Mitts Pick

[Gaspar]

All Paul is doing is removing benefits and giving all the money to the rich.

Keep pushing the lie.

Did you read it?  All he is doing is providing the younger generation with a stable plan that offers a degree of choice and forces competition in the marketplace.  It was originally written with Democrat Alice Rivlin, and Democrat Ron Wyden.  It was a by-partisan plan to shore up Medicare and preserve it, because the path it is on is unsustainable. Sure, it was bold, because it had to be.  The can had been kicked so far down the road by previous administrations that any plan to develop a sustainable system would mean reinventing Medicare as we know it.  

Coverage for existing seniors doesn't change in the plan.  Younger generations will transition to private insurers of their choice paid through a voucher program.  Much of the savings comes from the elimination of thousands of bureaucrats review nurses and coding specialists that make up the current Medicare leviathan.  Additional savings come from insurance companies competing for contracts.  Additional quality of care benefits come from physicians being unburdened of much of the medicare billing processes.  It kills so many birds with a single stone that I don't know where to start.

[erfalf]

Which is what I feel the solution should be centered around for health care reform. It isn't the actual care that needs reforming, it is the paying for it. Currently it looks like this:

Patient - Insurance - Health Care Provider

It needs to look like this:

Patient - Health Care Provider
     |
     |
Insurance

If patients were in charge of actually paying for things, my guess is that prices would not skyrocket they way they have. It would actually create price competition between health providers.

Obviously the solution is much much bigger than that, but that in my opinion is the best start. And that is what Ryan is doing with Medicare.

Funny some might say that continuing down the path that leads toward the cliff would be .... wait for it ... "radical". Couldn't help it. Ok, that's the last time I'll use that word this year when describing people.

[nathanm]

Much of the savings comes from the elimination of thousands of bureaucrats review nurses and coding specialists that make up the current Medicare leviathan.

And substituting private insurance companies that whine about having to make a MLR of 80 percent. And that have been proven, see Medicare Advantage, to have higher cost. Medicare's structure is not the problem. The problem is that health care costs are already significantly higher than in any other country and continuing to increase at a rate far outpacing inflation. That is the problem that needs to be solved. The only thing Ryan's plan does is push the cost off the government's books. That's not solving the problem, that's sweeping it under the rug. How cowardly can you guys get?

You're reduced to ignoring problems rather than solving them. It's a damn shame.

[Townsend]

I'm a little surprised no televangelists have made the news freaking out about a Mormon/Catholic ticket.

Have I missed any?  The freaking out I mean.

Have any of the folks formally running for GOP presidential candidate admitted to said freaking?  The ones who said God told them to run?  Have any of them said, "Oops, I heard God wrong."?

[RecycleMichael]

I'm a little surprised no televangelists have made the news freaking out about a Mormon/Catholic ticket.

Let's all hope that religion type ain't an issue. We are better than that.

This race has real differences in vision and plan for America. Those details should be discussed, not what church you go to.

[Townsend]

Let's all hope that religion type ain't an issue. We are better than that.

This race has real differences in vision and plan for America. Those details should be discussed, not what church you go to.

You'd think so, yeah.

Didn't work that way last time.  Never works that way in Oklahoma.

[Teatownclown]

I guess it depends whose religion....mine is free speech:

[Gaspar]

And substituting private insurance companies that whine about having to make a MLR of 80 percent. And that have been proven, see Medicare Advantage, to have higher cost. Medicare's structure is not the problem. The problem is that health care costs are already significantly higher than in any other country and continuing to increase at a rate far outpacing inflation. That is the problem that needs to be solved. The only thing Ryan's plan does is push the cost off the government's books. That's not solving the problem, that's sweeping it under the rug. How cowardly can you guys get?

You're reduced to ignoring problems rather than solving them. It's a damn shame.

Fewer companies competing for business. Monopolistic practices.  Collusion between big employers, big clinics, and big insurers. All of that combined with a bureaucracy that has grown so big and powerful that the right hand can't even see the left.  The Government books are half of the problem.  Your physician cannot operate outside of a large clinic or support group any more because they have to have a medical billing expert on staff just to code medicare patients.  That's why many are now refusing to accept medicare.  A. It doesn't pay enough, and B. It costs a significant amount to manage.

