This is a negative development, but its important to remember that a vote to begin debate is not a vote to end debate. The critical thing now is to see if there is a way to amend the bill to remove its worst features. I'd like to offer a grand compromise: The Democrats drop the abortion funding and public option, and in return the bill receives unanimous consent to proceed to a final vote. We'd need to flip a Dem or two first, but that strikes me as a responsible compromise.

Bring em on!

It's very dangerous to allow this mess to proceed. One way or another, the Senate will get a bill passed. Then some kind of monstrosity will get cooked up in the House-Senate conference. After that, it's really anyone's guess what might happen. Far better had the thing just died here. But it didn't.

It is the first step in a process; now the Senate can begin floor debate. Another supermajority vote is needed to bring debate to an end. Once that happens, a simple majority vote is needed to pass the bill.

Then, we'd have to go to conference; to hash out the differences between the House and Senate versions. Once that happens it goes to the President for signature.

And we'll then be on the hook for the full cost of the bill, which Congressional Democrats are necessarily downplaying because once you factor in all the taxes, fees, penalties, and changes, it will cost everyone far more than everyone was promised, and it will underdeliver by a whole lot more than anyone can possibly imagine.

No where in any of this debate is a discussion of how the same supply of doctors and medical professionals can handle increased demand - the millions that would suddenly have insurance and use those services. That necessarily means that with millions more seeking services, the time spent per patient would decline, and is is all too likely that quality of care will decline.

I have a real bad feeling about it; but there's not the slightest thing anyone can do about it if the Democrats can hold firm and maintain their numbers. The GOP doesn't have the votes to stop it, let alone force changes that can reduce the cost of the behemoth.

Perhaps the real problems with the public option will be discussed instead of all this emotional name-calling. So far the only criticism of it I have seen discussed in public is of the "socialist!" and "nazi!" variety. Even a lot of "socialist nazi!" comments, which pretty much brands you an idiot.

re: #1 Dark_Falcon

This is a negative development, but its important to remember that a vote to begin debate is not a vote to end debate. The critical thing now is to see if there is a way to amend the bill to remove its worst features. I'd like to offer a grand compromise: The Democrats drop the abortion funding and public option, and in return the bill receives unanimous consent to proceed to a final vote. We'd need to flip a Dem or two first, but that strikes me as a responsible compromise.

There's already some talk that Reid will sell out the public option because Landrieu and Blanche Lincoln are saying they'll join Lieberman in a filibuster if it's included.
As to the abortion funding, I have to disagree with you there, partly because there is reason to believe that it will lead to abortion not being covered in anyone's insurance plans-- and make no mistake, that most certainly is Stupak's ultimate intent.

re: #6 iceweasel

There's already some talk that Reid will sell out the public option because Landrieu and Blanche Lincoln are saying they'll join Lieberman in a filibuster if it's included.
As to the abortion funding, I have to disagree with you there, partly because there is reason to believe that it will lead to abortion not being covered in anyone's insurance plans-- and make no mistake, that most certainly is Stupak's ultimate intent.

And that is an intent I approve of. It would de-normalize and reduce abortion and to me that is a thing worth doing.

Maybe someone can bring up the trial lawyers? Yes? So far the only one in congress I have seen mention it is Barney Frank (D-Mass) who answered a question by stating that no one in congress had the balls to go after the trial lawyers. Who runs this country, anyway?

re: #1 Dark_Falcon

This is a negative development, but its important to remember that a vote to begin debate is not a vote to end debate. The critical thing now is to see if there is a way to amend the bill to remove its worst features. I'd like to offer a grand compromise: The Democrats drop the abortion funding and public option, and in return the bill receives unanimous consent to proceed to a final vote. We'd need to flip a Dem or two first, but that strikes me as a responsible compromise.

And you're willing to compromise in what? So far, all I've heard from the right is that they are willing to compromise, as long as it's only the left that has to sacrifice.

re: #5 Vreejack

I agree when they resort to name-calling and throwing out crazy labels it makes it seem like there must be no legitimate criticism of the actual healthcare plan. The GOP could impress a lot of people simply by rolling with the facts and shelving the name calling.

re: #5 Vreejack

Perhaps the real problems with the public option will be discussed instead of all this emotional name-calling.

I doubt it.

I mentioned this Matt Taibbi piece about Palin on the prior thread; I think it makes some good points about the political climate in general:

The really beautiful thing about the culture war, from an entertainment standpoint, is that it is fundamentally irresolvable. There isn’t a concrete set of issues involved, where in theory both sides could give in a little and find middle ground, reach some sort of compromise.

That’s because there are no issues at all. At the end of this decade what we call “politics” has devolved into a kind of ongoing, brainless soap opera about dueling cultural resentments and the really cool thing about it, if you’re a TV news producer or a talk radio host, is that you can build the next day’s news cycle meme around pretty much anything at all, no matter how irrelevant — like who’s wearing a flag lapel pin and who isn’t, who spent $150K worth of campaign funds on clothes and who didn’t, who wore a t-shirt calling someone a c--t and who didn’t, and who put a picture of a former Vice Presidential candidate in jogging shorts on his magazine cover (and who didn’t).

