Found this article in the New England Journal of Medicine http://www.nejm.org/doi/full/10.1056/NEJMp1106090 It's a pretty interesting look at one real life example of what happened when going from a single payer system to a "competition based" model. Since being in school, I've come across more articles and tidbits of information and we are no where near a reasonable solution, which is no surprise to anyone. One of the better quotes I've heard is that a dollar of spending on health care is a dollar of income to somebody. This is self evident of course, but the reality is that when we talk about cost savings, cutting costs or managing costs, we are indirectly saying that we want SOMEONE to make less money. One suggestion being offered is that if people have only a limited amount of dollars to spend, insurance companies will "compete" for those dollars and this will magically make health care cheaper. The reality of course is that all it does is create a middle man who denies payment (manages costs) or denies coverage (lowers demand for service and hence, payment).
No matter what system is in place, health care is going to cost more every year. Period. New drugs, new procedures, new knowledge develops all the time and when they are deployed, they cost more money. Competition, as described above, will simply dictate that doctors and hospitals make less money while they deliver more and more complex care. Have we seen this before with competition? Of course we have. While the productivity of the American worker increased quite a bit over several decades, their wages did not. And I'm sure that most here know, despite the vast level of money that we spend, our outcomes are not really comparable to countries who spend less.
Admittedly, I am in favor of a single payer system. Not because I favor socialism or any other stupid ideology, but because after dealing with insurance companies from within health care, I feel like they are just leeches who do nothing but shuffle money around and suck out their share while doing absolutely nothing to improve the system or the lives of the insured. That said, I am also in favor of having our fat assed nation stop eating such shitty food and start taking better care of themselves. We could legitimately spend trillions of dollars less on health care if people consumed less care by attempting to be more healthy. For quite awhile, we are going to remain locked in a philosophical battle about this rather than engaged in a discussion about what is the best path to finding a solution that a majority of people in this country want. Obama care is a bad plan, but what people like Ryan are offering is simply not what people like seniors want.
Fuckin commie, move to Denmark and enjoy yourself.
ReplyDeleteWhat a pile of horseshit.
I can always tell when I've hit a nerve and you have nothing to say because you simply lash out like a child. You don't have some Heritage response line up ready to go?
DeleteWhenever you play the victim max I can't resist.
DeletePoor, poor Maxie.
good response Max that is exactly what he does. As Pfunky says below ultimately single payer would be the cheapest. It removes all the middle men out of healthcare. It removes all the profit except for doctors out of healthcare. Why should the health and welfare of the nation ever, ever been a for profit enterprise. There is one thing that definitely falls as more important then money and that is life. Every time.
Delete@ William. You in the healthcare system? Max is and has been for a while so I give a lot of weight to how he says it works. My daughter in Texas is the office manager of a urgent care facility and I hear a lot of the same stuff from her. So I think maybe you ought to consider what others say sometimes instead of always thinking your little group of Tea Party Nations are the only ones who are right.
DeleteSingle Payer would actually be cheaper for the taxpayer than Obamacare. That's what makes the ACA a shitty law. It's a reach-around for the health insurance industry just like Bush's prescription drug law was for Pharma.
ReplyDeleteThe only problem with single payer is the government.
DeleteExample:
The VA.
Medicare fraud.
Medicaid fraud.
While single payers sounds great and probably is in other countries. We're talking about a government who can't get a web site up and working in the specified time, not to mention the enormous cost to the taxpayers. But it's not their money, that's whey it's a bad idea.
Get the government out.
ReplyDeleteThey FUCK everything up.
Agreed. I cannot recall one thing in the history of this nation that the government did and it saved us money.
DeleteThe VA has rationed care. Does anyone with half a brain think that death panels are not right around the corner?
DeleteWe can't find fucking IRS emails on fucking hard drives. Does anyone really think that the government gives a shit about your health?
Never said it would be a good system. Just cheaper.
DeleteIf you changed nothing else at all about how we deliver health care in this country, you could save 20%-40% simply by eliminating the middleman' s take, the insurance companies, depending on the procedure.
That's not ideology. That's math.
If you eliminate the insurance function and replace it with government we will see another SS, Medicare, Medicaid non funded nightmare. More inflation passed down to future generations.
DeleteTax and spend, print and inflate.
