Healthcare Reform Thread

[Drake Tungsten]

Even your boy Ezra Klein won't claim that a strong public plan would compete on an equal footing with private insurers...

The Weak Public Plan: This is what people are talking about when they refer to a "level-playing field." This incarnation of the public plan -- first proposed by Len Nichols at the New America Foundation and later echoed by Peter Harbage and Karen Davenport at the Center for American Progress -- would have no special advantages over private insurers. It couldn't use the low rates that Medicare sets or access taxpayer subsidies. It couldn't force its way into networks. It would simply be another insurer, albeit with different incentives than traditional insurers.

The Strong Public Plan: This would be like Medicare for the rest of us. It could throw the federal government's weight around. It could negotiate deep discounts with providers. It could muscle its way into networks. Outside groups like the Commonwealth Fund estimate that it would save the average consumer 20 percent to 30 percent. That would give it a massive competitive advantage over private insurers, and would probably result in tens of millions of Americans dropping their current coverage and entering the public plan to save money. A variant of this was in the draft of Ted Kennedy's bill that was leaked last week.

http://voices.washingtonpost.com/ezra-klein/2009/06/health_care_reform_for_beginne_3.html

[Ramo]

Which has ****all to do with your earlier claim.

As I said:

Only in the sense that empirical evidence suggests that it'd be cheaper, and by the magic of capitalism, consumers would flow to it.

[Ramo]

Thanks for emphasizing my original point, though. Your objection is that the public plan would outcompete the private industry.

[Drake Tungsten]

You are a moron.

[Ramo]

You are an ignoramus. Who can't back up his bald assertions.

[Drake Tungsten]

Let me help you understand what your boy Ezra Klein was saying...

The Weak Public Plan: This is what people are talking about when they refer to a "level-playing field." [Implication: A strong public plan won't create a "level-playing field"!] This incarnation of the public plan -- first proposed by Len Nichols at the New America Foundation and later echoed by Peter Harbage and Karen Davenport at the Center for American Progress -- would have no special advantages over private insurers. It couldn't use the low rates that Medicare sets or access taxpayer subsidies. [Implication: A strong public plan can use both!] It couldn't force its way into networks. It would simply be another insurer, albeit with different incentives than traditional insurers.

The Strong Public Plan: This would be like Medicare for the rest of us. It could throw the federal government's weight around. It could negotiate deep discounts with providers. It could muscle its way into networks. Outside groups like the Commonwealth Fund estimate that it would save the average consumer 20 percent to 30 percent. That would give it a massive competitive advantage over private insurers, and would probably result in tens of millions of Americans dropping their current coverage and entering the public plan to save money. A variant of this was in the draft of Ted Kennedy's bill that was leaked last week. [Implication: Ted Kennedy supports an unfair playing field that favors a public plan, which includes taxpayer subsidies!]

[Ramo]

Seriously, can someone who isn't a douchenozzle parse what Drake posted, and find one iota about funding from the tax payer?

The Strong Public Plan: This would be like Medicare for the rest of us. It could throw the federal government's weight around. It could negotiate deep discounts with providers. It could muscle its way into networks. Outside groups like the Commonwealth Fund estimate that it would save the average consumer 20 percent to 30 percent. That would give it a massive competitive advantage over private insurers, and would probably result in tens of millions of Americans dropping their current coverage and entering the public plan to save money. A variant of this was in the draft of Ted Kennedy's bill that was leaked last week.

[Ramo]

[But a strong public plan can do both!

You fail reading.

The strong public plan, obviously, won't create a "level-playing field"!

A level playing field is a subjective phrase. Obviously, a public plan could use its size to negotiate lower costs (like other large institutions). That's partially why I support a public plan!

[Drake Tungsten]

[But a strong public plan can do both!

You fail reading.

.

You are a moron.