It doesn’t matter what the argument is about. What’s important is that once the argument starts, the two sides will automatically coalesce around the various instant-cocoa talking points and scream at each other until they’re blue in the face, or until the next argument starts.

And while some of us are old enough to remember that once upon a time, these arguments always had at least some sort of ideological flavor to them, i.e. the throwdowns were at least rooted in some sort of real political issue (war, taxes, immigration, etc.) we’ve now got a whole generation that is accustomed to screaming at cultural enemies as an end in itself, for the sheer dismal fun of it. Start fighting first, figure out the reasons later.

re: #7 Dark_Falcon

And that is an intent I approve of. It would de-normalize and reduce abortion and to me that is a thing worth doing.

So, you are OK with forcing rape victims to go thru the pregnancy?

re: #8 Vreejack

The Bildbergers? Illuminati? Greys? Ori? Priors? CIA? ///conspiracy du jour.

I wonder if the Democrats will vote this month against a health care amendment prohibiting insurance companies from paying for abortions.

Too bad being a woman is a pre-existing condition.

re: #1 Dark_Falcon

This is a negative development, but its important to remember that a vote to begin debate is not a vote to end debate. The critical thing now is to see if there is a way to amend the bill to remove its worst features. I'd like to offer a grand compromise: The Democrats drop the abortion funding and public option, and in return the bill receives unanimous consent to proceed to a final vote. We'd need to flip a Dem or two first, but that strikes me as a responsible compromise.

Can you tell me what private insurance companies actually deliver in the way of efficiencies or innovation? Typically, the strength of the private market is that it can innovate and provide efficiencies, prompted by competition and the profit motive, and thereby benefit everyone including itself.

However, with health insurance, I don't see the profit motive inspiring efficiency or innovation, except in a rather negative fashion, such as the 'pre-existing condition' innovation. Moreover, the ideal customer for a health insurance company is someone who needs no health care expenditure, and so anything a private insurance company (or a non-profit without ideological goals) can do to remove unprofitable members from its group and poach profitable members from other groups, the better. The 'pre-existing' condition innovation was to take on a more unhealthy population but controlling expenditure on them.

My general feelings on governmental expenditure is that the government should only do things that the private market cannot sufficiently supply; it seems to me incontrovertible that there is a population of people who the private insurance market can never adequately address.

Yet, the sicknesses of these people do economically affect me, both in the treatment of it; as someone with insurance, I already pay the price for the uninsured, both directly-- my insurance rates are higher because hospitals charge more to allay their expenditures on the uninsured, and my taxes likewise support hospitals that do so-- and indirectly, since a worker who could be productive and tax-paying lying at home sick because he has inadequate medical coverage shifts the tax burden onto me and removes his economic benefit from society.

That is why I support the public option, or single-payer insurance. It is not based on any ideology but pragmatism.

I have yet to see an explanation of how the private insurance companies actually add any benefit to the system of health care in this country.

Thanks for bothering to read the whole thing.

re: #9 andres

And you're willing to compromise in what? So far, all I've heard from the right is that they are willing to compromise, as long as it's only the left that has to sacrifice.

I'd accept the restriction on the insurance companies, for a start. I'd also accept a non-government run program designed to insure that health insurance is available for anyone who wants (but I would not make said insurance mandatory).

re: #15 Obdicut

Once I get to 50 comments posted I'm going to make a special trip back to this thread to upding this comment.

re: #7 Dark_Falcon

And that is an intent I approve of. It would de-normalize and reduce abortion and to me that is a thing worth doing.

We can all agree, no matter how pro-choice we are, that reducing the number of abortions by reducing the need for abortion is a common and admirable goal. (or we should all agree on that, if we genuinely care about women and about children).

But we don't do that simply by making it more difficult for a woman who wants one to obtain one, or more difficult only for the poor to obtain them.

re: #12 andres

So, you are OK with forcing rape victims to go thru the pregnancy?

You're new, so I can't blame you for asking that question. To answer it: No, I've always been willing to allow exceptions for rape, incest, life of the mother, or permanent injury to her.

I thought Jay Cost's take on this vote was interesting. From the article:

A nay vote would gravely damage prospects for reform. And legislators on the Democratic side do not want to kill reform unless/until they absolutely have to, i.e. voting in favor on a particular item would seriously hurt their political careers. As noted above, a yea vote tomorrow will not damage anybody's political prospects. A nay vote, on the other hand, would make that senator a pariah in the broader party (the interest groups, activists, and enthusiasts on the Democratic side) - which, I hasten to add, is the primary funding source for all of these members. Lieberman's Independent Democrat status makes him basically half a Dem and half a GOPer. He's voting yea, which should tell you all you need to know.

re: #15 Obdicut

Cannot Concur. I have zero faith in the government to undertake major non-security issues. I'd rather take my chances with the private sector, which at least is more efficient and self interested. If it ends up that I cannot obtain care I need to survive because the money for cannot be found, then I'm OK with dying, because I'd rather be dead than under the government's thumb.

re: #19 Dark_Falcon

You're new, so I can't blame you for asking that question. To answer it: No, I've always been willing to allow exceptions for rape, incest, life of the mother, or permanent injury to her.