Want cost efficient health care? Scrap all regulations and allow companies to compete.
Clearly, William, you have nothing to offer here but your slew of talking point epithets. I post an article from a peer reviewed journal that published facts about how moving to a competition system failed miserably. You respond with profanity and taunts of commie.
DeleteAllow companies to compete. What the hell does that mean? We should end medicare, give seniors 500 bucks a year and let insurance companies "compete" for business they don't want to underwrite? You are simply incapable of discussing anything outside of ideological purity. The VA has rationed care. And insurance companies haven't? Death panels? Really?
Yes death panels. Ask those Vets that were placed on those "secret" VA waiting lists. If you can find them short of the cemetery.
DeleteThe death panel stuff, is just pure bullshit William. It's just flat out, kool aid drinking nonsense. You continue, with each post you make, to prove that you have absolutely nothing to offer to this discussion and it's likely because you choose to never do your own homework. You are content to endlessly cut and paste the words of your masters from Tea Party websites, or simply utter empty platitudes of name calling.
DeleteI asked Lou a simple question, and he posted something relevant that could continue the discussion. Why is this so hard for you to do?
The government cannot contain fraud in medicare and medicaid. Imagine the millions the fraudsters can make with everyone in a government plan.
ReplyDeleteThe government cannot get a web site to work on time spending hundreds of million trying and you want to turn over my healthcare to the government?
No thanks.
Hmm, posted a response but it didn't print. Anyhow, do you have anything that shows that insurance companies prevent fraud? We actually got audited by medicare this year. They are a little more engaged that I think people realize.
DeleteYes they are and Medicare auditors are contract workers who get paid by a percentage of the fraud they get reimbursed to the government.. Contractors uncovered 900 Million in over payments in 2012 and 38 million in underpayments.
DeletePrivate Insurer Profits? $13 Billion. Medicare Fraud? $48 Billion. Health Reform? Priceless.
DeleteJeffrey Anderson of The Weekly Standard points out that a recent government report estimates that Medicare fraud alone is at least $48 billion a year, almost four times the profits of the private insurance industry (h/t Michael Cannon):
In a newly released report, the Government Accountability Office (GAO) estimates that, in fiscal year 2010, $48 billion in taxpayer money was squandered on fraudulent or improper Medicare claims. Meanwhile, the nation’s ten largest health insurance companies made combined profits of $12.7 billion in 2010 (according to Fortune 500). In other words, for every $1 made by the nation’s ten largest insurers, Medicare lost nearly $4.
This is sobering news for the minority of Americans who (for some reason) continue to think that government-run health care is a model of efficiency and cost-effectiveness. Last year, total outlays for Medicare were $509 billion; therefore, Medicare spent nearly 10 percent of its outlays on fraudulent or improper claims. Actually, it may have been even worse than that: The GAO writes that this $48 billion in taxpayer money that went down the drain doesn’t even represent Medicare’s full tally of lost revenue, since it “did not include improper payments in its Part D prescription drug benefit, for which the agency has not yet estimated a total amount.”
http://www.forbes.com/sites/aroy/2011/03/04/private-insurer-profits-13-billion-medicare-fraud-48-billion-health-reform-priceless/
But then again, rick is always right no matter the source.
Now I know why I quit post here.
Usual response from you lou. You can't really discuss anything anymore without casting about derogatory statements. If you can't keep up don't post. Yes medicare fraud was 48 billion dollars in 2010. But Lou put it in comparison. Medicare is the largest health system in the nation with total payouts of 528 Billion dollars. You do realize that that amounts to about 1% of total medicare activity right?. And you do also realize that some of the most major fraud activity comes from your darling insurance companies acting as a 3rd party in transactions and over billing medicare. You knew that right?
Deletehttp://en.wikipedia.org/wiki/Medicare_fraud
Rick,
DeleteObviously math isn't your strong point. 48 billion out of 528 billion is nearly 10 percent. Take into account all of the fraud not found and it could easily be 25 percent or more. Private insurers have a vested interest to discover fraud as it might cut into their meager profits (less than the "awful" oil industry) while the government can just tax away for more revenue.
The Government Accounting Office doesn't think this estimate is far wrong. It reported that in 2011, Medicare and Medicaid paid an annual $65 billion in "improper payments." It defines "improper" to include payments that are made in error -- not fraud, but wrong just the same.
