Originally Posted by JohnMc82

You're right - relative to other countries, research in America is relatively privatized. It still relies heavily on publicly funded research, but they do get huge tax breaks and a great argument for patent monopolies. Two things "the market" does poorly: utilities, and pure research. Medicine is both, so if we want a functional system, we have to get rid of all the middle-men who use that defense to justify their accumulation of wealth.

Sounds good to me!

Originally Posted by JohnMc82

It still undermines your theory that America is doing things right when it comes to promoting research. The bigger aggregate costs get, and the more the government gets squeezed out, the less we're going to see of new developments and treatments. The most popular new drugs are of questionable safety and efficacy, but they're selling like hotcakes.

Whoa, that's not my theory. I do tend to take serious that R&D is expensive and often doesn't bare fruit so there has to be some sort of system of supporting it - profits, incentives, tax breaks, govt sponsored. I'm also not thrilled with govt takeover of it all especially the "D" side of the R&D. I'm still a capitalist when it comes to best way of moving the ball forward on tech development; I just seem like a commie because of my concern for my fellow man, and even that has a heavy Henry Ford capitalist pragmatism to it. (I even like a lot of Justin's production ideas which we don't get too much of here because, well, he hates me! )
I really don't know what the possible answers are here. I like to see an Alexander or Butler weigh in on it but they seem to avoid the place these days. Why, I wonder what Justin thinks about it if we could stay just a sliver short of the total anarchy model. I just don't know.

Originally Posted by JohnMc82

Didn't we just go over the fact that the MLR rule change is only going to affect about .1% of what we spend on healthcare each year? $2 billion is nice, but it's not even peanuts on the scale we're looking at. It doesn't get to be a trump card for every problem in the system, and no, you can't just wave off the ridiculous incentives created by investors in the other .1% who can only see the world in terms of personal profit & loss.

Well, essentially that boils down to not much more blood is going to be squeezed out of the insurers unless we can reduce their role to being optional supplemental insurance over and above single payer. But you know my political opinion of the likelihood of that in the foreseeable future (have I mentioned I don't do magic pony land?) So where do we go from here? I suggested medical care providers have a role to play. I've suggested the American consumer paying for the incentives (or outrageous profiteering, depending on one's outlook) of medical tech R&D as another. You don't seem to care for either one of those so where else do we go? Rani's death panels? (I just like to put her name in front of that because I know it makes her head explode. I kinda like that - yes, I'm a sick old man )

Originally Posted by Marx & Lennon

Doctors limit Medicare patients, because they make more from others, not because they make too little to survive. Think about it. We have the most expensive healthcare system on earth, and one of the few cost managment systems is just s-o-o-o mean to the providers that they can't take it any more. Yeah, right.

Medicare, is now going to reimburse doctors at a much lower rate if they don't cross all of their T's and dot all of their I's just so. Doctors, for now, are continuing to see Medicare patients. As we have discussed here, there are many hidden costs to physicians that we patients don't always see and understand. My doc showed me the numerous pages of information on each patient she now has to fill out to be reimbursed. So almost twice as much time will be spent on each patient, which means less pay. These paper pushing time expenditures add nothing to a quality of health care.

The PTB are undermining our health with this added paperwork by physicians, yet they are paying the private Medicare Advantage programs 14% more to treat patients.

NOTE: I needed to clarify by what I wrote in this post.

Originally Posted by Marx & Lennon

Doctors limit Medicare patients, because they make more from others, not because they make too little to survive. Think about it. We have the most expensive healthcare system on earth, and one of the few cost managment systems is just s-o-o-o mean to the providers that they can't take it any more. Yeah, right.

I agree that we have the most expensive 'non-system' in the world. We also need a real system ( perhaps by using a 'BRAC' approach since Congress is broken).
But, I think that you are ignoring the situation of the direct providers(physicians) who no longer control the 'system'.

Originally Posted by Deb C

Medicare, is now going to reimburse doctors at a much lower rate if they don't cross all of their T's and dot all of their I's just so. Doctors, for now, are continuing to see Medicare patients. As we have discussed here, there are many hidden costs to physicians that we patients don't always see and understand. My doc showed me the numerous pages of information on each patient she now has to fill out to be reimbursed. So almost twice as much time will be spent on each patient, which means less pay. These paper pushing time expenditures add nothing to a quality of health care.

