Mitts Pick

[heironymouspasparagus]

You keep mixing insurance and health care choices. People in the U.S. have ultimate choice in what health care provider they choose. Insurance only comes in to the payment for said services. Don't mix the two up.

You really need to look around you.  A lot.  Maybe YOU are lucky enough for that to be true.  MOST are not!!

[erfalf]

So yes, since Medicare essentially dictates pricing for Medicare patients by saying take it or leave it, Medicare reimbursements are not necessarily at market rate (in reality, many services leave a hefty profit margin for the doctor compared to insurance company negotiated rates, while others do not, it's a total package), that does nothing to stop insurers and doctors from negotiating on their own. Nor does it stop doctors, as Gaspar loves to point out, from not dealing with any insurance at all and just letting you handle any paperwork that may be necessary if you are insured.

Yes, you finally nailed it. Medicare is not allowing true price discovery. My bet is that it is more than likely higher than what it would be if true price discovery actually took place.

And how you price your services is fair. You price them, people either come or they don't and you adjust accordingly. That's capitalism. And it's fair. No one has to use your services. They decide for themselves if this is a good value.

Medicare sets reimbursement rates. Insurance companies more or less piggy back off of that to set there rates as well. So doctors that I have talked to just price a little higher than that. So that when they get reimbursed, they just write off the difference.

Medicare is only 21% of the health care market. Why is the other 79% non functional if the problem is a lack of market-based reforms?

If Medicare is functional in your book because it takes out more than it takes in, then fine I guess. But I wouldn't call it that. Unfortunately the private market doesn't have that luxury.

So poor people should be left to die in the street if they can't pay? Or do you prefer the current system, where they're not left to die in the street and we all get to pay for their crazy expensive care that could have been prevented by 5 minutes of a doctor's time and an $5 antibiotic scrip. Sounds like cutting off your nose to spite your face to me.

Enough with the guilt/scare tactics. You and I both don't want ill for other people. But, I realize we live in America where it is not others responsibility to take care of everyone else. As it sits, the only two solutions are for us to pay for everyone else. Or let people fend for themselves. There will always be takers.

Please fix the private insurance market so that we have that option when the time comes. Instead you complain about how Medicare somehow is breaking the system, but without explaining how.

How about we fix Medicare first, you know the one that is broke.

You clearly have no conception of how Medicare actually works. It has required coinsurance payments. Not surprising. Everyone who has actually used it loves it, while folks who haven't all hate it. It's really weird how that works. Moreover, Medicare Advantage plans, which generally cover more stuff, are rated less favorably than the normal Medicare Part A/B.

You're right, I'm not an expert on Medicare, but I know that any insurance system that pays out far more than it takes in is probably going to be more popular than one that doesn't. This is by definition an unfair playing field.

Read an economics textbook so you understand what efficiency actually is. A system that is less expensive for a given standard of care is by definition more efficient. Unfortunately for us, most countries have health care systems that are more efficient than ours. That's OK in and of itself. Efficiency isn't everything. I would be totally fine with having a less efficient system if we actually had better patient satisfaction. Ideologically driven capitalists may feel otherwise, of course.

But cost is not the only determinant of efficiency. If cost is hindering the production of goods or services, then yes. But I don't think that is the case in the U.S. There still seem to be plenty of patients for the amount of doctors that we have. Actually when you think about how much we spend on health care (more than anyone else), the U.S. is the most efficient at providing health care services in the world. Supply = Demand.

To address the point you made that had nothing whatsoever to do with efficiency, read your insurance plan documents and see what things you need to get pre-approved for. You'll likely be very surprised if you think you don't have to get permission beforehand for many procedures. Sure, maybe you've got a great PPO plan and can go see that cardiologist without bothering your GP about it. Then you can get ready for a long discussion with your insurance company as to whether or not you actually need that stent. You act as if our system is somehow different than the others. It's not, at least in that regard, we just have more sets of rules and more people writing and paying the bills.

And in Canada (and the UK, and Germany, and France, and basically every other country in the world) they have the same choice. There is nothing exceptional here in that regard. And given that most people's access to health care is mediated by their health insurer, it's perfectly fair to bring them into the discussion of choice.

I don't know about the European countries, but in Canada, they more or less have minimal choices. What doctors they can go to, when, where and if they can have certain procedures done. I fail to see how this is really any better than what we currently have in terms of delivering health care services.

I prefer solvency. Solvency wouldn't be an issue if health care costs (not price, costs) weren't growing at twice or more the rate of inflation and hadn't been doing so since before I was born. (Insurance premiums have risen even faster than overall spending..go figure).

So do you blame health insurance companies or doctors (or something else) for the rise in health care service costs?

The only solution you offer is to make people's care worse without any actual plan for making the system you're throwing them into any better. Where are the action items? All you've thrown out there so far are ideological platitudes.

The solution I offer is to allow market forces to price things accordingly. Hardly some ideological platitude.

[erfalf]

May not be an idiot, but certainly don't live your "convictions".  Wouldn't that be considered hypocritical?