The big clinics have it easy because they get to distribute the administrative cost over all of their fees.  They can treat medicare patients at a loss, and make you pay for it by ordering a damn CT scan every time you have a headache or hangnail. Medicare is the problem at the foundation of skyrocketing healthcare costs.  By removing healthcare from free market forces like competition, you force prices up.  To combat that you continue to layer on levels of bureaucracy and regulation in an attempt to control prices, and that forces up the cost of administration on both sides of the fence.

Additionally, if you think that medicare patients are viewed or treated the same as insurance patients, you have a lot to learn (I worked in a hospital for 7 years, and drove an ambulance for 3).  Each bandage, needle, procedure, consultation, sponge bath, aspirin, meal, and vital recording has to be coded individually, and appropriately and is subject to audit. Medicare coding is very different from standard medical coding and billing.  It's a nightmare.  Because the margins are so low and the administration so high, healthcare providers do their best to provide only the very minimum they can get away with. If you are old enough to be on Medicare, the first question you are going to receive is if you carry any supplemental plan.  If you don't, your expectations shouldn't be to high.

The medicare approved formulary sucks and covers only the cheapest pharmacology. Most of the intelligent seniors on Medicare carry a supplement plan just to cover the cost of better drugs.  Sure the drugs on the formulary will do the job, but perhaps grandma would like to take a beta blocker that doesn't cause incontinence.  $150 a month extra?  Medicare would rather just have grandma wear a diaper.

The current medicare system is turning our seniors into second class citizens.  It has to be fixed, we can't just ignore it.  Sure, we probably can't help the quality of Medicare for those already receiving or close to receiving it, but we can transition away from the downward spiral of care and escalating cost that we have now.

Everyone keeps proposing that we just put a bandage on medicare.  It's the most devastating expenditure we currently face.  Ryan and his Democrat colleagues were the first brave enough to tackle the problem with a reasonable, workable, well scoring (CBO) plan to preserve medicare and transition it away from disaster.  The current administration will either just kick the can again or offer another bandage.  Well if it's a bandage that you want, the medicare code is A4465, or Q4050, and sometimes 99070, then depending on the size it could fall under A6448, A6449 or A6450, you could also use 92071 or 92072 if they are for home use.

[heironymouspasparagus]

The current medicare system is turning our seniors into second class citizens.  It has to be fixed, we can't just ignore it.  Sure, we probably can't help the quality of Medicare for those already receiving or close to receiving it, but we can transition away from the downward spiral of care and escalating cost that we have now.

And yet, now that at least a beginning has been made, you are still against it!  Versus the absolute refusal to even start doing anything that has been the hallmark of the RWRE since Reagan.  Ignoring it has been and still IS the official stated policy of the Republican party, as most recently evidenced by the candidates now (as in currently) running for office of President and VP.  Just can't get away from that reality.


Maybe this start isn't optimal - one big factor affecting one's opinion may be how many kids you have going to be 18 soon, who now get to stay on your insurance until 26 if need be.  Or whether you ever change jobs and can't get insurance for a year (or more) due to "pre-existing conditions".  Or whether you insurance recently cancelled you just because you actually made a claim against that policy you have been paying on for many years.

But hey, if one lives in a perfect world...why would one care??

[Gaspar]

And yet, now that at least a beginning has been made, you are still against it!  Versus the absolute refusal to even start doing anything that has been the hallmark of the RWRE since Reagan.  Ignoring it has been and still IS the official stated policy of the Republican party, as most recently evidenced by the candidates now (as in currently) running for office of President and VP.  Just can't get away from that reality.


Maybe this start isn't optimal - one big factor affecting one's opinion may be how many kids you have going to be 18 soon, who now get to stay on your insurance until 26 if need be.  Or whether you ever change jobs and can't get insurance for a year (or more) due to "pre-existing conditions".  Or whether you insurance recently cancelled you just because you actually made a claim against that policy you have been paying on for many years.

But hey, if one lives in a perfect world...why would one care??

Huh?  Your posts are getting rather Shadowy.  Could just be the buzz from your other thread.

What am I against?  Obamacare?  Hell, yeah!  The point of Obamacare is to be transitional until a single payer platform can be passed.  We all know that.  Basically making the entire healthcare system a giant Medicare.  It's insanity, but some people really believe that giant government bureaucracies can produce a better product.

