GOP--Sore Losers

[IGTN]

Why do Pro-Lifers hate abortion, but love capital punishment?

Because they stole the term from people who were opposed to the death penalty, war, and economic injustice, and made it all about abortion.

[Akula]

Simpler answer: They want to stand on the moral high-ground and want everyone else to know it.

Even simpler answer: Manipulative pricks.

[Crissa]

The ones that think that health care reform should more prominently address the cost of health care, rather than just having a national insurance plan. Increasing competition is a good idea to drive costs down, but its an inadequate response.

'Addressing the cost' is the Democratic position. Increasing competition isn't even on the board.

Hawaii has 95% market concentration of its insurer, but its out-spent per capita by California, which has a very intense competition amongst insurers.

Your point here is very strange. Are you supporting the Leftist position of single payer? That's not even on the table.

Health care has been increasing at 10+% for over a decade, and its not solely a function of insurance companies.

It's higher than 10%. It's more like 100%. In the last three decades, health care has increased in cost by 4x after accounting for inflation.

Except we have to deal with the mouthbreathers we have.

-Crissa

[mean_liar]

Actually, the Democratic proposal does little to the health provider market and focuses on the public option for insurance. That's precisely intended to provide a competitor to every insurance company in America. The competition is for different slices of the market (especially the currently uninsured), but as far as the cost of providing actual care, there's little traction for anything there.

The point of comparing HI was CA was that increased competition doesn't translate into decreased costs in all cases.

There are ways of introducing market efficiencies into health care delivery that aren't being discussed because Republicans are chained to their constituencies and the Democrats don't want to overplay themselves into the Socialist tag. You can do it without single payer, and in fact single payer kiboshes those efficiencies.

The 10%+ was per year.

[tzor]

Why do Pro-Lifers hate abortion, but love capital punishment?

I should point out that capital punishment divides the pro-life community; some are for it, some are against. But hey, if you gave the same appeal process for the fetus as you do for those under of capital punishment, not only would there not be any abortions, most cases wouldn't be decided until the fetus graduated high school.

N.B.: The "evil" Catholic Church opposes both abortion and capital punishment (and involuntary euthanasia often caused by denying medical treatment to the elderly under the grounds of “cost savings” but that is another issue).

[tzor]

I heard an interesting thing last night; call it the 800 pound gorilla in the room. The bulk of medical costs are not malpractice, they are not related to senior care, nor this cause, not that cause. The biggest cost is apparently young middle age people (in their 40’s) getting heart attacks and their accumulated expenses from operations, complications, follow-ups, etc throughout their lives. Unfortunately this was an oral point from a doctor making a reference to rationing care for seniors in the proposed medical bills so I don’t have any links to back that statement up.

[Heath Robinson]

mean_liar,

That information is meaningless unless you can do the regressions necessary to control for differing coverage plans and economic activities. One of the ways to reduce the cost of a medical insurance plan is reduce the procedures that insurance covers. That's not an efficiency gain.

[mean_liar]

The example was only one. I wish I had the list of state-by-state market control and average cost, but it was clear that though there was some correlation it was a loose one.

As for your reduction comment, you're addressing the insurance company's profit margin (not a concern here) and I'm addressing the base cost-of-care that leads to increased insurance costs.

[Username17]

I heard an interesting thing last night; call it the 800 pound gorilla in the room. The bulk of medical costs are not malpractice, they are not related to senior care, nor this cause, not that cause. The biggest cost is apparently young middle age people (in their 40’s) getting heart attacks and their accumulated expenses from operations, complications, follow-ups, etc throughout their lives. Unfortunately this was an oral point from a doctor making a reference to rationing care for seniors in the proposed medical bills so I don’t have any links to back that statement up.

The US has a system where "emergency" procedures are much easier to demand out of an insurance company than "non emergency" procedures. Furthermore, you are guaranteed the right to emergency treatment regardless of ability to pay. The fact is that emergency treatment is much more expensive than preventative care. If we just bankrolled people going to the doctor whenever they felt funky, total costs would drop. By a lot.