The PTB are undermining our health with this added paperwork by physicians, yet they are paying the private Medicare Advantage programs 14% more to treat patients.

NOTE: I needed to clarify by what I wrote in this post.

Two problems here:

1. First, the cost containment issue is being driven by the need for, well, cost containment. Yes, paper pushing is part of the problem, but the model is trying to change to an outcome base. That requires a lot of data and analysis. It will settle out in time, or should.
2. Medicare Advantage is the source for removing spending from Medicare. It was supposed to be flat after 5 years, yet here we still are after 10. Well, enough of that.

At some point, the systems had to converge.

Originally Posted by radind

I agree that we have the most expensive 'non-system' in the world. We also need a real system (perhaps by using a 'BRAC' approach since Congress is broken).
But, I think that you are ignoring the situation of the direct providers (physicians) who no longer control the 'system'.

People have gone into medicine for the money for decades. Time for that to end. We need doctors, not accountants with MDs or DOs. I don't know what the new model will look like in the end, but we need a change. We may need a few rounds of changes to get it right.

Originally Posted by Marx & Lennon

People have gone into medicine for the money for decades. Time for that to end. We need doctors, not accountants with MDs or DOs. I don't know what the new model will look like in the end, but we need a change. We may need a few rounds of changes to get it right.

Yes, we have been at this for the past 50 years. Even if you are correct that we can attract enough altruistic doctors, nothing is being done for a transition to train a new generation of physicians.
I don't like plans based on unproven theories, but it seems that the ACA is leading the way.I just hope that we can survive the 'few' rounds of changes.

Originally Posted by Marx & Lennon

People have gone into medicine for the money for decades. Time for that to end. We need doctors, not accountants with MDs or DOs. I don't know what the new model will look like in the end, but we need a change. We may need a few rounds of changes to get it right.

Seriously? Please tell me that your jesting about that accusation. I mean, how do you know why people choose which professions? While it could be somewhat true that some did go into the profession for the money but it's also true that some probably chose that path because they had a calling on their life. I would think there are various reasons for entering such a demanding job. To place doctors in that one tight box is a bit unfair.

Originally Posted by The Rani

At no time did I say that anyone making less than $11K per year would be "forced" to pay anything.
If you weren't such a dumbfuck and/or douchebag liar, you would stop making posts to the contrary.

Here, again, is what you stated -

Originally Posted by The Rani

...Having checked out the website myself and looked at the rates, I don't see how anyone actually believes that anyone with an annual income of less than $11K is going to shell out $2K year in health insurance premiums. It's just not gonna happen. (Which I'm sure is why state legislators knew that refusing to expand Medicaid would effectively destroy ACA.)

Now tell us what you where trying to convey here. I think most people (not toadies) would read this as you believing the website/ACA was attempting to force this (i.e., you're responding to what you found on the website). Instead, it appears you are trying to tell us that you were trying to alarm us with the obvious - e.g. the sun will set in the West, there's a difference between males and females, etc. Either way, you're pretty much a dumbfuck and pretty damn insecure about it as well. But go ahead, tell us otherwise and tell us what incredible insight you were trying to convey that doesn't fit one or the other of these two possibilities.

Also, it's kind of funny that you believe no one will notice your surprise that the ACA actually prevents the scenario you raised. Now why would that be a surprise to you? Hmmm.

And finally, can you explain your conclusion that state legislators, knowing the 11k man would not pay 2K, opted out of the M-expansion because it would destroy the ACA? I can see the connection if one believed the ACA needed to force the 11k man to buy, but it seems like just another dumbfuck assertion if someone didn't have that as a basic assumption. So which way is it? Which way are you a dumbfuck?


You are proving more entertaining than even Justin! I like that!

Originally Posted by playwrite

Or we could go with the GOP approach and just let those 40 million die. That at least appeals to thier Nihilist wing.

