An Attempt at a CIVIL Health Care Discussion

You cannot have health care "reform" without addressing unnecessary cost factors.

Factor 1 - the medical malpractice lottery. Put meaningful tort reform in place, watch about $100B drop from the health care costs.

Factor 2- illegals accessing emergency-room service. This is a biggie, particularly in border states. Solution - illegal aliens access public health care services through the emergency rooms, fine. Treat them, stabilize them, then put them on a bus back to where they came from. It's called "illegal" for a reason.

Factor 3 - state risk pools. Allow the purchasing of health care by residents of any state, from the companies of any state. You'll gain efficiencies through competition, and in fact the insurance companies themselves will gain economies of scale.

By the way, someone above mentioned the bad ol' insurance companies and denials of claims. That person is wildly uninformed. According to a recent Wall Street Journal survey, the worst private health care company for claim denial is Aetna. They turn down about 3.8% of claims. Every other insurance company turns down less.

Medicare is at about 6.2% turn downs, Medicaid at 6.4% claim refusal.

Existing government programs already deny NEARLY DOUBLE the amount of claims denied by the WORST private insurance company.

Nope. Not trolling, just hoping that moving the focus away from the specific bill that passed to what the system really needs might reduce the level of vitriol. Originally Posted by Gryphon

I didn't say YOU were trolling.

Part of what makes the whole issue so tough to deal with is the fact that everyone is emotionally invested in some way. Originally Posted by Gryphon

I agree.

Interesting, KS. Tell us a little more about those Medicare denials if you would though. How do they break down? For instance, are they denied because they are incorrectly billed, or denied because regulation prohibits payment for a particular service? Most providers who take Medicare are very good at providing covered services as opposed to providing non covered services and then trying to bill Medicare for them. The problem comes in the coding of the bills and the submission. Wrong code, no payment, then you have to re-bill. After resubmission, how many of that 6.4% claim refusal rate end up being paid? Valid questions, I believe.

So lets compare apples to apples if we can. What percentage of Aetna's denials are for incorrect coding as opposed to them just saying "we aren't covering that, there's no money in it". Medicare is so well established that most providers know exactly what is covered. And I don't believe Medicare has a profit motive.

My idea would be to cover every treatment a doctor would want to provide. It would use Medicare in a modified form as the means of delivery.

To me it is not a issue of money or politics, it is an issue of morality. If we can treat the sick we should do so without consideration of profit by the payer is how I think of it. Doctors should profit, hospitals can profit; it's their work, their facilities and their investment. But why should we tolerate a unneeded third party "wetting its beak" in how my doctor treats my cancer? Establish fair rates of compensation for medical services, all of them, even the new ones as they are developed, and then have the "Modified" Medicare for everyone see to it that they're paid for when you need them.

I'd like to know how much this would cost. Has any think tank or agency anywhere looked into it that anyone knows of?

And by the way, I don't trust the Wall St Journal to tell me anything. Rupert Murdoch owns it now, and their journalism and editorials are far to interested in appealing to their own means of profit rather than journalistic integrity and fact. At least in my opinion.

tort reform come on what dose a doc getting sued have to do with insurance the docs pay for insurance for this. Tort reform is bullshit. Stop giving Isreal my money along with any other country. The billion dollar wars get real we should sent our black ops boys in wacked saddom & old bin what his name. 5 guys 10 guns 2 bombs ends a war real fast. I vote Tom Clancey for sec of defs.

In theory, I agree. Actions have consequences. But executing a policy decision like that requires being able to say to a 55 year old father of three, "You chose to smoke two packs of cigarettes a day for the last 30 years and you chose not to buy health insurance. Now you have lung cancer. Because of your previous poor choices, you aren't going to be treated. Now go home and die quietly." Who gets to have that conversation? Originally Posted by Gryphon

I'd be happy to have that conversation - because that's the conversation that he will be having with Obama's "death panels". If he was smart enough to have purchased insurance ahead of time, he would be treated for his affliciton if covered under his policy - which is what normal people with families would do - buy health insurance for themselves and their families.