And there's the thing where the United States government ha guaranteed the drug companies that on their end they will pay whatever the companies decide to ask without bargaining. That drives up the cost of medicaments, and drugs cost people in the US several times what the same drugs cost anywhere else. And there's the thing where private insurance pays 32 cents on the dollar in administration fees while the Canadians are paying 11 cents. And there's the thing where adversarial financing and personal billing drives hospital administration fees up.

The United States has the worst medical system in the world. Not that it provides the worst care, the United States is the 37th best in the world. It's that its costs are much much higher than any other country, and it comes in at the tail end of any of the supposedly first world countries. The US is running neck and neck with Slovenia and Cuba while spending almost twice the money as Switzerland. It's an obscenity. And there are a lot of problems with what we are doing that add up to that overall disgraceful performance.

The overall solution is not really that complicated. The top medical systems on Earth are those of France and Italy. We can describe those systems fairly succinctly and emulate them. Problem solved. But we're not going to do that.

We are not going to do that because Left-wing answers to problems like nationalizing the health care "industry" are not even part of America's political debate sphere. Even moderate policies like nationalizing and standardizing health insurance while allowing individuals and companies to continue to purchase supplemental private insurance on top is not on the table. The only thing that is on the table is the far right wing solution of having the government provide an at-cost government health insurance option that people can buy into. That even that plan is being attacked by the even farther right wing demonstrates that we do not have a real and complete political discussion in the US. Turn on the news networks and you get spirited debates between Keynesians (who are capitalists), Monetarists (who are capitalists), and the guys from Beyond Thunderdome (who I guess are capitalists too). The world has socialists and communists and greens and you'd never know that even watching MSNBC.

-Username17

[violence in the media]

More healthcare bullshit.

[mean_liar]

Any heavily government-funded solution in America has costs and those costs could threaten its currency position as the world's primary reserve currency, and that's the primary thing keeping America on the map right now.

Providing a socialized system has more ramifications than its effects on medical care: the French government spends roughly 9% of its GDP on health care and Italy, 6.8%. Currently, the US spends 6.8% solely on SCHIP, the VA, Medicare and Medicaid.

The US covers roughly 28% of the population. If you increase that amount solely on a per-capita basis for the uninsured (15%) you're looking at a rough relative increase of +53% of costs, taking the US expenditure to 10.2% of GDP.

With GDP at $13.8T, that's a cost increase of $469B a year to cover only the uninsured.

Disregarding special appropriations, the US gov't budget for 2008 is $3T. The US spends $1.2 for every $1 in taxes it collects, meaning that increasing the US budget by $469B a year is the equivalent of raising that ratio to $1.39:$1, or, said alternatively, running the US twice as far into the red as it was last year.

Taxes can offset that, but currently the US collects $2.7T in taxes per year. You'd have to increase that amount by 17% to offset the cost of public care, again ONLY for the uninsured.

Pretending that generating an additional 17% of tax revenue will not have an adverse affect on the economy is a difficult sell, and at that point you're trying to predict the effect of a large monetary policy shift on employment, since if you overtax and people lose their jobs then they're not paying taxes anymore while you're still covering their healthcare.

It's not a problem you can just wave a wand at and say, France and Italy are going great.

[Username17]

Any heavily government-funded solution in America has costs and those costs...

I'm going to cut you off there because that is a completely stupid argument.

The United States' system has the highest costs on Earth. Not by a marginal or arguable amount, but by huge insane amounts that are visible from space.

Emulating the system of literally any other country on Earth would by definition have negative relative costs. There has never been a system that is as costly as the system America has now.

-Username17

[mean_liar]

You are a fucking idiot sometimes, Frank. Those costs I'm laying out are government costs only.

EDIT: Since you don't like to read shit you don't agree with:

Currently, the US spends 6.8% (of its GDP) solely on SCHIP, the VA, Medicare and Medicaid.

[virgil]

I think Frank is including the private sector too, where a more socialized system wouldn't have as large a private sector for money to sink into.