Fortunately, not all of them are taking that approach: http://www.nytimes.com/2013/11/22/us...it_th_20131122

Originally Posted by radind

Yes, we have been at this for the past 50 years. Even if you are correct that we can attract enough altruistic doctors, nothing is being done for a transition to train a new generation of physicians.
I don't like plans based on unproven theories, but it seems that the ACA is leading the way.I just hope that we can survive the 'few' rounds of changes.

Maybe what we need to attract are politicians who aren't in the pockets of the for mega profits insurance industry. I actually find it ironic that providers are seen as just in business for the money when billions of dollars go into the coffers of the insurance CEO's and corporations. I'm concerned that many citizens are buying into the hype that it's some how partially the providers fault that we have such a disaster of a health care system in this country. We forget that the corporate hold on our healthcare is the main reason for the dysfunction that we currently have.

What we need to attract are more altruistic citizens who are willing to put time and energy into a movement to challenge our broken health care system. Instead, there are way too many defending a so called reform that feeds the most greedy and powerful corporate insurance giants more of our tax dollars.

Originally Posted by Deb C

Maybe what we need to attract are politicians who aren't in the pockets of the for mega profits insurance industry. I actually find it ironic that providers are seen as just in business for the money when billions of dollars go into the coffers of the insurance CEO's and corporations. I'm concerned that many citizens are buying into the hype that it's some how partially the providers fault that we have such a disaster of a health care system in this country. We forget that the corporate hold on our healthcare is the main reason for the dysfunction that we currently have.

What we need to attract are more altruistic citizens who are willing to put time and energy into a movement to challenge our broken health care system. Instead, there are way too many defending a so called reform that feeds the most greedy and powerful corporate insurance giants more of our tax dollars.

I think that one of the big problems here is the fact that it takes so much money to run a campaign these days that only the well-connected can afford to do so. Do you feel as though this is the main reason why any legislation that would be beneficial to the Lower 90 on the economic scale almost always falls through the cracks? Might suggest reading Sasha Abramsky's book "The American Way of Poverty--How the Other Half Still Lives". It is a real eye-opener.

Originally Posted by Deb C

Maybe what we need to attract are politicians who aren't in the pockets of the for mega profits insurance industry. I actually find it ironic that providers are seen as just in business for the money when billions of dollars go into the coffers of the insurance CEO's and corporations. I'm concerned that many citizens are buying into the hype that it's some how partially the providers fault that we have such a disaster of a health care system in this country. We forget that the corporate hold on our healthcare is the main reason for the dysfunction that we currently have.

What we need to attract are more altruistic citizens who are willing to put time and energy into a movement to challenge our broken health care system. Instead, there are way too many defending a so called reform that feeds the most greedy and powerful corporate insurance giants more of our tax dollars.

I think that you are correct. It will take a strong push from the citizens to make effective changes.

Originally Posted by Brian Beecher

I think that one of the big problems here is the fact that it takes so much money to run a campaign these days that only the well-connected can afford to do so. Do you feel as though this is the main reason why any legislation that would be beneficial to the Lower 90 on the economic scale almost always falls through the cracks? Might suggest reading Sasha Abramsky's book "The American Way of Poverty--How the Other Half Still Lives". It is a real eye-opener.

While it's true that politicians need money to run for office, it's also true that our citizens are stuck in the rut of main stream thinking. There have been numerous candidates who ran for office who won't get support from so called progressives, because they have this self defeating idea that they can't win. Many a good candidate has fallen by the way side because of such embedded thinking.

Real progressive leadership doesn't have a chance as long as we have a media that ignores them and people who won't support them. We can be our own worst enemies when it comes to following our American Idol style politics, instead of doing what our hearts think to be best. Look at the attacks on the people's advocate Ralph Nader. The media blamed him for Gore's loss and some progressives believed them. Defamation is what happens to people who dare to enter politics and who won't bow to the PTB. Bottom line; corporations rule.

Originally Posted by Deb C

Maybe what we need to attract are politicians who aren't in the pockets of the for mega profits insurance industry. I actually find it ironic that providers are seen as just in business for the money when billions of dollars go into the coffers of the insurance CEO's and corporations. I'm concerned that many citizens are buying into the hype that it's some how partially the providers fault that we have such a disaster of a health care system in this country. We forget that the corporate hold on our healthcare is the main reason for the dysfunction that we currently have.