DeleteThe government is working on the problem. In 2012, the Department of Justice and the FBI together recovered $4.2 billion in fraudulent payments. They opened 1,311 new criminal health care fraud investigations involving 2,148 defendants. Once these crooks are convicted, the Affordable Care Act authorizes more jail time. Medicare scammers will receive 20 percent to 50 percent longer sentences for crimes that involve more than $1 million in losses.
www.bankrate.com/financing/retirement/how-big-is-medicare-fraud/#ixzz35BoZMEaI
Why bother responding when your in denial? Government is always the best avenue for everything. Bigger government is better government
And Medicaid is just as bad, or worse. New York City has been a huge problem for Medicaid with one former official suggesting that 40 percent of NYC’s Medicaid payments are “questionable. ” The New York Times, in a multi-story expose several years ago, reported that a Brooklyn dentist had filed 991 claims in one day.
And while every state struggles with Medicaid fraud, the Office of Inspector General says the five topping the list are California, Texas, New York, Ohio and Kentucky. The good news is that states recovered $1.7 billion in fraudulent payments in 2011. The bad news is the government had to spend $208 million to do it.
Federal authorities boast of recovering $4.1 billion in 2011 from fraudulent activity, but again spent millions of dollars to recover it.
How much Medicare and Medicaid fraud is there? No one knows for sure. In 2010 the Government Accountability Office (GAO) released a report claiming to have identified $48 billion in what it termed as “improper payments.” That’s nearly 10 percent of the $500 billion in outlays for that year. However, others, including U.S. Attorney General Eric Holder, suggest that there is an estimated $60 to $90 billion in fraud in Medicare and a similar amount for Medicaid. Big money!
Ironically, ObamaCare cutting $500 billion, as I have pointed out elsewhere, was an accounting sham. However, there is so much Medicare and Medicaid fraud that Democrats could have covered much of the cost of ObamaCare without the accounting tricks, had they really gone after it.
http://www.forbes.com/sites/merrillmatthews/2012/05/31/medicare-and-medicaid-fraud-is-costing-taxpayers-billions/2/
Single payer would be a disaster as the government cannot control what they have today.
I read the article and this is what I was looking for "There are no good numbers on how much money private sector health insurers lose in fraud, but working with a well-known health care actuary a few years ago, we estimated that private insurers lose perhaps 1 to 1.5 percent in fraud. Medicare and Medicaid may be closer to 10 to 15 percent. And one of the primary differences is that the private sector insurers embrace software and other new technologies that help them find discrepancies and fraud in health care claims."
DeleteWhile this guy states an estimated rate of 1 - 1.5% for insurance companies, he doesn't back that up with very much. A well known health care actuary? The focus here on the profit generated does not add anything useful. Insurance companies have many ingredients that go into that profit figure, including the fact that they run a risk pool of younger and healthier people compared to medicare which covers the people that insurance companies don't want.
What is useful is that this guy did mention that insurance companies use software to help them catch scammers and he also acknowledges that the government is getting better. He chides them on spending millions to pull in 1.4 billion. I'd say that's still a pretty good return on investment. Bottom line is that there is always stiff resistance to letting agencies go after people who are defrauding the government or who are attempting to skirt the law to protect profit.
I guess my only other question Lou is this, "What's more important, fixing the system to crack down on fraud, or using the stats on fraud to win a philosophical argument in the hopes of taking away something that only a tiny slice of America is outraged by?" I think it's the latter. Insurance companies do not want seniors and seniors could not afford what insurance companies would charge somebody who is in such poor health. Seniors are not stupid and they realize this, which is why they don't want Medicare taken away.
Death panels? A metaphor for the IPAB?
DeletePresident Obama’s ACA established the Independent Payment Advisory Board (IPAB), a 15-member panel of unelected federal employees; its members to be appointed by the president and confirmed by the Senate. The law does not require the IPAB to be bi-partisan in structure, as is required for almost all other independent agencies. Its mission is specific – to restrict payments to doctors and hospitals in order to achieve a reduction in Medicare spending beneath a specified cap.
