Equity market says US Health Bill is killed

[Newtons Bit]

Then why aren't insurance companies suing states on the grounds that states have no authority to prohibit out of state competitors?

Why would they want to? They have less competition the way it is and thus can make higher margins.

 

[TellyKNeasuss]

1. They like having little to no competition.

In other words, insurance companies are colluding by "if you stay out of my territory than I'll stay out of yours" agreements?

2. Lacking any federal laws in this area the states are free to do as they wish.

So my understanding that the Constitution prohibits states from regulating interstate commerce is not correct?

 

[TellyKNeasuss]

Why would they want to? They have less competition the way it is and thus can make higher margins.

If that is true, would relaxing state regulation do much to increase competition?

 

[TellyKNeasuss]

As the saying goes, when the only tool you have is a hammer everything looks like a nail.

And when you've spent a lot of money to buy that hammer, you're going to want to drive in a lot of nails.

 

[WildCat]

In other words, insurance companies are colluding by "if you stay out of my territory than I'll stay out of yours" agreements?

No, they've managed to have state regulations made such that entrance barriers are high.

So my understanding that the Constitution prohibits states from regulating interstate commerce is not correct?

States cannot regulate interstate commerce, but I have no idea what this has to do with the subject at hand?

 

[TellyKNeasuss]

States cannot regulate interstate commerce, but I have no idea what this has to do with the subject at hand?

I was thinking that a discussion about whether states can prohibit insurance companies from operating across state boundaries is related to whether states can prohibit interstate commerce, but I guess I was wrong.

 

[theprestige]

The possibility of no HCR isn't Obama's fault in the slightest...

Very true. It really isn't Obama's failure...

I assume from these statements that both of you agree that Obama should get little or no credit for any legislation passed in 2009, nor should he get any credit "in the slightest" should a meaningful healthcare reform bill pass this year after all. Is this correct?

 

[theprestige]

Between death or bankruptcy from medical bills. You don't have that kind of choice over there now do you?

Last time I checked, everybody dies sooner or later. Are you saying your health-care provider is promising to keep you alive indefinitely, regardless of cost, and without billing any cost increases back to you?

 

[ponderingturtle]

I think this is illegal under HIPAA, which is still law now as far as I know. The most a PEC can be excluded is for 12 months, and only if the PEC wasn't previously covered last year by a former employer's (e.g.) insurance.

Sure it might not be legal, but they can spend a lot of time denying claims for petty reasons in the hopes that it will make them go away.

 

[ponderingturtle]

Why not get the states out of regulating health insurance entirely, and regulate it at the federal level? Replace 50 state insurance bureaucracies, each with hundreds if not thousands of pages of regulations, with one federal one.

Not a bad idea. But I am generaly for federal regulations over state regulations for this reason.

 

[ponderingturtle]

The supply of doctors is kept artificially low by the AMA, the only group which can certify medical schools in the US. They want a shortage, which keeps prices high. And the fee for service model (which you call "ala carte") is a major reason health care in the US costs twice as much as almost every other country on earth. Pay by each service, and you will get more services, whether or not they're needed. There's no reason at all doctors can't get paid a salary like almost every other professional.

Um not nessacarily, you see medical care is something that an over abundance of supply can increase demand. If your doctor doesn't have a lot of patients he might schedule you for a follow up in 3 months if he is busy it might be 6. Unless there is a reason 3 months is better than 6 he just increased the demand for doctors.

I remember hearing a guideline for cataracts.

If there is one doctor in town you get them at 20/200.

IF there are two doctors in town you get them at 20/80

If there are three doctors in town you get them at 20/40.

Which is why there should be laws/rules in place favoring salaried doctors, rather than fee-for-service.

This could be helpful.

 

[ponderingturtle]

Its not just medical tests though. C-sections and hysterectomies have been way more common in the US than statistics in other countries would dictate, tonsilectomy rates can vary wildly from town to town and doctor to doctor, there seems to be a great deal of back surgery going on that is unneeded and dangerous, etc.

I remember an NPR story that one town had something like 3 times the hysterectomy rate of surrounding towns. Once you get a doctor who over perscribes them, and they start to know lots of people who have had them it is easy to get clusters of treatment like that.

 

[ponderingturtle]

Last time I checked, everybody dies sooner or later. Are you saying your health-care provider is promising to keep you alive indefinitely, regardless of cost, and without billing any cost increases back to you?

So you are ok dying tomorrow instead of in say 30 or 40 years? Why are you even arguing about health care then?