What we need to attract are more altruistic citizens who are willing to put time and energy into a movement to challenge our broken health care system. Instead, there are way too many defending a so called reform that feeds the most greedy and powerful corporate insurance giants more of our tax dollars.

actually, Obamacare will probably kill the insurance industry in the long run, which was probably its purpose.

""We may have an 'I-told-you-so' moment, but it's hard to get any pleasure out of it knowing how many people are actually going to get hurt," said Stephanie Woolhandler, a New York-based doctor who co-founded Physicians for a National Health Program, a group that pushes for universal health care. "You had a bad system, and you're putting a patch on it using the same flawed insurance companies that got us here in the first place," she said."

When Congress debated health-care reform in 2009 and 2010, the creation of a government-run, single-payer program that would provide health coverage to everyone was never seriously considered. Although Obama and many congressional Democrats say they support the idea, none forced it onto the agenda.

"I didn't talk about single-payer a lot during the run-up because it was clear that was not going to happen, and I didn't want to get people away from looking at what we can get done," McDermott said. "We got a hell of a lot done, and I'm proud to be a part of it."
Democrats focused on preserving and expanding the private health-insurance system, with all its complexities and shortcomings, to minimize disruption for consumers. And in a bid to secure support from insurers, hospitals and other private health care interests, the Senate -- with the White House's blessing -- eliminated the so-called public option, a government-run health plan that would have competed alongside private plans on Obamacare's insurance exchanges.


"When you have a system which is so complex, its main function is to enable insurance companies, drug companies, medical equipment suppliers to be making huge amounts of money off of the system. The more complex it is, the easier it is for them to do that," Sanders said.

Conclusion:

The troubles of getting Obamacare off the ground could hurt or help the single-payer cause, Sanders said. "What many people are going to say is that the federal government can't even run a bloody website," he said. On the other hand, the headaches of the insurance exchanges could generate renewed interest in a more straightforward approach, he said: "We need a system that is not as complicated as this system is."

Originally Posted by Wallace 88

actually, Obamacare will probably kill the insurance industry in the long run, which was probably its purpose.

I hope it does eliminate the chains of needing a corporate driven system to get the health care that all of us do or will need.

Originally Posted by Marx & Lennon

People have gone into medicine for the money for decades. Time for that to end. We need doctors, not accountants with MDs or DOs. I don't know what the new model will look like in the end, but we need a change. We may need a few rounds of changes to get it right.

Decades? Try centuries! Our current textbook had a chapter on the Tudor era medical establishment and Henry VIII's "Quack Licensing Bill" which essentially allowed paraprofessionals like surgeons, bonesetters, etc to practice medicine as long as they didn't try to pass themselves off as university-trained. This in the wake of a nasty, fatal new STD that was spreading like the Plague and which the medical establishment could not cure. And man, did the "real" physicians scream about it, too!

Backing up into the Middle Ages ....

well, nothing new under the sun there, folks.

Originally Posted by Wallace 88

actually, Obamacare will probably kill the insurance industry in the long run, which was probably its purpose.

I hear this from both sides... but... how can anyone actually believe this?

The Senate Finance Committee bill that eventually became the ACA was written by one of Max Baucus's aids. He's the Democrat who collected the most corporate campaign cash, and the person he hired has job experience as an insurance executive & lobbyist. It's also virtually identical to the plan proposed by the Heritage Institute in the 90s, back when the insurers were looking for something that would protect their profits from the increasing calls for universal coverage.

Further, insurance stocks are currently outperforming the market. I mean, now they've got a fixed overhead rate and customers being forced to buy the product - what else could an industry ask for?

Originally Posted by The Grey Badger

Decades? Try centuries! Our current textbook had a chapter on the Tudor era medical establishment and Henry VIII's "Quack Licensing Bill" which essentially allowed paraprofessionals like surgeons, bonesetters, etc to practice medicine as long as they didn't try to pass themselves off as university-trained. This in the wake of a nasty, fatal new STD that was spreading like the Plague and which the medical establishment could not cure. And man, did the "real" physicians scream about it, too!