Which, if you've researched the current bill, are the only exceptions allowed for federal funding to abortion.

re: #7 Dark_Falcon

And that is an intent I approve of. It would de-normalize and reduce abortion and to me that is a thing worth doing.

It's an intent I absolutely disapprove of.

re: #15 Obdicut

Thanks for bothering to read the whole thing.

Huh?
/

re: #15 Obdicut

Here's one area in which they excel - it's called pressure to eliminate waste and fraud, since it interferes with the bottom line of making a profit. The government run health insurance systems, Medicare and Medicaid have tens of billions in fraudulent claims paid every year. That costs everyone billions more; eliminating the fraud and waste would mean many more people would be able to get services and/or costs could be reduced.

Instead, the government waste gets swallowed up in tax hikes and spreading the cost around to everyone else.

re: #21 Dark_Falcon

Cannot Concur. I have zero faith in the government to undertake major non-security issues. I'd rather take my chances with the private sector, which at least is more efficient and self interested. If it ends up that I cannot obtain care I need to survive because the money for cannot be found, then I'm OK with dying, because I'd rather be dead than under the government's thumb.

Again, I ask why it is about efficiency in the private insurance market that is good for you or anyone else? What does the insurance company actually do that benefits health care delivery?

And I'm sorry, but it is not possible for you to say that you are okay with dying. If you are uninsured or otherwise unable to pay for your care, and are involved in an accident, care will be given to you. Not only is it not possible to believe that everyone will take such a principled stand as you on refusing care, you may not even have that choice, if you are unconscious or otherwise badly hurt in an accident.

re: #4 lawhawk

It is the first step in a process; now the Senate can begin floor debate. Another supermajority vote is needed to bring debate to an end. Once that happens, a simple majority vote is needed to pass the bill.

Then, we'd have to go to conference; to hash out the differences between the House and Senate versions. Once that happens it goes to the President for signature.

And we'll then be on the hook for the full cost of the bill, which Congressional Democrats are necessarily downplaying because once you factor in all the taxes, fees, penalties, and changes, it will cost everyone far more than everyone was promised, and it will underdeliver by a whole lot more than anyone can possibly imagine.

No where in any of this debate is a discussion of how the same supply of doctors and medical professionals can handle increased demand - the millions that would suddenly have insurance and use those services. That necessarily means that with millions more seeking services, the time spent per patient would decline, and is is all too likely that quality of care will decline.

I have a real bad feeling about it; but there's not the slightest thing anyone can do about it if the Democrats can hold firm and maintain their numbers. The GOP doesn't have the votes to stop it, let alone force changes that can reduce the cost of the behemoth.

I think that an awful lot of current supporters will also be shocked to learn that there will be a variety of fee-for-service charges, akin to copays and deductibles, that will be levied simply to discourage frivolous use. They're a necessity, but not one is talking about them, and those expecting "free" healthcare are in for a rude awakening.

re: #25 lawhawk

Here's one area in which they excel - it's called pressure to eliminate waste and fraud, since it interferes with the bottom line of making a profit. The government run health insurance systems, Medicare and Medicaid have tens of billions in fraudulent claims paid every year. That costs everyone billions more; eliminating the fraud and waste would mean many more people would be able to get services and/or costs could be reduced.

Instead, the government waste gets swallowed up in tax hikes and spreading the cost around to everyone else.

Quite Concur.

re: #25 lawhawk

in tax hikes and spreading the cost around to everyone else.

But ,, BUT ,, how can there be Tax Hikes and Spreading Costs when it's ... welll ,, FREE!!!

/

re: #27 SixDegrees

Had a customer last night expecting to get free house remodeling from our President.

re: #30 Fat Bastard Vegetarian

Had a customer last night expecting to get free house remodeling from our President.

Did you give her his telephone # ???

re: #29 sattv4u2

Just call the increase in taxes a premium. It'll help you fee better.

re: #32 Fat Bastard Vegetarian

Just call the increase in taxes a premium. It'll help you fee better.

Not too much in the past 10 months has me feeling better

HOPE
CHANGE !

re: #31 sattv4u2

I should get business cards made with the White House switchboard's phone number.

re: #4 lawhawk

"No where in any of this debate is a discussion of how the same supply of doctors and medical professionals can handle increased demand - the millions that would suddenly have insurance and use those services. That necessarily means that with millions more seeking services, the time spent per patient would decline, and is is all too likely that quality of care will decline."

You're dead on there. I don't know about you guys, but when I see my Doctor now his schedule is clearly full. We don't sit around and talk about the weather. He always has people waiting.

...and if you've been to an emergency room over the last few years, imagine how much more crowded they will become.

re: #25 lawhawk

Here's one area in which they excel - it's called pressure to eliminate waste and fraud, since it interferes with the bottom line of making a profit. The government run health insurance systems, Medicare and Medicaid have tens of billions in fraudulent claims paid every year. That costs everyone billions more; eliminating the fraud and waste would mean many more people would be able to get services and/or costs could be reduced.

Instead, the government waste gets swallowed up in tax hikes and spreading the cost around to everyone else.

The number of fraudulent claims in private insurance is unknown, since they're not transparent. Using it as an example of private insurance being better therefore requires an assumption on your part.