[Username17]

And putting it all into "government costs" as if that meant something is completely disingenuous. Ultimately in a capitalist economy, everything is paid for from the coffers of the businesses. Right now, the businesses are paying for the healthcare of their workers. And if you ran it through a single payer system or a national health service, or fucking anything else, they would still be paying for it. They'd be throwing their money at the IRS instead of throwing it at Blue Shield, but they'd still be supplying the money for the system.

The system we have right now is one which the businesses cannot afford. GM and Chrysler basically went down this year because they can't afford the health care costs in the US. And maybe they wouldn't be able to afford some much cheaper system that was being run through taxes. Maybe they could. But the point is that it would be much more likely that they could afford it if the total costs were less than half of what they are now.

If you cut the costs of corporations by 20 billion and you make them pay 10 billion in taxes they haven't lost 10 billion, they have gained 10 billion. The cost reductions are so tremendous that we could seriously raise taxes more than is necessary to cover the health care costs, pay all the healthcare costs, and then have money left over to throw giant sexy parties where fatcat politicians shipped in schoolbuses full of highschool cheerleaders to get naked with. The companies would still come out ahead. That's what they do in Italy, and it works great.

-Username17

[mean_liar]

You're assuming that the US is a balanced budget system? Nice fundamental premise.

The cost reductions you're talking about are basically unachievable in the US: France and Italy have 50% more doctors per person than what the US does. They don't appear overnight. In absolute terms that's roughly an additional 300k doctors. POOF.

Fundamentally you're using Magic Wand theory of health access and costing: countries have better systems than the US so we should just import them!

The fact that they're built on a raft of other things without being able to quantify the cost savings that implementable strategies save is just bullshitting. No one really has a great idea how to control costs in America for the same reason that we haven't managed to get gun violence down to reasonable levels either.

Sure, let's use negotiated pharmaceutical costs. That's a real savings. It also probably amounts to a 5% reduction in health costs. That's nice and I can't come up with a compelling reason why not to do it, but it's not going to address the massive +50% per capita costs that America bears relative to other countries.

There's something fundamentally broken in American health care delivery before it even gets to the part where you figure out what it costs and until you can actually identify it then hoping the Magic Wand covers the gap is wishful thinking.

[Username17]

Sure, let's use negotiated pharmaceutical costs. That's a real savings. It also probably amounts to a 5% reduction in health costs. That's nice and I can't come up with a compelling reason why not to do it, but it's not going to address the massive +50% per capita costs that America bears relative to other countries.

A big chunk of that is literally and exclusively the fact that we don't have universal coverage.

• The administration costs of private, for-profit health insurance is 3 times what it is for any nationalized systems. over 30 cents on the dollar. Simply not doing that is a magic wand that reduces costs by 20%.
• The administrative burden hits on the other end too. The fact that the US has a vast system of differential billing and opposing corporations trying to dump the bills on each other creates a huge need for administrative costs in the hospitals and clinics. And by huge, I mean 25% of total costs. In contrast, countries like Canada pay about 2% in administration costs. So again, just cutting out the corporations on the payment end is literally a magic wand that reduces costs by over 20% here too.
• The lack of "free" healthcare drives up costs. The more people put off getting care, the more that care will cost when they eventually get it. The American "wait until you can go to the ER" system of care distribution is hugely costly to hospitals. Again, just not doing that would drive costs down by another 20% or so.

To say that we could wave a magic wand, go single payer, and then miraculously pay less than half of what we do not for healthcare sounds like crazy utopic magic talk. But it's conservative. Italy doesn't even spend two thousand bucks per person per year. Seriously, our system s so crazy, so shitty, and so much of an outlier that we actually could just enact major reform and pay half as much tomorrow. It's seriously that bad.

-Username17

[Lago PARANOIA]

I can sort of understand why the health insurance industry is going along with this; I mean, Russia held onto feudalism into the 20th century even when it was proven beyond a doubt that nearly any other economic system, even extreme lasseiz-faire capitalism, would make the czars many times richer.