The reality is that the IPAB represents an unprecedented shift of power from individual Americans and their families to a centralized authority, a controlling Board of political appointees that is virtually unaccountable, and destined to become President Obama’s version of the NICE rationing board in Britain’s socialized medical system, the National Health Service.
President Obama and the ACA supporters point to specific language in the ACA law that explicitly prohibits “rationing.” Beyond the obvious – the absence of any definition of rationing in the law – is that this is implausible deniability, since all evidence points to the de facto rationing that will clearly result from IPAB’s dramatic payment cuts to doctors and hospitals.
We know that doctors cite the money-losing reimbursement rates for government insurance as the Number One reason for refusing new Medicaid and Medicare patients. And we know, even before the ACA payment cuts of 31 percent in 2013, more than 20 percent of primary care doctors already were not accepting any new Medicare patients (five times the rate of doctors who refuse private insurance), and about 40 percent of primary care doctors and 20 percent of specialists already refused most new Medicare patients. By 2019, Medicare cuts under the Obama law will be so severe that payments will become even lower than Medicaid, a system by which almost one half of doctors already refuse to accept new patients.
Is no doctor that will accept you as a patient in some cases a death panel decision?
"Is no doctor that will accept you as a patient in some cases a death panel decision?"
DeleteRespectfully, this response Lou is very specious. You speak as if the ACA will suddenly unleash a wave of denial of payment and denial of service that doesn't currently exist. From within, I have seen countless procedures performed SOLELY because a pt was insured. And I have also seen MD's from the ER to cardiac surgeons refuse to perform some invasive procedure because A) the pt was not insured and B) because the patient was non compliant with medication, was a drug or alcohol abuser, had an unpleasant personality, or some combination of all the above. I become frustrated in a discussion like this because whether you intend it or not, there is an embedded and patently false premise that the ACA is bringing some bad shit that doesn't exist now.
The IPAB represents an unprecedented shift away from the individual to a centralized authority? I honestly don't understand how you think this is different from an insurance company who demands that you jump through fifty hoops to get a claim covered only to later tell you they are denying payment because you didn't cleanly jump through hoop 35. If you tell me that you don't want the ACA because you are happy with the current state of things no matter how screwed up they are, that is at least honest. The majority of this response is intellectually dishonest in the least.
It does, however, represent the crux of where America is today. We aren't having a discussion about what goal we want and how we can get there. We are instead having arguments that are largely based on false premises. I think even you would likely agree that we provide way too much futile medicine in this country that neither cures nor brings comfort. Should we not ever attempt to reign that in?
The purpose of the IPAB is to reign ion cost. They cannot cut services to seniors. That leaves cutting payments to providers.
DeleteShould they reduce payments to providers 20% to reign in spending, how many doctors may drop medicare patients as they cannot afford to service them? Today my physician accepts medicare but not medicaid as payments are lower and he cannot afford to maintain the office with less income.
I am not in the ACA. I chose a plan outside the ACA when my JUNK policy was cancelled. Made the mistake of changing my deductible from 1K to 2.5K in 2011. The costs of my new policy is 2400 more a year for essentially the same coverage.
p.s. I have never had a problem with insurance paying claims to date and I have had many and they are not cheap.
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Delete"The Independent Payment Advisory Board, or IPAB, is a fifteen-member United States Government agency created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act which has the explicit task of achieving specified savings in Medicare without affecting coverage or quality. Under previous and current law, changes to Medicare payment rates and program rules are recommended by MedPAC but require an act of Congress to take effect. The new system grants IPAB the authority to make changes to the Medicare program with the Congress being given the power to overrule the agency's decisions through supermajority vote."
DeleteActually Louman I would think that you would approve of the IPBA. but you really don't understand it's function. You deem it a "death Panel".
But if you read above it's function is to find savings in the medicare program without cutting the quality and coverage. It is an independent board that can make changes to medicare rates and programs without , without, the approval of congress. Doesn't that get it out of the control of the congress. Less government just like you like it. You know that this part of the program is based on the "best practices" format developed by the likes of the Mayo Clinic and the Giesinger Health system in Pa that happens to be one of the most profitable in the nation. Anyway Lou it is designed to help cut costs by doing those tests and procedures that have proven to be successful and ending the practice of multiple overlapping tests and procedures that add no value to a patients treatment. It doesn't mean that is all that can be done. It is the proven direction for treatment that does the most good.