Private insurers have a profit motive to reduce fraud to the point where it is economically possible for them to do so; as in, when the benefit of going after the fraud is worth the return. There is no incentive to get rid of a $5,000 fraud if it's going to cost you $6,000 to do it. However, if you can find a cheaper solution that also perhaps defunds legitimate customers, it definitely makes sense to do it.

I'd like to remind everyone that, under ERISA, you generally cannot directly sue your insurance company for your death or disablement or injury due to them not approving medical care, if you receive your insurance through your employer or most managed care groups.

re: #35 rwmofo

"No where in any of this debate is a discussion of how the same supply of doctors and medical professionals can handle increased demand - the millions that would suddenly have insurance and use those services. That necessarily means that with millions more seeking services, the time spent per patient would decline, and is is all too likely that quality of care will decline."

You're dead on there. I don't know about you guys, but when I see my Doctor now his schedule is clearly full. We don't sit around and talk about the weather. He always has people waiting.

...and if you've been to an emergency room over the last few years, imagine how much more crowded they will become.

But emergency rooms have to treat everyone already, and all Americans already have access to health care...

//

re: #25 lawhawk
Good point lawhawk about private enterprise excelling in reducing/eliminating waste and fraud. Out of curiosity, does the proposed legislation have any oversight provision? Is it possible to have any gvt oversight on health care?

I don't get the principle of having a vote whether or not to debate something as important as this. What do those who vote NO contribute to the process?

re: #39 Naso Tang

I don't get the principle of having a vote whether or not to debate something as important as this. What do those who vote NO contribute to the process?

A clear signal that they want it to die in the Senate.

re: #36 Obdicut

There is no incentive to get rid of a $5,000 fraud if it's going to cost you $6,000 to do it. However, if you can find a cheaper solution

You can't just manufacture figures out of whole cloth and THEN state you have to find a cheaper solution to fix it!

re: #36 Obdicut

The number of fraudulent claims in private insurance is unknown, since they're not transparent. Using it as an example of private insurance being better therefore requires an assumption on your part.

Private insurers have a profit motive to reduce fraud to the point where it is economically possible for them to do so; as in, when the benefit of going after the fraud is worth the return. There is no incentive to get rid of a $5,000 fraud if it's going to cost you $6,000 to do it. However, if you can find a cheaper solution that also perhaps defunds legitimate customers, it definitely makes sense to do it.

I'd like to remind everyone that, under ERISA, you generally cannot directly sue your insurance company for your death or disablement or injury due to them not approving medical care, if you receive your insurance through your employer or most managed care groups.

That highlighted one is something that could be cured by not routing insurance through employers anymore and expanding competition. If insurer A acts like a weasel and cheats his customer, insurer B will take said customers from him with better service. It's called "The Free Market At Work".

re: #40 SanFranciscoZionist

A clear signal that they want it to die in the Senate.

I understand that much, but it still seems so blatantly un American to deny debate, free speech even, that I find it odd they can get away with contributing nothing except spoilers.

re: #35 rwmofo

"No where in any of this debate is a discussion of how the same supply of doctors and medical professionals can handle increased demand - the millions that would suddenly have insurance and use those services. That necessarily means that with millions more seeking services, the time spent per patient would decline, and is is all too likely that quality of care will decline."

You're dead on there. I don't know about you guys, but when I see my Doctor now his schedule is clearly full. We don't sit around and talk about the weather. He always has people waiting.

...and if you've been to an emergency room over the last few years, imagine how much more crowded they will become.

One thing about free markets - they are incredibly efficient at matching supply to demand. As a result, there are pretty much exactly enough doctors available to meet current demand for doctors. Add a large dollop of new customers to the system, all at once, and you've got a shortage - leading inevitably to higher prices, among other things.

And this will happen to a system with a training pipeline that is several years long.

re: #41 sattv4u2

The figures are just for example. They could be X and X+1. They don't matter specifically.

What I'm saying is that, for example, many large retailers make only a perfunctory effort at controlling shoplifting. They accept that 'fraud'-- the theft of their goods-- is occurring at a certain rate, because forcing it below that rate would cost them more than it is worth to do so.

re: #45 Obdicut

The figures are just for example. They could be X and X+1. They don't matter specifically

Yes they DO matter "specifically"

You have NO idea if it costs MORE to investigate the private ins fraud than the fraud itself! Yet you throw it out there as an absolute!

re: #45 Obdicut

re: #46 sattv4u2

The figures are just for example. They could be X and X+1. They don't matter specifically

Yes they DO matter "specifically"

You have NO idea if it costs MORE to investigate the private ins fraud than the fraud itself! Yet you throw it out there as an absolute!

AND ,, we're not talking about someone pinching a bag of candy out of a Wal Mart.

A repost of an article from yesterday. It is educational to see what others can achieve, largely through attitude, that we cannot.

The Henry Ford of Heart Surgery

re: #42 Dark_Falcon

That highlighted one is something that could be cured by not routing insurance through employers anymore and expanding competition. If insurer A acts like a weasel and cheats his customer, insurer B will take said customers from him with better service. It's called "The Free Market At Work".