Oh come on, seriously? Besides, my convictions are to take care of my family by pretty much any means necessary. If it means using a system that is perfectly legal, then yes, I will do it. It is called responsibilities. There are plenty of people on Social Security that think it is not the best system, but they use it. It doesn't mean they are hypocritical. They're just living their life.

And yes, you did show extraordinarily good sense in going to OSU!   "GO POKES!!" is how it should be written, though.

Truly a grave mistake on my part.

Actually, the argument you should have made and should be making NOW is that the subsidies/freebies/etc you enjoyed are part of what is called the social contract.  It encompasses a shared risk/benefit element where you actually ARE now paying for those things now, in a distributed fashion by your state income taxes.  And will continue to do so as a resident of this state.  (Assuming you stay employed, of course).

And if you ever get to the point (may be there now, even) where your taxes end up exceeding what benefit you derived, then you are subsidizing someone else, in exactly the same fashion I subsidized YOU a few years ago, and I was previously subsidized by someone before that.  But then you also get the benefit of the contribution made by that person when they get out and find work, to maintain infrastructure, and hopefully build a better overall society.  (And yeah, I know how this kind of falls apart when the Oklahoma legislature and Mary Fallin gets involved...)

That person you (and I) are subsidizing today is more likely to have a better job, earn more money, pay more taxes, and be less of a burden on society (us).  Hopefully leading to a reduced societal cost, since they won't have to be boxed up in prison for whatever reason that might have occurred without the opportunities you and I help provide through that education.  It is NOT a case of do we get to pay none or a lot.  It IS a case of do we get to pay some or a whole lot more.

Health insurance is exactly the same.  If everyone participates, then you and I don't have 40% of our hospital/doctor/medicine bills paying for others who are not insured - we get a benefit - reduced subsidies to others.  That is what the people you are listening to on Fox don't want you to understand.

There will always be "takers" and they will never be able to pay to share the cost.

[AquaMan]

I agree. What we call Progressives are not what the founders were. And the founders were a collection of many different view points for that matter.

The fact that you can equate modern and historic progressives to the founders who believed certain rights could not be taken away by any government or man is quit comical as well, considering progressive dogma.

Progressives as we know them came to prominence during Theodore Roosevelt.

Funny I actually saw an article saying a similar thing because if the founders were conservative we would still be pledging allegiance to the king. Yikes.

Sorry, I've been away for training for a few days.

You guys (Gas and Erfalf) are hung up on semantics and phrases rather than what they refer to. And that comes from idiots like Beck who, after having succeeded in demonizing the word "Liberal" were astounded to see it morph into "Progressive", so they play whack a mole till all of this nonsense borne of humanism is stamped out.

Yes, Roosevelt's era was the time of the "Progressive Movement" which succeeded in changing the dominance of business interests over the people during that time. Conservatives didn't care for the progressives then, labeling them muckrackers, revolutionaries, traitors and fought them like conservatives fight progressivism today. Yesterday's demon liberal/progressives are todays heroes.

This same group of Beck-ians are busy re-writing what our founding fathers were about so that now there exists two histories for the same group. I was told recently that Washington was a Baptist and that all the founding fathers were Christians! Strange.

The founding fathers were quite radical in their day, yet their radicalism was progressive in nature. But we wouldn't dare call them radicals because of the current pejorative nature of the word. That is to say, they favored progressing with the writings and philosophy of the day by the likes of John Locke and others. They espoused that certain rights were inalienable to humans regardless of what the state, the church or the King forced upon them. That was far from conservative thinking and was quite radical. Radical enough that the King would hang you and the church would ex-communicate you for repeating these thoughts.

[nathanm]

Yes, you finally nailed it. Medicare is not allowing true price discovery. My bet is that it is more than likely higher than what it would be if true price discovery actually took place.

I'm confused. You said Medicare was squeezing doctors. As in forcing them to accept a lower price for their work than they would like. Now you're saying that the doctors would lower their prices were it not for Medicare? This makes no sense at all.

They decide for themselves if this is a good value.

What's the value of your arm?

Medicare sets reimbursement rates. Insurance companies more or less piggy back off of that to set there rates as well. So doctors that I have talked to just price a little higher than that. So that when they get reimbursed, they just write off the difference.

If Medicare is functional in your book because it takes out more than it takes in, then fine I guess. But I wouldn't call it that. Unfortunately the private market doesn't have that luxury.

Medicare serves the oldest and most medically expensive part of our population. Expecting it to turn a profit is ludicrous. I prefer the more important measure, which is that Medicare is more efficient than the private insurers. A dollar spent on Medicare buys more (and better) care than a dollar spent at Aetna or whomever.

How about we fix Medicare first, you know the one that is broke.

Broke only because the private system that it buys care from is broken. You yourself agree that private system is broken. The numbers show it's more expensive. Why on god's green earth would you want to take people from one, less expensive, broken system and put them in another, more expensive, broken system? Why not make a system that actually works first?