Backing up into the Middle Ages ....

well, nothing new under the sun there, folks.

The immediate concern to most of us is the escalating increase in US health care costs starting around 1960.

Originally Posted by Deb C

While it's true that politicians need money to run for office, it's also true that our citizens are stuck in the rut of main stream thinking. There have been numerous candidates who ran for office who won't get support from so called progressives, because they have this self defeating idea that they can't win. Many a good candidate has fallen by the way side because of such embedded thinking.

Real progressive leadership doesn't have a chance as long as we have a media that ignores them and people who won't support them. We can be our own worst enemies when it comes to following our American Idol style politics, instead of doing what our hearts think to be best. Look at the attacks on the people's advocate Ralph Nader. The media blamed him for Gore's loss and some progressives believed them. Defamation is what happens to people who dare to enter politics and who won't bow to the PTB. Bottom line; corporations rule.

Which is one of the big reasons why Obama seems to have bit off more than he could chew in 2008.
Do you feel that we are stuck forever with the scenario where the interests of Wall Street damn near always trump those of Main Street?

Awhile back I came across a suggestion-HMOs for children. (Health Maintenance Organizations). Something to keep in mind if trying to come up with a Plan B.

Originally Posted by Brian Beecher

Which is one of the big reasons why Obama seems to have bit off more than he could chew in 2008.
Do you feel that we are stuck forever with the scenario where the interests of Wall Street damn near always trump those of Main Street?

Nothing is forever. The worm will turn as more and more people get disenfranchised. I see a bit of awakening among young people who see how corporations and the 1% are manipulating our country. I seriously see the recent popularity of the "Hunger Games" as an indication of eyes opening.

Originally Posted by The Rani

So you're a lying dumbfuck with a short attention span:

Sure, deary, sure. I guess we'll all have to just bid our time and wait for your next alarming insight of the incredibility obvious - sun rises in the east, water is wet, Katie Perry is not a guy? Can't wait!

"At this pivotal, historic, teachable moment, progressives should not leave the messaging battle about the ACA to right wingers and Obama loyalists. While critiquing the law for its entanglement with the profit-voracious insurance industry, we should fight for quality healthcare for everyone—definitely including the people who live in states where right-wing officials are blocking expansion of Medicaid coverage. (In a recent Nation article, historian Rick Perlstein cited a grim example of a chronic mentality: “the policy wizards in the Obama White House build a Rube Goldberg healthcare law that relies on states to expand Medicaid and create healthcare exchanges, and then are utterly blindsided when red-state legislatures and governors decline.”) We should challenge all efforts to deny the human right of healthcare." Norman Solomon

Originally Posted by Deb C

Maybe what we need to attract are politicians who aren't in the pockets of the for mega profits insurance industry. ....

.... reform that feeds the most greedy and powerful corporate insurance giants more of our tax dollars.

If one wants to have any influence on meaningful attempts at dealing with health care costs, one needs to have the basic facts.

From a profit-making standpoint, the insurers are a pretty pitiful lot. Here's some analysis from 2010 -

http://mjperry.blogspot.com/2010/02/...ank-88-by.html

- when insurers were 88th in ranking in profit margins among 215 industry groups with an average of a 3.3% profit margin. Working that out, the insurers make an ANNUAL profit of $100 on an individual plan and $200 on a family plan. In other words, if you took away 100% the insurer's profit and assume the most liberal estimate of how many plans there are, we are talking about at most about $2B in savings - a drop in the bucket in a nation's healthcare bill that is closing in on the $3 TRILLION mark - essentially, the insurers' profits represent about 0.1% of US healthcare cost!

And since 2010, the insurance industry's profit margin has gone from 3.3% to 3.7% but relative to the 215 industries it has dropped from 88th place to around 135th place -

http://biz.yahoo.com/p/sum_qpmd.html


That's a lot of evil, Debs, for us to wade through before we get to the insurers!

I'm a single payer advocate, but these idiotic statements about the mean old insurers being evil profiteers are clearly made by people who have no clue what is really going on and what are the actual issues let alone possible solutions.