Well, it's a little more complex than that. Theoretically, that could happen now-- you have multiple insurance plans offered by most employees, but most employees show no sign of switching based on the reputation of those companies, more just of immediate cost.

In addition, the health insurance companies have marketing departments, and they often settle lawsuits with gag rules attached, meaning that you don't actually hear about the case. Their financials are not transparent, nor, obviously, their actuarial decision making caulculi.

It is very hard for an ordinary consumer to in any way judge whether an insurance company will be good for them, especially since insurance companies can change your policy after you've bought it.

There is no reason to believe, given that local markets have tended to get less competitive over time, that a national market would get more competitive over time.

re: #44 SixDegrees

One thing about free markets - they are incredibly efficient at matching supply to demand. As a result, there are pretty much exactly enough doctors available to meet current demand for doctors. Add a large dollop of new customers to the system, all at once, and you've got a shortage - leading inevitably to higher prices, among other things.

And this will happen to a system with a training pipeline that is several years long.

This is not true. We are critically short of doctors in many specialties. The number of doctors on the market has been artificially restricted by none other than the government, who subsidize all medical residencies through medicaid.

The number of doctors every year is an entirely non-market-determined figure.

re: #47 sattv4u2

re: #46 sattv4u2

AND ,, we're not talking about someone pinching a bag of candy out of a Wal Mart.

No, I said "If". That's not an absolute.

There is no incentive to get rid of a $5,000 fraud if it's going to cost you $6,000 to do it.

That's what I said. It's true. I'm not claiming there aren't $5,000 frauds it only costs you $10 to go after. I'm saying if the cost of recouping or stopping the fraud is X+1 where the cost of the fraud is X, it doesn't make economic sense to do so.

re: #48 Naso Tang

A repost of an article from yesterday. It is educational to see what others can achieve, largely through attitude, that we cannot.

The Henry Ford of Heart Surgery

i can't think clearly on that one. I applaud his innovation, but his opening of a clinic in the Cayman Islands strikes we as outsourcing, which is something I don't think clearly about. I've got a subclinical case of Nativist Bad Craziness where outsourcing is concerned.

re: #50 Obdicut

But to even bring up "IF" set up the 2nd part of your scenarion. What I stated is that you have no basis for "IF" therefore not worth mentioning!

"IF I had balls, I'de be King", said the Queen

"Bulshit" said the Prince. "I do, and I'm not!"

re: #15 Obdicut

I have yet to see an explanation of how the private insurance companies actually add any benefit to the system of health care in this country.

Are you saying you don't see the benefit of health insurance, or do you mean you don't see any advantage for it to be managed privately rather than by the government?

re: #50 Obdicut

That's what I said. It's true. I'm not claiming there aren't $5,000 frauds it only costs you $10 to go after. I'm saying if the cost of recouping or stopping the fraud is X+1 where the cost of the fraud is X, it doesn't make economic sense to do so.

Yes, there's some point beyond which it isn't worth pursuing fraud.

Is there a point? This is always true, no matter what the circumstance or who is running things. It's not something that will change in any way if the government is in charge, except that it may become politically expedient to pursue such fraud, and economic analyses will be ignored in favor of overt waste.

re: #53 Scrutineer

Are you saying you don't see the benefit of health insurance, or do you mean you don't see any advantage for it to be managed privately rather than by the government?

Yes, I don't see any benefit brought to health insurance by the private market, because the market for health insurance is so different from a standard market.

re: #54 SixDegrees

Yes, there's some point beyond which it isn't worth pursuing fraud.

Is there a point? This is always true, no matter what the circumstance or who is running things. It's not something that will change in any way if the government is in charge, except that it may become politically expedient to pursue such fraud, and economic analyses will be ignored in favor of overt waste.

That is the point. It is true that private industry is good at getting out fraud, but only to a certain point. Also, if it is easier for them to address that fraud and also dispossess valid customers, that gives them an economic incentive to do so.

So, without knowing how much fraud the private insurance companies don't address, we have no idea if they're more or less successful than medicare/medicaid, nor if they dispossess more unjustly than they do.

re: #52 sattv4u2

I have no idea what you're talking about. I'm stating a perfectly ordinary economic principle.

re: #55 Obdicut

I have no idea what you're talking about. I'm stating a perfectly ordinary economic principle.

No. You speculated that it takes more in the private sector to root out the cost of the fraud, thereby there MUST be fraud in the private sector without any proof that it DOES take more in the private sector to root out fraud than the cost of the fraud

re: #55 Obdicut

Seems to me that we're better off letting the private sector handle this, then, given the government's inability to address fraud effectively.

Given that there's a floor below which it isn't worthwhile to pursue such problems - even if the floor isn't at ground level - it seems as though the private sector will chase fraud right down to the floor. I don't see how customers are "dispossessed" through this process; it's the competition within the private sector which forces companies to provide value through lowered costs that seems to work in favor of consumers, not against them. If political forces control the process, some types of fraud will be discouraged that are economically inefficient to pursue, while other types will be ignored for purely political reasons, with costs inevitably rising as a result.

re: #56 sattv4u2

No, you just misunderstood me.

I'm sure there is plenty of fraud that no longer exists in the private sector because they have rooted it out.