What I want to know is why the other members of the corporate lobby are going along with it. When they're not pushing for single-payer they're effectively paying money to a competing industry for no good reason--first it siphons money out of their customers' pockets to pay for the increased cost of insurance in the first place and then it siphons money out of their own pockets paying for their employees' insurance plans.

They would make so much more money and eliminating a major capitalist competitor if we had health care reform, so why aren't they pushing for it?

[Crissa]

As a comparison, in 1977, most grocery chains provided health benefits to their stockers and checkers. Currently, the largest grocer is WalMart, which is also the largest company providing insurance. It also has the largest number of employees of any group of publicly traded companies on government welfare and medical insurance. That wasn't the case thirty years ago. Any competitor which tries to pay for health benefits goes the way of GM: Down the tubes.

So, company A doesn't provide benefits, pays the same taxes as company B. Company B does provide health benefits. Which company has higher profits, if they have the same gross income and capital outlay?

So far, no one in this thread has pointed to a position held by a named Republican in the Senate or ranking member of the House as a cheaper option to what we do now.

-Crissa

[Crissa]

You're assuming that the US is a balanced budget system? Nice fundamental premise.

Irrelevant aside to the conversation.

The cost reductions you're talking about are basically unachievable in the US: France and Italy have 50% more doctors per person than what the US does. They don't appear overnight. In absolute terms that's roughly an additional 300k doctors. POOF.

...But we could, I dunno, pay for more doctors instead of administrators? Because we haven't enough doctors today, we cannot ever have enough doctors? Is that an argument? The bills in Congress don't actually start handing down care requirements until 2013. Enough time to train or import a few more doctors, don't you think?

Fundamentally you're using Magic Wand theory of health access and costing: countries have better systems than the US so we should just import them!

Magic wand ≠ import better solution.

The fact that they're built on a raft of other things without being able to quantify the cost savings that implementable strategies save is just bullshitting. No one really has a great idea how to control costs in America for the same reason that we haven't managed to get gun violence down to reasonable levels either.

Irrelevant aside.

Sure, let's use negotiated pharmaceutical costs. That's a real savings. It also probably amounts to a 5% reduction in health costs. That's nice and I can't come up with a compelling reason why not to do it, but it's not going to address the massive +50% per capita costs that America bears relative to other countries.

'Because one part of the bill won't address 100% of the costs, it is insufficient.'

What?

There's something fundamentally broken in American health care delivery before it even gets to the part where you figure out what it costs and until you can actually identify it then hoping the Magic Wand covers the gap is wishful thinking.

Again, none of this has solutions in it. It's not an argument. It's just hot air.

-Crissa

[PhoneLobster]

I can sort of understand why the health insurance industry is going along with this

Precedent.

What next?

If the great private health care con goes down anyone could be next!

A working public electricity network? Cheap and ubiquitous public transport?

In the world of cheap effective "socialist" utilities that provide savings and benefits to corporations and the public at large there are a LOT of privatization leeches in the gun sights.

[mean_liar]

Re: admin costs.

Those costs are based on Medicare and Medicaid, which run around 11 cents on the dollar.


Re: provider administration

This might take an amendment to do, since it interferes with state regulation of their own health systems and falls into non-enumerated powers. And again, this is actually based on government billings, which are the folks that are going to be doing this so this doesn't address my numbers.


Re: abuse of the ER

Actually, most ER visits are from insured people since the uninsured try to stay away. I'm not sure where you're getting your figures, but the largest chunk of healthcare costs are old people, terminal cases and chronic care. Uninsured ER visitors drive up ER costs but those aren't the bulk of costs.


Re: irrelevancy.

It was to respond to Frank's assessment that $20 in taxes was $20 in gov't expenditures.


Re: more doctors.

Now you're talking, but I don't know how this would actually play out. This, so far, isn't on the table. My point in bringing it up is that this system is a lot more complex than a Magic Wand solution. Yes, more doctors is good, but now you're talking single payer since who the hell wants to pay $100k for a degree and then be forced to work in nowhere Nebraska? There's nothing wrong with single payer, but there's going to be trouble with implementation and follow-on effects in America that goes beyond just saying "we need more". You're really starting to hit onto some fundamental things that the US gov't has never traditionally done. There is going to be problems with it from every angle of society - liberals and conservatives.