 

[theprestige]

So you are ok dying tomorrow instead of in say 30 or 40 years? Why are you even arguing about health care then?

I'm not really ok with dying at all. Mostly, I spend the resources necessary to avoid death. I might even go so far as to avoid death at all costs. But when the day comes that I can no longer afford to pay those costs...

... On the other hand, I might reach a point where I am ok with dying, or at least where I believe my resources might be better spent on other things than my survival--a better tomorrow for my children, for example; or a quick, painless exit from this world.

I'm arguing about health care because I wonder how much life I'm entitled to, and how much of your resources I'm entitled to when mine run out, and how much of your resources I'm entitled to if I decide to spend mine on things besides survival.

I'm also genuinely curious about your earlier statement: You say, "Between death or bankruptcy from medical bills. You don't have that kind of choice over there now do you?" like it's somehow avoidable.

Am I entitled to be put on life support at your expense, for say 30 or 40 years, if it means I don't die tomorrow? And if it bankrupts you? Why should you be bankrupted by the cost of my life, instead of me? Who better to make the choice between death and bankruptcy, than the person whose life and death it is?

While I myself am not a Catholic, it seems to me that Catholics have a distinct advantage, here: The believe that all human lives are sacred to their God, and they believe their God will judge them in part on the charity they show to those around them.

You have no such advantage, and are left insisting that all human lives must be sacred to the State, and the State should be empowered to compel charity from all citizens.

And yours is a dogmatic religion, not simple social welfare argument. If that were the case, I'd be more than happy to entertain your ideas for a tax on the affluent, to provide for the needy enough that they do not burden society in excess of the tax. And I'd be happy to pay any welfare tax we all agreed on, to minimize the overall costs to our society of those that need.

An Emergency Room Tax, for example, to cover the emergency room costs of those who cannot afford to pay those costs for themselves. Ideally such a tax would cost society less than it costs to let emergency rooms fend for themselves, etc.

But that's not what you're talking about, is it? Welfare programs for the needy, paid for by taxes we all agree are necessary to maintain and improve our society are one thing. Your idea, of every life, needy and affluent alike, being sacred to the State is something else entirely. That is why I'm even arguing about health care.

And you still haven't answered my question: Do you claim that your own State has somehow relieved you of the burden of having to choose between death and bankruptcy? Does your State not now have to make that choice, not only on your behalf, but on behalf of every soul you've committed to Its care?

 

[Rolfe]

Hyperbole, much? People do get put on life support here for many years, at public expense, and nobody is bankrupted.

This is a persistent right-wing meme, that the costs of on individual are borne exclusively by another individual. Half a second's thought demonstrates this isn't so.

You can get a helluva lot of life support for the same level of tax you guys pay just to support Medicare and Medicaid, you know.

Rolfe.

 

[theprestige]

Hyperbole, much? People do get put on life support here for many years, at public expense, and nobody is bankrupted.

How many years? Is it unlimited? Or do people just tend to die before the State's life-support funding runs out?

This is a persistent right-wing meme, that the costs of on individual are borne exclusively by another individual. Half a second's thought demonstrates this isn't so.

Half a second's thought reveals the general case of the costs of one group are borne by another group. The principle is the same, and dividing my costs among you and nine of your friends doesn't answer my questions: How much of your group's resources am I entitled to?

You can get a helluva lot of life support for the same level of tax you guys pay just to support Medicare and Medicaid, you know.

And yet it's not unlimited life support, is it? If I were buying that life support for myself, I'd still end up, sooner or later, at a point where I'd have to choose between death and bankruptcy.

None of which brings you any closer to answering my questions, or addressing ponderingturtle's implied claim that they live in a State which has somehow abolished the choice between death and bankruptcy, both on for individuals and for the community as a whole.

 

[ponderingturtle]

I'm not really ok with dying at all. Mostly, I spend the resources necessary to avoid death. I might even go so far as to avoid death at all costs. But when the day comes that I can no longer afford to pay those costs...

... On the other hand, I might reach a point where I am ok with dying, or at least where I believe my resources might be better spent on other things than my survival--a better tomorrow for my children, for example; or a quick, painless exit from this world.

See in america you get the choice no one else gets, that is between say living for 6 months more, and leaving an enheritance to your kids and lot having your spouce lose the house.

That is not a choice they get in other countries, because they don't have to worry about as much of the expenses personaly. So they get to choose both living longer and not financialy destroying their family.