Sooner or later everyone is going to develop a serious health problem. When they do, they want and expect to be treated regardless of their ability to pay. Originally Posted by Gryphon

If it's an immediate, life-threatening situation (heart attack, stroke, high fever), you are treated regardless of your ability to pay until you are stablized to be released or you die - and no one asks for insurance information until after treatment has occurred and, if you have no insurance, payment arrangements are made or the hospital eats the cost of treatment, which is built into the cost of treatment charged to insurance companies. Otherwise, if you didn't have the foresight to purchase insurance, you're out of luck. And I would have no problem telling someone that.

tort reform come on what dose a doc getting sued have to do with insurance the docs pay for insurance for this. Tort reform is bullshit. Stop giving Isreal my money along with any other country. The billion dollar wars get real we should sent our black ops boys in wacked saddom & old bin what his name. 5 guys 10 guns 2 bombs ends a war real fast. I vote Tom Clancey for sec of defs. Originally Posted by Cheaper2buyit

Cheaper, tort reform is essential to bringing the costs of health care down. The threat of being sued causes health care providers to order multiple diagnostic tests in order to "cover their ass". More tests mean more costs for the patient. Lawsuits for malpractice, regardless of whether the case has merit, usually results in the malpractice insurance settling out of court, which would cause the doctor's insurance to go up, which causes his fees to go up, which causes the health insurance to go up due to the "usual and customary" costs for an area to go up, and so on, and so on....a vicious cycle. Limiting judgements makes the incentive for personal injury attorneys to solicit clients less lucrative, thereby reducing the number of lawsuits and/or reducing the potential liability for physicians and hospitals, which reduces the number of excessive tests performed, etc., etc. etc.

Whether you agree with the policy decision that led the UN to establish Israel back in 1947, the soverignty of Israel is necessary both strategically and politically. The US has pledged through treaty arrangements to assist in the defense and sustainability of the country, and Israel, in turn, has been the US's staunch supporter in the mideast.

You cannot have health care "reform" without addressing unnecessary cost factors.

Factor 1 - the medical malpractice lottery. Put meaningful tort reform in place, watch about $100B drop from the health care costs. Originally Posted by Kshunter

I have to be careful not to reveal too much here, but I can say with 100% confidence that malpractice doesn't even move the needle on health care costs. Doctors love to complain about but EVERY licensed professional, including lawyers (yes, lawyers), carries malpractice insurance.

Malpractice settlements and verdicts tract exactly with the cost of health care. All the actuarial studies confirm this. Malpractice reform is red meat for part of a political base, but it has very little to no impact on costs.

RR - you make some excellent points and a methodology of distribution that I had neither thought of nor heard espoused by anyone in this debate. I would take your idea one step further, in allowing the purchase of insurance across state lines. In this way, the lowest price insurance would be available regardless of the location of the insurer. I would disagree, however, in allowing the government any power to regulate pre-existing conditions, coverage requirements, co-pays and deductibles - that should be up to the individual insurer in how it markets its product. Competing firms will make the most attractive product available based on the firm's morbidity experience and the pool of insureds under its plan. I would also like to see small businesses who would be otherwise be ineligible to purchase group insurance to pool their businesses together and purchase group insurance from a common carrier - that would provide coverage for most individuals otherwise not covered in the present system. Originally Posted by fritz3552

Totally and completely agree about opening up the market to sell across state lines. A complete oversight on my part not to have included that in my original post.

However, pre-existing conditions will have to be resolved through regulation. Not something the market can or will cover. But the beauty of my idea is that, once this system is in place, covering them won't be a big deal. As it is now, if you move from group coverage to group coverage, pre-existing conditions ARE covered. Once we have everybody (well, everybody here legally; I would provide coverage to legal residents even if not citizens but deny coverage to all illegals) under the tent through a voucher system, we can do the same thing. The key is getting everyone into the insurance pool. Once there, the logic of exempting pre-existing conditions (can't by insurance for something that's already happened) vanishes.

What the market could do is create different plans within the context of those requirements. For example, company A might offer better drug coverage but not so good coverage for, say, hospitalizations while company B might offer better hospitalization coverage and not so good drug coverage. The market can tailor to what people want, and people will still have to think for themselves about what suits them best.

One last thing that never gets mentioned about opening up the market across state lines. As much as I don't like it, opening up the market will probably require creation of a federal insurance commissioner. Right now insurance companies are regulated and controlled only by state insurance commissioners. Once the market opens nationally, and it absolutely should, there will be a need to regulate nationally along the lines of the SEC. I don't like it, but I'm willing to accept it as a small price to pay for opening up the market.

I've never understood the reason health insurers didn't compete across state lines, but the need for interstate regulations make sense. I think anything to encourage competition needs to advanced. I have a doctor client who when asked about ways to bring down the cost of health care talked about the endless series of unneeded tests that are performed. One thing he mentioned was that some doctors who order the tests, benefit from them because they own the testing services to which they refer the patient and profit from every test they order. I read an article where in Texas, certain countys had far greater costs per patient then others and this was the reason. Patients were treated as profit centers by the doctors treating them.