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DeleteBut then again, rick is always right no matter the source.
ReplyDeleteNow I know why I quit post here.
Exactly...!
But then again, rick is always right no matter the source.
ReplyDeleteNow I know why I quit post here.
Exactly...!
. Damn scott you are better then being a magpie for lou.
DeleteThis argument is becoming too partisan to produce a solution to your perennial problem of health care. Living in Australia we constantly hear of abuses on all sides of the US system. Hospitals itemizing accounts down to the last dose of paracetamol, the last minor dressing and the last box of tissues. A patient refused admission and as Mike Moore has pointed out patients left outside in the park.
ReplyDeleteAll the while this is going on; insurance companies and government are squabbling about providing care so that everyone gets to make a buck. Let me, if I may, point out a few Australian ways of doing the same job.
You will be aware we have a form of socialized medicine. Taxpayers pay a small levy (about 4 percent of taxable income) to cover fully, inpatient care in Public Hospitals. Age pensioners are excluded from the payment as they normally pay no tax. All hospital treatment including doctors, operating theatre, Lab and X-ray services etc are covered. In addition, outpatient visits to the Dr are reimbursed at the level of about 85 percent and even here there are significant exceptions and the physician also bulk bills in most cases. Therefore no expenditure by the patient. Pharmaceuticals are subsidized for aged pensioners and for those in the lower socio economic groups. For service veterans, we receive all medical care of whatever nature totally free once we reach 70 years of age.
We also have private cover for hospitals if desired. This costs about 130 dollars per month and apart from the first 200 dollars the services are free. My wife has this cover and although seldom used, it does provide some peace of mind. Many of the private hospitals here are owned and run by churches and religious groups of various kinds. Surely there is reason enough for the user pays principal, so dear to so many of my friends to be reexamined in your country.
So there you are, socialized medicine, a system decades old here; brought in by the socialists and refined by the conservatives and running about as smoothly as any government department can. Try it for yourselves
Cheers from Aussie
Hospitals itemizing accounts down to the last dose of paracetamol, the last minor dressing and the last box of tissues.
DeleteYes they do and are forced to.
Please remember that the non payers are taken care of. No one going to an emergency room is refused healthcare that cannot afford to pay to nor illegals who do not pay refused care.. The cost is passed to the people who do pay.
The new healthcare system is financed by the middle class and wealthy. The best way to finance healthcare would be with a national sales tax. Every one uses healthcare, everyone would pay for it.
In 1952 households spent 5% of their income on healthcare. Today it's 20%. The difference? Years and years and years and years, and thousands and thousands and thousands of pages of government regulations on all levels.
DeleteFood has gone down from 29 to 14%, clothing from 11 to 3%, housing stable percentage wise.
And yet our faithful Roosevelt bred socialists continue to bleat out their "we know what's good for you proles" message.
17.5 Trillion and counting. The fucking socialists are bankrupting our country.
And as far as cry baby Max is concerned, suck it up shithead.
By the way, it was reported this evening the the VA passed out 400 million dollars in bonuses this year.
Delete400 fucking million tax payer dollars. But then again 40% of that we owe to ourselves so it's really not debt.
400 fucking million dollars. Secret waiting lists. This is totally fucked up.
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DeleteThe difference? Greedy insurance companies and providers who place profits over health. William, King just described for you a health system that seems to be working. Most every one pays and I bet a Tylenol in Australia when administered by a hospital doesn't have a price tag of 16-20 dollars a pill. And William think about it. Is most of your local healthcare church run? Being church run would require it to be non profit. But no it is not. Hospital have mainly become corporate run behemoths that buy up everything around them so that they can better dictate prices without competition.
DeleteWilliam here is a point we agree on. Why is the government ever bonusing anyone for anything. Here's common ground William. Let's take the bonus out of government service.
Yes their profit of 4-5% is sure greedy. Bet your restaurant has a higher profitability level.
DeleteThe reason hospitals charge so much? Medicaid paying less than the cost of services.
Illegals paying nothing.
Medicare paying less than the cost of service.
Insurance companies negotiating lower payments.
Doctors over testing patients to avoid lawsuits.
People demanding more services, top of the line testing.
Free is never free, someone always pays.