I'm just asserting that there is some amount of fraud that it would cost them more to uproot than the cost of enduring the fraud.

That doesn't mean that they haven't already address a lot of fraud; in fact, it implies it.

Would it help if I said:

"If it costs them $5,000 to root out $5,001 in fraud, they will do so, but if it costs them $5,002, it is not economically sound for them to do so"?

re: #57 SixDegrees

Seems to me that we're better off letting the private sector handle this, then, given the government's inability to address fraud effectively.

Given that there's a floor below which it isn't worthwhile to pursue such problems - even if the floor isn't at ground level - it seems as though the private sector will chase fraud right down to the floor. I don't see how customers are "dispossessed" through this process; it's the competition within the private sector which forces companies to provide value through lowered costs that seems to work in favor of consumers, not against them. If political forces control the process, some types of fraud will be discouraged that are economically inefficient to pursue, while other types will be ignored for purely political reasons, with costs inevitably rising as a result.

I'm sorry, but you don't see how customers could possibly be dispossessed by measures taken by insurance companies to prevent fraud?

Getting pre-approval is one way they combat fraud. I've personally been hit with that, due to being almost unconscious. Since I was partially conscious, and failed to get pre-approval, the cost of my hospital visit was denied by my insurance company.

Pre-approval is a strategy to reduce fraud, but it also is to reduce expenditure in general. It is a measure that often results in a paying customer being denied a service they have a right to.

And again, you are assuming that private industry is better at combating fraud in this arena than the private sector, yet you don't have any non-theoretical reason to do so. Private insurance companies do not have transparency, so you can't know how their rate compares to medicare/medicaid's rate of fraud.

re: #58 Obdicut

"If it costs them $5,000 to root out $5,001 in fraud, they will do so, but if it costs them $5,002, it is not economically sound for them to do so"?

Thats all well and fine, but you misunderstood me!

You have no emperical data that shows that in the private sector it costs more to investigate/ eleimnate fraud THEREFORE they "allow" said fraud as cost of business.

As I stated, you came out with a scenario made out of whole cloth then extrapolated out of that!

re: #59 sattv4u2

While it's true I'm making that assumption, it's just a naturally true assumption. There are always going to be forms of fraud that defeat the system-- that cost more to investigate than to just pay. If you don't believe me, I'm sorry, but every system can be gamed. It's a truism.

You are entirely right I'm making an assumption, but it's an assumption every economist makes; some people will be gaming the system.

re: #60 Obdicut

While it's true I'm making that assumption, it's just a naturally true assumption. There are always going to be forms of fraud that defeat the system-- that cost more to investigate than to just pay. If you don't believe me, I'm sorry, but every system can be gamed. It's a truism.

You are entirely right I'm making an assumption, but it's an assumption every economist makes; some people will be gaming the system.

And again, you have NO basis to say that.
A) you have no idea how much fraud is in private ins
B) you have no idea the total cost to investigate it
EQUALS
C) you have no idea if it costs more or not

re: #61 sattv4u2

And again, you have NO basis to say that.
A) you have no idea how much fraud is in private ins
B) you have no idea the total cost to investigate it
EQUALS
C) you have no idea if it costs more or not

We're really at an impasse here. As I said, I"m assuming that, out of X amount, a fraction of X is going to cost more to investigate than it costs to endure. I definitely am making that assumption.

However, it's a basic assumption of economics. If you have some reason to believe that there can be a system that defeats that, I encourage you to start selling it to every corporation you meet.

re: #62 Obdicut

We're really at an impasse here. As I said, I"m assuming that, out of X amount, a fraction of X is going to cost more to investigate than it costs to endure. I definitely am making that assumption.

However, it's a basic assumption of economics. If you have some reason to believe that there can be a system that defeats that, I encourage you to start selling it to every corporation you meet.

Snarky is the way to go!
/

re: #63 sattv4u2

Well, seriously: it's a basic assumption in economics. You're saying that for some reason that it's a bad assumption for me to make. You're not explaining why, you're just saying that I'm making an assumption.

Just as it's not bad to assume that a private company will address fraud and cut costs wherever it benefits them, it is not bad to assume that any complex system can be gamed to a certain extent.

re: #51 Dark_Falcon

i can't think clearly on that one. I applaud his innovation, but his opening of a clinic in the Cayman Islands strikes we as outsourcing, which is something I don't think clearly about. I've got a subclinical case of Nativist Bad Craziness where outsourcing is concerned.

This is capitalism at it's best, even though many Americans would dismiss it as socialism.

As to outsourcing, I don't think this falls into the standard category of exporting jobs. I don't think it is simply a matter of having cheaper labor in the Caymans. I would bet you that the cost of living there is considerably higher than in most of the USA, if not all of it and I bet you will see American doctors there. There are other factors that are more important than the hourly pay of surgeons, not least the lawyer overhead.

re: #50 Obdicut

That's what I said. It's true. I'm not claiming there aren't $5,000 frauds it only costs you $10 to go after. I'm saying if the cost of recouping or stopping the fraud is X+1 where the cost of the fraud is X, it doesn't make economic sense to do so.