I like this.  It's president Obama attempting to make a point, er, uh, about understanding Ryan's plan.  I like it when he states that the Ryan plan would keep voucher and reimbursements flat, and Ryan corrects him, that they would be tied to medical inflationary rates, then he continues to disagree with Ryan's plan and implies that rates would be flat again.  This is the intellectual deficit within the administration that we have to deal with.

[nathanm]

they have to have a medical billing expert on staff just to code medicare patients.

You speak as if this is not true of private insurers, who refuse to standardize. If you want to replace something, you should at least replace it with something that works better. It should also preferably be cheaper, which you deftly handwave away. If the private market is so great at this, why has it produced crappy results for so long? Before you say Obamacare, remember that the problem has been ongoing for several decades now.

Also, before you go on about doctors not accepting Medicare, you might want to think of the doctors who don't accept private insurance, either.

The problem isn't government, the problem is cost. I might buy that the problem was government if we weren't far ahead of every other country regardless of whether their healthcare is socialized partially, fully, or not at all. There's no there there, but your response to everything is privatize, deregulate, and cut taxes. While those things may make your bits tingle, they aren't actually solutions to the problem we're talking about right now, which is the overall cost of healthcare driving Medicare costs into the stratosphere.

If you have a problem with Medicare coding, feel free to propose a solution to that. Every bit of efficiency helps. You're just ignoring 30 years of history if you think private insurers are somehow going to solve that problem by themselves. They've had plenty of time, but have yet to make anything more than the most weak of moves in that direction. Once the benefits you claim will arise in the private market actually materialize, it would be more appropriate to discuss privatizing Medicare. As it is, you're yelling that one system is broken and saying that we need to dump everybody into one that's even more broken by almost every measure, including patient satisfaction.

P.S. It's strange that you fault the government program for not being gold plated. Supplemental insurance is only affordable because Medicare already covers all the big ticket stuff. Besides, private insurance doesn't cover everything, either. Most people who go bankrupt due to medical bills actually have insurance.

Edited to add: I just saw your claim that doctors order unnecessary procedures to make up for Medicare patients. That's freakin' rich. You do realize that you could simply decline to have the CT if you're concerned about the cost and don't think it's medically necessary.

[Gaspar]

You speak as if this is not true of private insurers, who refuse to standardize. If you want to replace something, you should at least replace it with something that works better. It should also preferably be cheaper, which you deftly handwave away. If the private market is so great at this, why has it produced crappy results for so long? Before you say Obamacare, remember that the problem has been ongoing for several decades now.

In 1945 the ability for insurance companies to compete became limited.  Each state was given the authority and requirement to regulate the insurance industry separately.  Insurance providers were made exempt from federal anti-trust laws.  This meant that they were bound to offer differing programs in each state and free from the competitive pressures that existed nationally.  Over decades as state regulations grew, only a handful of insurers survived in each state.  They could name their price, and as prices grew, more and more employers began offer medical plans as a employee bonus, taking more and more of the individual choice out of the market, and again allowing this small number of companies to set prices far above market.

In the 60's Medicare comes into play and physicians, as well as seniors are thrilled.  The plan is a simple reimbursement system listing procedures supplies and reimbursement rates.  It was based on current medical costs and fees.  You know where this goes from here. . . The bureaucracy grew as did the regulations, and responsibilities put on medical practices.  Code books went from a printed 40 page billing manual to phone book sized volumes.  Physicians hired administrative people, actual degree programs in Medicare Billing became available, and reimbursement rates under medicare remained lower than market rates.  

In the meantime insurance companies are finding ways to cut corners.  They have nothing to worry about because they've sewn up deals with the big hospitals and big employers, legislators, and pharma. Insurers have doctors locked down into one plan or another, so if patients (or their companies) change insurance, the patient runs the risk of losing their doctor.  Insurance companies have their own formularies patterned after medicare systems binding patients to specific drugs.  

By limiting competition, we increase cost.  By burdening providers, we increase cost.  By taking healthcare decisions away from the individual, we further limit competition, and therefore increase cost.  

You can't blame the insurance companies any more than you can blame an invasive species introduced into an ecosystem without competition.  Government intervention gave birth to the disaster.  Again, the remedy is simple, but some people don't want to hear simple solutions.  Markets are organic, and when we forget that we court the law of unintended consequences.