Pure socialism.

I'm arguing about health care because I wonder how much life I'm entitled to, and how much of your resources I'm entitled to when mine run out, and how much of your resources I'm entitled to if I decide to spend mine on things besides survival.

Ah so you are against patient rights and treating the poor.

I'm also genuinely curious about your earlier statement: You say, "Between death or bankruptcy from medical bills. You don't have that kind of choice over there now do you?" like it's somehow avoidable.

Funnily enough they spend as much per capita on social medicine as the US, and cover everyone, and get equal or better outcomes. So they certainly seem to have avoided it.

 

[ponderingturtle]

How many years? Is it unlimited? Or do people just tend to die before the State's life-support funding runs out?

As it is paid for each year how would the funds run out? The thing is like with many current suggestions there is no maximum cap on coverage ammount. Just what is and is not covered which is based on scientific evidence(mostly). Sure some treatments that offer little benefit at great cost are not covered, but by and large it is not a substantial difference.

None of which brings you any closer to answering my questions, or addressing ponderingturtle's implied claim that they live in a State which has somehow abolished the choice between death and bankruptcy, both on for individuals and for the community as a whole.

Sure if everyone in britian got cancer tomorrow their public health system would have serious problems. Otherwise they do seem to have gotten out of that issue. Because as a community you will have a relatively stable number of people in need of serious expensive treatment. But this focus on individual caps is an artifact of some american health care plans.

 

[Faithkills]

See in america you get the choice no one else gets, that is between say living for 6 months more, and leaving an enheritance (sic) to your kids and lot having your spouce (sic) lose the house.

You forgot the third choice. Take responsibility for yourself so you can take care of yourself without bankrupting your family or being a burden on society.

That is not a choice they get in other countries, because they don't have to worry about as much of the expenses personaly. So they get to choose both living longer and not financialy (sic) destroying their family.

Pure socialism.

And bear the high unemployment, and loss of personal freedom associated with socialism.

Ah so you are against patient rights and treating the poor.

The right to take from others you mean.

Funnily enough they spend as much per capita on social medicine as the US, and cover everyone, and get equal or better outcomes.

Except of course that's an absolute lie. Medical outcomes are superior in the US.

http://www.ncpa.org/pub/ba596

Which is of course why most medical tourism in the world is to the united states.

http://blogs.wsj.com/health/2008/05/06/medical-tourism-dont-believe-the-hype-yet/tab/article/

There are absolutely places with higher life expectancies. If you want to live longer go on a diet and start an exercise regime.

What you want from health care is .. health care.. like when you need health care. If you get sick, and you want to live, there's no better place to be than the US.

I have no problem reforming health care. The current legislation is however a disaster and deserves to die. Most Americans understand this, and that's why they are against it.

What we need to do is devolve subsidies for people who can afford insurance (most people) and subsidize health care for legal citizens who can't, invoke the commerce clause to allow interstate competition, end special interest groups insurance mandates, (if you want chiropractic or aromatherapy pay for it), specifically allow catastrophic only coverage, end the AMA/LCME provider monopoly, end government protection of big Pharma IP rights, tort reform (loser pays), eviscerate the FDA's obstructionist bureaucracy, etc.

The base problems are:

1) (perceived) third party payer which increases effective demand.

Why not use resources you will lose them if you don't? Why not use it if there's a mandated low copay?

2) Oversubsidization which increases effective demand. It's economically impossible to subsidize something without driving up prices.

Why not use resources if someone else is paying?

3) Artificially controlled supply. AMA/LCME.

Subsidies are a dangerous tool. Consumption subsidies drive up costs by increasing demand in addition to their direct cost.

Subsidizing people that need it may be necessary but has a twofold cost.

Subsidizing everyone is simply insane. You just create a never ending 'need' for more subsidies.

(it's funny how the Disney economists of the world understand 'price support' subsidies but think that an entitlement subsidy somehow is immune to the same effects)

 

[ZirconBlue]

You forgot the third choice. Take responsibility for yourself so you can take care of yourself without bankrupting your family or being a burden on society.

Oh, the old "responsibility" canard. Tell me, do you have millions of dollars in savings, just in case you get cancer?

And bear the high unemployment, and loss of personal freedom associated with socialism.

Virtually every other developed Western nation provides universal healthcare to their citizens, at a lower per capita cost than we pay for Medicare and Medicaid. Can you demonstrate that all of those countries have higher unemployment and less personal freedom than the US?