Yes it does, otherwise you would be out of business in no time because there would be DVD lessons available on how to beat the system with $5000 schemes.

The point is that there is more to investigating a fraud; there is the lesson in how to prevent or catch the next one earlier, not to mention preventing the ones the first perpetrator would have committed next.

.

re: #65 Naso Tang

This is capitalism at it's best, even though many Americans would dismiss it as socialism.

As to outsourcing, I don't think this falls into the standard category of exporting jobs. I don't think it is simply a matter of having cheaper labor in the Caymans. I would bet you that the cost of living there is considerably higher than in most of the USA, if not all of it and I bet you will see American doctors there. There are other factors that are more important than the hourly pay of surgeons, not least the lawyer overhead.

Good point. Like I said, it wasn't a situation I was thinking clearly about. Thanks for helping me understand.

re: #15 Obdicut

Well said.

There is, IMHO, a fundamental disconnect between the principle of sharing risk (traditional insurance) and buying risk (for-profit insurance).

The latter is well suited for, say, auto or shipping or commercial coverage, but when it comes to health insurance there are social dimensions that the profit motive is only inclined to exploit, not alleviate.

re: #35 rwmofo

<
...and if you've been to an emergency room over the last few years, imagine how much more crowded they will become.

Actually if people have insurance there will be a good chance that instead of waiting until something becomes an emergency they will just go see a Doctor. Also those using the ER for gen health issues because they cannot afford to pay a Dr. at the time of service will go down because those people will alos be able to just go to the Drs office.

Yes, there will always be people who will just use the ER, but we can't not help our fellow citizens because some people are morons.

re: #66 Naso Tang

Yes it does, otherwise you would be out of business in no time because there would be DVD lessons available on how to beat the system with $5000 schemes.

The point is that there is more to investigating a fraud; there is the lesson in how to prevent or catch the next one earlier, not to mention preventing the ones the first perpetrator would have committed next.

.

There are DVD lessons on how to beat the system available, for many different systems.

And I am talking about the total cost of the fraud, not just the one-time cost.

Again: This is a perfectly ordinary economic assumption. Retailers know a certain amount of shoplifting is inevitable and that only a system that would cost more than it was worth would prevent it. Companies know that some workers will abuse 'sick days' but they know that attempting to figure each and every last one makes less sense than allowing that minimal amount of fraud.

re: #68 Naso Tang

Well said.

There is, IMHO, a fundamental disconnect between the principle of sharing risk (traditional insurance) and buying risk (for-profit insurance).

The latter is well suited for, say, auto or shipping or commercial coverage, but when it comes to health insurance there are social dimensions that the profit motive is only inclined to exploit, not alleviate.

This part i completely agree with you on, unsurprisingly, since you're agreeing with me. You put it very pithily, better than I could.

re: #7 Dark_Falcon

Cannot Concur. I have zero faith in the government to undertake major non-security issues. I'd rather take my chances with the private sector, which at least is more efficient and self interested. If it ends up that I cannot obtain care I need to survive because the money for cannot be found, then I'm OK with dying, because I'd rather be dead than under the government's thumb.

WOW. My head is spinning from this comment.

We have experience with health care that I'd like to share. This thread looks like it may not be too active, but I'd like to share our story. I'd like people to think about these issues as we debate health care reform.

In 2003 my husband was diagnosed with cancer. He underwent an expensive surgery ($80,000) and returned to work. Six months later his employer (of 10 years) laid him off. Whether this was a coincidence or a premeditated act to get him off their insurance rolls is something we will never know, however there is great pressure on employers to keep health insurance costs down, and one way to do that is to make sure you don't employ people who need insurance.

At the time, I was a stay at home mom, so we went on Cobra, paying $800 per month until our savings ran out, then we went on Minnesota Care. We qualified only because we made almost nothing. During my job hunt, I had to worry about what to put down on the insurance forms if I got hired: when you know you will increase your employers premiums just by signing on it's a REAL dilemma. You can't lie. But then when you tell the truth, the job could disappear. This happened to me. A company offered me a job, but when I inquired about health benefits suddenly the job offer was rescinded.

I eventually found work. At first we were afraid to put my husband on the work insurance plan, because if he had a claim they might lay me off, but we had to do it because we couldn’t keep him on MNCare. I talked to my very understanding employer and she agreed to put him on our plan in 2004. Because we went on three different plans during that time we ended up with over $10,000 in out-of-pocket expenses as we moved from one plan to another, even though all were “Medica”.

In 2007 his cancer reoccurred. He had another operation. This one was more expensive because he came down with a MRSA staph infection which required even more hospital time.

The past two years our insurance premiums have gone up 22% and 23% respectively. Each time it’s resulted in a pay cut for me as my salary does not increase, but our health care costs do. This year I will take a $200 per month “pay cut” so we can have health insurance. Additionally we pay a $1500 out-of-pocket and a $3500 deductible. My husband's latest CAT scan cost us $1240, and the doctor visit was $357, and he will need to do it again in 3-4 months because it looks like there may be re-growth of his cancer and we have to decide on whether to start Chemo. I don't even want to think about how much that medication is going to cost us. At that point we will pay 20% of every bill (outside of the few things covered at 100% like office visits) because our plan is 80/20.