Simple, clear purpose and principles give rise to complex, intelligent behavior. Complex rules and regulations give rise to simple, stupid behavior. – Dee Hock

[erfalf]

It's really not just a "government is the problem" thing. But it is.

Government spending and regulation cause dislocation. Dislocation causes chaos in markets. We say medical care is expensive, but we don't really know, because the true price is not what the cost is now. Right now we have prices that rely heavily on government boards that dictate the rates, and everybody just prices accordingly.

I pointed out in a post above that I think the first priority should be getting insurance (private or public) out from in between the doctor and patient. Want to eliminate paper work by doctor's offices, make the patient do it. Why is it the doctor's responsibility anyways, it's not their money. Like I've said ad nausea, insurance is a financial tool. And it is a financial tool for the patient, not the doctor.

I really am not particularly adverse to subsidizing those that need assistance purchasing health insurance due to job loss/injury/whatever. But make it just that. It takes far less bureaucracy to just cut some checks to people that need it. Instead the federal government seems to want to create more and more jobs for itself when there were simpler far more efficient solutions staring them right in the face. Let's say instead of what we have now, we had a standard subsidy based on income/employment kind of like unemployment of something. It pays $200 (or whatever) per month. I would bet my lunch that private insurers (if allowed) would start offering plans close to that amount. Probably a no frills plan only covering catastrophic events, but that's fine. Why should they have all the bells and whistles when all we as a society want is to not have to cover the catastrophes.

Nathan, I appreciate all your input, but I have yet to hear any real solutions besides government involvement. While we likely will never agree, did it ever occur to those on the left that there may be more than one way to skin a cat?

[nathanm]

Interestingly, in that entire screed on why the insurance industry is not to blame for its problems, you failed to articulate why it is they cannot control costs. They are perfectly capable of doing so, so why don't they do it? Wouldn't the one that managed to be cheapest and still provide the best care get more business? That there are few does not mean they are not free to compete. Interestingly, they do.

Explain to me how turning Medicare into a voucher system fixes the private system. How about you fix that before throwing the highest cost people into the already highest cost system we have. Medicare has a better MLR, so you're proposing we either spend more to get people the same level of care or make seniors make up the difference.

Again, nobody is forcing the private insurance companies to be arcane and waste money on bureaucracy. They seem to do that just fine on their own, even in the face of competition.

erfalf, we know what the costs are. The insurer sends you an EOB detailing what was paid for what services. Your employer sends your insurer a check (or you do). The doctor knows what his costs are, the insurer his. Many insurance companies are public, and therefore have open books. Studies clearly show that prices paid per procedure are much higher here than they are anywhere else in the world for no better care on average, and often worse care. Insurers have dismal MLRs, doctors order more procedures, care is less standardized here, there's a long list of reasons why it's expensive. Whacking Medicare doesn't change any of it, so all you're doing is pushing the cost off the government's books, not actually fixing the problem.

Edited to add: It has occurred to me. After all, Obamacare's solution of making everyone buy insurance, with premium support for the poor, (which you oddly seem to promote as a solution) is different than what I would prefer to have seen, which is a public option forced to compete with private insurers in a functional market. Unfortunately, the Republican plan on offer of rolling back Obamacare without any replacement for the components which are projected to provide some cost containment doesn't actually solve any problems. It takes us back to the system that was so broken the country was clamoring for reform of some kind. The cart comes after the horse, not before.

[heironymouspasparagus]

Huh?  Your posts are getting rather Shadowy.  Could just be the buzz from your other thread.

What am I against?  Obamacare?  Hell, yeah!  The point of Obamacare is to be transitional until a single payer platform can be passed.  We all know that.  Basically making the entire healthcare system a giant Medicare.  It's insanity, but some people really believe that giant government bureaucracies can produce a better product.

Not at all...

It is only insanity that the Republicans have been advocating the same thing that is now in place - at least mouthing the noises - but have completely and absolutely avoided actually doing anything about it.  They have had decades.  And did nothing.  In the same way the actual healthcare system has done nothing to solve the cost issues.  So, we are stuck with a government intervention that could possibly be done outside in better fashion - BUT WAS NOT!!

Of course this is transitional - everything the government does is transitional (except for the great resource giveaways from our national properties through obsolete mining and forestry laws).  It will change and it should change.  That is called progress.  That is what progressive does for a system.