Re: irrelevant aside

No. You cannot say, "let's pay for everything" and expect it to mean anything without details. So far, those details are very short. We have promises to reduce costs but no deliverables, and a gov't insurance plan. That's about it. Trying to port in an entire social system to fix healthcare isn't a solution, its bullshittery. It's like trying to institute a civil service exam or something like that: it hits wide and deep against traditional American methods of governance and society and dodging the impact that would have on American society just so you can point to someone else with a good idea and clunkily trying to implement that idea is just a poorly-thought but pleasant canard.


Re: negotiated pharms

It's a good idea. It should be done. But its a tiny amount - my point was that there is a more fundamental problem with American health care delivery and it hasn't been examined in detail. We know some areas cost less than others even within the same state, but nailing the why and trying to implement that is even more important than throwing a dart at a goal.


If there's no solutions, it's because I haven't seen the real research to point out how American medical services can actually be better. So far I just see people that don't want to do the math or confront the real issues because someone somewhere else under an entirely different set of circumstances got a better result.

[Username17]

Re: admin costs.

Those costs are based on Medicare and Medicaid, which run around 11 cents on the dollar.

Yeah. As does the Canadian system that happens to also be called Medicare. There is a pretty consistent pile of data that shows that government insurance costs 11 cents on the dollar. But American private insurance costs more than 32 cents on the dollar. That's just objective fact: Humana takes 21% of the money that they look at in the healthcare field and set it on fire. Kick them out and we get that money back over night.

Re: provider administration

This might take an amendment to do, since it interferes with state regulation of their own health systems and falls into non-enumerated powers. And again, this is actually based on government billings, which are the folks that are going to be doing this so this doesn't address my numbers.

I'm trying to parse this, and I just can't.

The fact is: because the hospitals have to repeatedly harangue multiple different insurance companies and private individuals to get paid for any procedure they run internal administration costs of 25%. In countries with nationalized healthcare and countries with nationalized insurance the admin costs are less than 5%.

I don't give a fuck about nonenumerated powers, this is just a free market invisible hand action. If you take away the adversarial relationship of the hospital getting their money they don't have to spend so much on fighting to get paid. And then they don't do that and their costs go down. And then your costs go down. Everyone wins.

This goes hand in hand. The insurance companies are paying about 20% of the total cost of healthcare in fighting to not pay for healthcare. The hospitals are paying about 20% of the total cost of healthcare in fighting to have healthcare paid for. If you go national health insurance or national healthcare these costs vanish. And since it's ultimately the corps in nonhealthcare fields that are paying for both ends of the fight, that's a huge deal for American industry.

-Username17

[Crissa]

Oh, finally! Republican plan for healthcare reform. This plan does several simple things:

1. Eliminate employer deductions for healthcare benefits: No more employer base healthcare!
2. Provide a small ($2.5K per or $5K for families) non-refundable tax credit for qualifying individual health plans.
3. Eliminate Medicaid support for low-income workers.

That's their 'serious' plan!

-Crissa

[mean_liar]

Item #1 is probably going to be on the table anyway. Tax the employer, tax the benefit, it's the same. Healthcare is about the only fringe benefit other than 401k that isn't taxable. Ultimately, they have to raise the money somehow.

As for #2, that's going to be useful in about ten years when employers have more or less totally stopped providing insurance and you'll be picking the public option because that's what's on tap and affordable. Subsidies are a necessity, and the only question is how much you give. For the Republicans to be considering a subsidy is a big deal in and of itself, even before discussing magnitudes.

#3 is a bag of shit, depending on how the public insurance interacts with things. It could very well just replace Medicaid so this may not be the deathknell it looks like.

I agree with you Frank that cooperative care is the way to go as far as reducing costs, but I haven't seen a lot of definables about how its going to proceed in the US. Americans like their expensive treatments and doctors have to really fight that training they get.