Our total medical costs per year are around $10,000, making health care almost 20% of our gross wages each year.

If there is no public option and I lose my health insurance or the small business I work for goes under what insurance plan would we be able to afford and who would insure us? I know that if we do not let our insurance lapse they can't turn us down, but our reserves are gone, and keeping up on insurance premiums without an employer's help would be almost impossible now. If we lose our health care insurance because we can't pay for it any more, waiting times to see a doctor are the LEAST of our worries. My husband won't be able to get the care he needs because we won't be able to afford it.

re: #72 JoyousMN

I logged back in solely to upding you and thank you for sharing your story. More people need exposure to stories like these so that they understand the reasons why the current system isn't working and why we need a public option.
Thank you again for sharing yours-- I hope everyone sees it and I just favourited it; I know I'll be linking to it in the future -- and best wishes to you and your husband and family.

re: #73 iceweasel

Thanks Iceweasel. I have been vocal in talking about our issues, not because I think our case is special, but because it not.

If you've never needed your health insurance, then you likely think it doesn't need to be fixed. Those of us who have had to use it know it's a really broken system.

re: #71 WindUpBird

it's a new take on Paul Revere i'll grant you.

"Give me liberty or a slow, painful, lingering death that burdens those around because an otheriwse widely available drug was not available to me due to my mistrust of a system there to stop what happened to me happening"

One other point I'd like to make is about abortion coverage.

Another big problem with not covering abortion is in those cases where a woman discovers late in her pregnancy that she is carrying a malformed fetus. Those are the expensive abortions that require hospitalization. If your insurance doesn't cover abortions then you could be looking at huge bills.

I had my two children when I was 37 and 39. We did an amnio in both cases, not knowing what we would do if there were problems (thank goodness both my boys were healthy). But the decision to carry a fetus to term that may not live, or may require lots of health care is one that should be made by families in those circumstances, not by the government.

Oh well...if this bill passes and you have a health savings account, kiss it goodbye.

re: #77 hugh59

Hugh,

I don't know why you say that. There is nothing that I know of in the bill that takes away HSA's.

But even if it did, what good does a health savings account do if you get cancer? Do you have any idea how much surgery costs? How would you possibly save up enough money to pay for it?

Joyous,

Thank you for sharing your story. The problem that your family is facing shows a weakness in the current system-the fact that people depend on their employers to help them afford health insurance. However, what is the best way of correcting this weakness?

We need a system that will make certain that people who are stricken with catastrophic illness can continue their insurance coverage even if they lose employment. But I don't know if a "public option" type of system will give us the service we hope for.

In reality, the "health insurance" we pay today is actually prepaid health care. The complexity in the pricing and the mechanism for payment hinders control of costs. The people receiving services don't know what they really cost as long as their insurance company pays for it. The insurance company does not know how much service is really needed since it is not there at the time the service is provided.

An HSA is not a replacement for health insurance. Rather, by having insurance with a higher deductible, you lower your premium costs. The savings in premiums, for most people, will allow them to save enough money to pay several years worth of deductibles.

However, there will always be people with exceptional circumstances where this approach will not work. In those cases, we need to have an alternate approach.

I don't think that we will ever be able to come up with one approach for health insurance that will work for everyone. So, let's come up with an approach that works for most people, then have a backup system for those people with exceptional needs.

re: #80 hugh59

...I don't think that we will ever be able to come up with one approach for health insurance that will work for everyone. So, let's come up with an approach that works for most people, then have a backup system for those people with exceptional needs.

Wouldn't that, then, be a system that works for everyone?

re: #79 hugh59

the government is the only viable provider for people with long term catastrophic conditions. they are the only people with the big enough pockets.

cancer patients, aids patients, heart patients, dialysis patients - all the high intensity patients use good will and money from insurance companies very quickly.

the government does not have to turn a profit - it there fore doesn't need to raise premiums as much as a private firm, it can bulk buy from big Pharma so it won't need to raise premiums as much, it can run cash cow low usgae Company Employee Insurance Cover to subsidise high impact patients.

No one has come up with a stellar alternative - co/ops would run non profit but would not have the purchasing power or enrollment numbers to remain viable and be cheaper for the catastrophic cases than private firms.

re: #80 hugh59

So, let's come up with an approach that works for most people, then have a backup system for those people with exceptional needs.

thats where we are in a nutshell - 75% of Americans are covered - and the Government wants to close the gap with a public programme, subsidies and an exchange. Along with de-regulation to encourage competition and forcing companies to keep people on roll and removing most pre-existing unrelated conditions as excuses for denying treatment.

re: #79 hugh59

Hugh,

We aren't that far apart. From your comment I thought you were proposing HSA's as the sole solution. I see that's not what you meant.

The biggest problem we (my family) faces is that employer based health insurance only works well for healthy people, not people like my husband. It also does nothing for those who are unemployed or with employers who do not provide coverage.

"...employer based health insurance ...It also does nothing for those who are unemployed..."

Why should it do something for those that don't work?

I'm likely just talking to myself now, but via Ezra Klein here is a summary of the healthcare bill:re: #85 bunnymud

What if you work for a company that doesn't provide health insurance and you get sick?