[KrazyHorse]

My suggestions for health care "reform":

1) Break the back of the American Board of Medical Specialties when it comes to setting residency standards for physicians. Any guild which is allowed to legally disqualify others from practicing will move towards more and more stringent requirements in order to secure their own privileged position. Currently residents are unbelievably underpaid and overworked; this disincentive to enter medicine, along with the accrued debts incurred in medical school and in interest payments through residency restricts the supply of doctors. The same type of self-imposed requirement to have a certain number of attendings present increases the demand for attendings. Both of these factors increase the wages of attendings beyond all reason. The longer the residency requirements, the higher the salary of attendings in that specialty. What a ****ing load of nonsense.

2) Legally limit the number of hours hospitals may ask their residents to work. This will increase the number of slots available for residents, increase their wages and therefore increase the number of new attendings being pumped out. It will also increase safety, as there is ample evidence that overworked, overtired residents are the source of many medical errors.

3) Accept that not every working individual is going to be able to receive the latest, most technologically sophisticated treatments. This may sound harsh, but medical technology is increasing to the point where costs become prohibitive for cutting edge treatments. Individuals are going to have to make choices about what different levels of coverage are worth to them. Many of these treatments can be sacrificed without sacrificing much in the way of outcomes, so the choices are not as stark as they initially appear. But there are still going to be hard choices to be made.

[Ramo]

Seriously, can someone who isn't a douchenozzle parse what Drake posted, and find one iota about funding from the tax payer?

The Strong Public Plan: This would be like Medicare for the rest of us. It could throw the federal government's weight around. It could negotiate deep discounts with providers. It could muscle its way into networks. Outside groups like the Commonwealth Fund estimate that it would save the average consumer 20 percent to 30 percent. That would give it a massive competitive advantage over private insurers, and would probably result in tens of millions of Americans dropping their current coverage and entering the public plan to save money. A variant of this was in the draft of Ted Kennedy's bill that was leaked last week.

.

[DinoDoc]

Seriously, can someone who isn't a douchenozzle parse what Drake posted, and find one iota about funding from the tax payer?

Why is it going to cost 1.5 trillion+ over a decade and why is the House considering 600 billion in tax increases to help pay for it if the reforms being discussed don't require taxpayer funding?

[Drake Tungsten]

My suggestions for health care "reform".

Good ideas, especially #3. The incentive structure of healthcare in America is what needs to be reformed; throwing more government money at the problem isn't going to fix things.

[KrazyHorse]

In general, I believe that my scheme would flatten pay across specialties, flatten pay between residents-fellows-attendings and increase the number of physicians per capita.

[Ramo]

My suggestions for health care "reform":

1) Break the back of the American Board of Medical Specialties when it comes to setting residency standards for physicians. Any guild which is allowed to legally disqualify others from practicing will move towards more and more stringent requirements in order to secure their own privileged position. Currently residents are unbelievably underpaid and overworked; this disincentive to enter medicine, along with the accrued debts incurred in medical school and in interest payments through residency restricts the supply of doctors. The same type of self-imposed requirement to have a certain number of attendings present increases the demand for attendings. Both of these factors increase the wages of attendings beyond all reason. The longer the residency requirements, the higher the salary of attendings in that specialty. What a ****ing load of nonsense.

Yeah, the whole medical standards infrastructure blows. We need more GP's with less debt. Specialization is not in the best interest of public health.

2) Legally limit the number of hours hospitals may ask their residents to work. This will increase the number of slots available for residents, increase their wages and therefore increase the number of new attendings being pumped out. It will also increase safety, as there is ample evidence that overworked, overtired residents are the source of many medical errors.

3) Accept that not every working individual is going to be able to receive the latest, most technologically sophisticated treatments. This may sound harsh, but medical technology is increasing to the point where costs become prohibitive for cutting edge treatments. Individuals are going to have to make choices about what different levels of coverage are worth to them. Many of these treatments can be sacrificed without sacrificing much in the way of outcomes, so the choices are not as stark as they initially appear. But there are still going to be hard choices to be made.

Yep. A Dartmouth study that has been going around recently shows variations in Medicare disbursements on the order of ~3 (controlling for demographics, IIRC), with very little correlation to health outcomes. Two major changes I'd like to see are portable insurance (and my preference would be a public insurer) and salaried doctors (so that they don't have immediate incentives to order more treatments).