We both agree that medical care costs too much. You seem to think the solution is to shift the cost from one pocket to another. I think the solution is to get a handle on the costs.

But cost is not the only determinant of efficiency. If cost is hindering the production of goods or services, then yes. But I don't think that is the case in the U.S. There still seem to be plenty of patients for the amount of doctors that we have. Actually when you think about how much we spend on health care (more than anyone else), the U.S. is the most efficient at providing health care services in the world. Supply = Demand.

Yeah, about that textbook..

We spend more, but get less care per dollar. This is a fact. The implication with regard to efficiency is obvious.

I don't know about the European countries, but in Canada, they more or less have minimal choices. What doctors they can go to, when, where and if they can have certain procedures done. I fail to see how this is really any better than what we currently have in terms of delivering health care services.

That's not actually true any more than it is for you if you chose an HMO plan. The difference being that all the doctors in your province are in your network. It varies by province, though, so I'm not completely sure on the details.

The solution I offer is to allow market forces to price things accordingly. Hardly some ideological platitude.

It is an ideological platitude when you can't or won't explain what exactly prevents market forces from operating in the 75% of the market that is not Medicare. Insurance companies are free agents. They are required to offer certain levels of coverage and keep certain levels of reserves to pay claims, and now under Obamacare, required to spend a certain amount of the premium dollars on health care, but there is absolutely nothing preventing them from bargaining for lower prices, thus allowing them to hold premium increases down and gain business. Gaspar has refused to name a state that has only one health insurer because no such state exists. There is competition, but it's not working. Your solution, as I've heard it so far, is to do what we're doing now, only with more hope attached.

[Conan71]

I thought this thread was about Romney's pick for Veep. 

How old is Paul Ryan?  18?

[heironymouspasparagus]

I thought this thread was about Romney's pick for Veep. 

How old is Paul Ryan?  18?

Mentally, physically, or emotionally?   (3, 40-something, 4)

[Gaspar]

It looks as if President Obama's attack on Ryan's budget has caused him to step in it again, and is becoming damaging to his party.  It's also becoming far too difficult for the major networks to softball the President and his surrogates.
http://www.forbes.com/sites/aroy/2012/08/13/yes-obamacare-cuts-medicare-more-than-president-romney-would/

I'm having a really hard time criticizing the main stream media lately.  CNN, CBS, and even MSNBC are shying away from the party line, and beginning to offer actual analysis. I guess it goes to prove that you can BS some of the people some of the time, but if you try to BS all of the people all of the time you look foolish.  I have to admire Wolf for actually reading the Ryan budget and not letting little Debbie get away with shoveling crap.

[Conan71]

She is a babbling idiot.

[Gaspar]

She is a babbling idiot.

I freekin love her!

Her and Biden are awesome!

[Conan71]

I freekin love her!

Her and Biden are awesome!

Faced with facts she just keeps on cobbling her own little reality to keep the old folks scared.

[Gaspar]

Faced with facts she just keeps on cobbling her own little reality to keep the old folks scared.

It's all they got.  President Obama did the same thing here, even when confronted by Ryan himself. 

[nathanm]

It looks as if President Obama's attack on Ryan's budget has caused him to step in it again, and is becoming damaging to his party.  It's also becoming far too difficult for the major networks to softball the President and his surrogates.

This is a bunch of crap that doesn't even reflect reality. Obama's "cuts" are paid for by reductions in cost growth. Romney's cuts are paid for by nothing. Obama's cuts go towards Medicaid, which some seniors require as a supplement to Medicare. Romney's cuts go to pay for tax cuts for the wealthy. Romney wants to increase the deficit, Obama doesn't. Go figure. We're living in freakin' bizarro world.

[Gaspar]

Nate, Obama's current cuts, and he himself referred to them as cuts, go to fund Obamacare.  Ryan's plan makes no cuts to current medicare recipients or future recipients over the age of 55.  After that it provides an option to younger folks to enter into a voucher program at the exact same expenditure level as current medicare, but far less expensive to maintain.  The voucher rates are adjusted to medical inflation rates.  The vouchers engage private insurance providers and re-introduce competition.  That's the last time I'm going to explain it.  You sound like one of the above videos.

[nathanm]

Nate, Obama's current cuts, and he himself referred to them as cuts, go to fund Obamacare.  Ryan's plan makes no cuts to current medicare recipients or future recipients over the age of 55.  After that it provides an option to younger folks to enter into a voucher program at the exact same expenditure level as current medicare, but far less expensive to maintain.  The voucher rates are adjusted to medical inflation rates.  The vouchers engage private insurance providers and re-introduce competition.  That's the last time I'm going to explain it.  You sound like one of the above videos.

First, Obamacare does not cut benefits. It cuts payments to providers when/if they fail to meet performance targets regarding quality and efficacy of care. I suspect you already knew that.

Secondly, if we are spending the same amount of money on Medicare, there are by definition no savings in Ryan's plan. Try again.

Thirdly, there is already competition in the health care market. Why do you and erfalf insist on denying that?