I have to be careful not to reveal too much here, but I can say with 100% confidence that malpractice doesn't even move the needle on health care costs. Doctors love to complain about but EVERY licensed professional, including lawyers (yes, lawyers), carries malpractice insurance.

Malpractice settlements and verdicts tract exactly with the cost of health care. All the actuarial studies confirm this. Malpractice reform is red meat for part of a political base, but it has very little to no impact on costs. Originally Posted by Racerunner

But the cost of malpractice insurance is higher for doctors as are the costs of the damages should they lose. If a lawyer loses a case because of a mistake he did not kill someone, jurys are going to aware huge settlements. But aside from that the fear of huge settlements causes a doctor to perform defensive medicine, this means tests that are conducted that are not necessary. This is done because the doctor knows that if he misses a diagnosis, a lawyer is going to ask why this or that test was not conducted. By limiting the amount of damages, doctors will be more willing to forgo some testing and go with their diagnosis, which for the most part is correct anyway.

"Interesting, KS. Tell us a little more about those Medicare denials if you would though. How do they break down? For instance, are they denied because they are incorrectly billed, or denied because regulation prohibits payment for a particular service? Most providers who take Medicare are very good at providing covered services as opposed to providing non covered services and then trying to bill Medicare for them. The problem comes in the coding of the bills and the submission. Wrong code, no payment, then you have to re-bill. After resubmission, how many of that 6.4% claim refusal rate end up being paid? Valid questions, I believe."

Interesting you question KS's figures but you should nothing that validates the figures you used. I guess we can just "know" that the figures you quote are accurate and those he uses are not.

By the way, I do know that medicare will not pay for my Dads hearing aids but Aflac pay their part as a supplemental insurance. I guess the government must not want them to hear what their saying.

As I have said, if you want a good picture of government health care in action, visit a VA hospital.

But the cost of malpractice insurance is higher for doctors as are the costs of the damages should they lose. If a lawyer loses a case because of a mistake he did not kill someone, jurys are going to aware huge settlements. But aside from that the fear of huge settlements causes a doctor to perform defensive medicine, this means tests that are conducted that are not necessary. This is done because the doctor knows that if he misses a diagnosis, a lawyer is going to ask why this or that test was not conducted. By limiting the amount of damages, doctors will be more willing to forgo some testing and go with their diagnosis, which for the most part is correct anyway. Originally Posted by dirty dog

None of the actuarial numbers support this, nor do many unbiased statistical studies.

And the verdicts aren't nearly as often as what people think. For example, there hasn't been a single verdict against a doctor in Johnson County, Kansas courts in FIFTEEN YEARS.

This is one of those issues that every thinks has an impact, but the numbers are all contrary to it.

I've never understood the reason health insurers didn't compete across state lines, but the need for interstate regulations make sense. I think anything to encourage competition needs to advanced. I have a doctor client who when asked about ways to bring down the cost of health care talked about the endless series of unneeded tests that are performed. One thing he mentioned was that some doctors who order the tests, benefit from them because they own the testing services to which they refer the patient and profit from every test they order. I read an article where in Texas, certain countys had far greater costs per patient then others and this was the reason. Patients were treated as profit centers by the doctors treating them. Originally Posted by KCJoe

A US Supreme Court decision in 1868 (Paul v Virginia) declared that insurance was not commerce and, therefore, was not subject to the Commerce clause of the Constitution and, therefore, was left to each individual state to regulate insurance under there own auspices. In 1944, another Supreme Court in U.S. v South-Eastern Underwriters Association declared that insurance was commerce and could be regulated federally. However, the McCarran-Ferguson act in 1945, in response to the States' concern regarding their authority to regulate insurance as a result of U.S v South-Eastern Underwriters, declared that insurance was not subject to anti-trust laws in most cases, which made the authority of the individual states to regulate insurance superior to the federal governments.

http://thomas.loc.gov/cgi-bin/cpquer...=&sel=TOC_6980&

"there hasn't been a single verdict against a doctor in Johnson County, Kansas courts in FIFTEEN YEARS"

I suspect the reason for this is the friendly neighborhood Settlement. Our business (not medical related) got sued, and when push came to shove, our underwriters told us to settle (close to $1 million) instead of go to court.

I know a few doctors, and the general concensus is: "Hell, yes, lawsuits are a huge concern, and malpractice insurance is about to put me out of business"

I believe them when they tell me tort reform would be very helpful in controlling costs. All the malpractice attorneys who advertise on the back of the phone book have to be paying their bills somehow.