premised the need for reform on the claim that medical costs are destroying the economy. True. But now we learn -- surprise! -- that universal coverage increases costs. The congressional Democrats' health-care plans, says the CBO, increase costs on the order of $1 trillion plus.

In response, the president retreated to a demand that any bill he sign be revenue-neutral. But that's classic misdirection: If the fierce urgency of health-care reform is to radically reduce costs that are producing budget-destroying deficits, revenue neutrality (by definition) leaves us on precisely the same path to insolvency that Obama himself declares unsustainable.

The Democratic proposals are worse still. Because they do increase costs, revenue neutrality means countervailing tax increases. It's not just that it is crazily anti-stimulatory to saddle a deeply depressed economy with an income tax surcharge that falls squarely on small business and the investor class. It's that health-care reform ends up diverting for its own purposes a source of revenue that might otherwise be used to close the yawning structural budget deficit that is such a threat to the economy and to the dollar.

These blindingly obvious contradictions are why the Democratic health plans are collapsing under their own weight -- at the hands of Democrats. It's Max Baucus, Democratic chairman of the Senate Finance Committee, who called Obama unhelpful for ruling out taxing employer-provided health insurance as a way to pay for expanded coverage. It's the Blue Dog Democrats in the House who wince at skyrocketing health-reform costs just weeks after having swallowed hemlock for Obama on a ruinous cap-and-trade carbon tax.

The president is therefore understandably eager to make this a contest between progressive Democrats and reactionary Republicans. He seized on Republican Sen. Jim DeMint's comment that stopping Obama on health care would break his presidency to protest, with perfect disingenuousness, that "this isn't about me. This isn't about politics."


It's all about him. Health care is his signature reform. And he knows that if he produces nothing, he forfeits the mystique that both propelled him to the presidency and has sustained him through a difficult first six months. Which is why Obama's red lines are constantly shifting. Universal coverage? Maybe not. No middle-class tax hit? Well, perhaps, but only if they don't "primarily" bear the burden. Because it's about him, Obama is quite prepared to sign anything as long as it is titled "health-care reform."

This is not about politics? Then why is it, to take but the most egregious example, that in this grand health-care debate we hear not a word about one of the worst sources of waste in American medicine: the insane cost and arbitrary rewards of our malpractice system?

When a neurosurgeon pays $200,000 a year for malpractice insurance before he even turns on the light in his office or hires his first nurse, who do you think pays? Patients, in higher doctor fees to cover the insurance.

And with jackpot justice that awards one claimant zillions while others get nothing -- and one-third of everything goes to the lawyers -- where do you think that money comes from? The insurance companies, which then pass it on to you in higher premiums.

But the greatest waste is the hidden cost of defensive medicine: tests and procedures that doctors order for no good reason other than to protect themselves from lawsuits. Every doctor knows, as I did when I practiced years ago, how much unnecessary medical cost is incurred with an eye not on medicine but on the law.

Tort reform would yield tens of billions in savings. Yet you cannot find it in the Democratic bills. And Obama breathed not a word about it in the full hour of his health-care news conference. Why? No mystery. The Democrats are parasitically dependent on huge donations from trial lawyers.

Didn't Obama promise a new politics that puts people over special interests? Sure. And now he promises expanded, portable, secure, higher-quality medical care -- at lower cost! The only thing he hasn't promised is to extirpate evil from the human heart. That legislation will be introduced next week.

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/23/AR2009072302723.html

[Ramo]

But that's classic misdirection: If the fierce urgency of health-care reform is to radically reduce costs that are producing budget-destroying deficits, revenue neutrality (by definition) leaves us on precisely the same path to insolvency that Obama himself declares unsustainable.

Seriously?

The problem is the health care deficit in a couple decades, not immediately. Deficit neutrality (the term that he was looking for; none of the plans are currently revenue neutral) refers to only the next ten years.

Tort reform would yield tens of billions in savings.

Bald assertion, conveniently unquantified. Texas, for example, has instituted pretty harsh tort reform (an absolute cap of IIRC $100k), yet costs are much higher than the mean. See, i.e. the Dartmouth study measuring Medicare reimbursements per enrollee, where Texas is among the most expensive states both in absolute terms and growth rate.

[KrazyHorse]

Ramo, why do you believe that something magic happens beyond 10 years?