Opinons on the new health care bill?

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being that rationing of some kind seems unavoidable, i would prefer the relatively impartial government rationing of universal healthcare, than capitalist rationing which totally excludes the working poor from primary healthcare, forcing them into ruinously expensive tertiary care in ERs. i recently had a malignant hypertensive emergency, and it was the weekend and the ER was the only game in town- they charged me [or tried to] $3000 for procedures which would cost only a fraction of that if it had been in a primary health care setting. i can't help believing that anybody who says there isn't rationing in our current system simply has never been in an adverse financial situation resulting in lack of insurance, IOW they've been too rich to ever be priced out of healthcare. being on the short end of the stick has shown me the present system is all about rationing of primary care based on how wealthy one is. if the repubs get their way and repeal both "obamacare" as well as EMTALA, then the reality would be totally undenieable rationing of ALL healthcare based on wealth, a boon for social darwinists but an abject and inhumane state of affairs for everybody else.

Then research will be cut to a pathetic fraction of what it is today, and the development of new drugs and technologies will grind to a standstill. Almost everyone who does biology-related research is funded at least in part through the NIH, and I myself will be paid with government grant money for research I'm doing this summer. The thing is, it's cheaper for taxpayers if we just go ahead and fund the research rather than leaving it up to private organizations.

My mistake then.



I disagree with the last part of that. I don´t think that lifestlyle plays a huge role. A 2007 report by Mckinsey Global Institute ( http://www.mckinsey.com/mgi/rp/healthca ... thcare.asp ) called "Accounting on the Costs of Health Care on the United States" after studying the prevalence of 130 diseases (including diseases associated with obesity) in the US and comparing with their prevalence in Japan, Germany, France, Italy, Spain and the UK concluded that "...the US population is not significantly sicker than other countries we studied...". That supposably would explain US lower performance. But the differential impact of the 130 diseases analysed is less than $25 billion in treatment costs. According to Paul Krugman that is less than $100 of the roughly $3,000 per person extra the US spends on health care each year.


[img][650:465]http://i367.photobucket.com/albums/oo119/MaxPower555/imagemmkcinsey.jpg[/img]




mmm yeah there are differences. We could use UNICEF´s data on infant mortality which tries to sort out the differences between estimates produced from different sources, with different methods. They explain their methodology here: http://mdgs.un.org/unsd/mdg/Metadata.as ... riesId=562 . According to their data ( http://mdgs.un.org/unsd/mdg/Data.aspx ) US scores at 45 in infant mortaliy rate behind Italy, Japan, Portugal, Austria, Belgium, Denmark, Estonia, France, Germany, Greece, Ireland, Israel, Korea, Netherlands, Spain, Switzerland, Australia, Canada, Cuba (!), New Zealand, United Kingdom.
Here is the data:
[img][291:800]http://i367.photobucket.com/albums/oo119/MaxPower555/infantmortalityUNICEF.jpg[/img]
Source: Unicef ( http://mdgs.un.org/unsd/mdg/Data.aspx )


There is also this report from the Centers for Disease Control and Prevention (CDC) ( http://www.cdc.gov/nchs/data/databriefs/db23.htm ) that conclude that differences in the reporting of mortality rates between countries are not likely to explain US low performance. In their words "There are some differences among countries in the reporting of very small infants who may die soon after birth. However, it appears unlikely that differences in reporting are the primary explanation for the United States’ relatively low international ranking."




I partially agree. According to the same McKinsey document drug costs in the US health care system are 70% higher than its peer countries and US patients consume 20% less prescription drugs than other countries. But that is only part of the problem. The authors of the study made an estimate that US spends $477 billion more on health care than would be predicted by its level of wealth. Of that $57 billion is spent more on drugs (prescription and OTC) than what was expected had the US a cost structure similar to other countries. Paul Krugman claims in "The Conscience of a Liberal" that unlike other advanced countries the US doesn´t have a centralized agency bargaining with pharmaceutical companies over drug prices. Still on the drugs question one study published on Health Affairs called "It´s the Prices Stupid: Why The United States is So Different From Other Countries" ( http://content.healthaffairs.org/cgi/re ... 2/3/89.pdf ) claims that Canada´s single payer system acts as a pure monopsony (monopoly on the buyer side) that gets enough bargaining power to drive medicine´s costs down at Canada. Ther author goes on telling that Medicare and Medicaid programs as well as large private insurers enjoy some monopsony power but the system is highly fragmented by international standards. According to the authors that is one factor that could explain the relatively high prices for health care and health professionals in the US. In comparison the government controlled systems of Canada, Europe and Japan allocate considerably more market power on the buyer side.



I agree with that. Private insurers have to screen clients in order to avoid high risk clients. That is the adverse selection problem. That adds a huge bureaucracy to the system. If a private insurer does not screen for its clients it will end up with a poll of clients with higher risks than the other insurers and will be at loss. Medicare spends about 3 percent of its funds on administration while private insurers the figure is about 15 percent (Britain’s National Health Service administration costs are 2% (McKinsey)) . In US the total administrative cost including both the costs of insurers and those of health care providers accounts for 31 percent of health spending compared with less than 17 percent in Canada according to the article "Costs of Health Care Administration in the United States and Canada" in the The New England Journal of Medicine ( http://content.nejm.org/cgi/content/short/349/8/768 ). The highly fragmented and complex U.S. payment system also requires more administrative personnel in hospitals than would be needed in countries with simpler payment systems (according to: It’s The Prices, Stupid: Why The United States Is So Different From Other Countries)


The McKinsey report says that the US spent $412 per capita on health care administration and insurance in 2003 that is nearly 6 times as much as the OECD average. That adds $98 billion above what the US health care system was supposed to cost. In the US private sector 64 percent of the administrative costs incurred by private payors is due to underwriting health risks, and sales and marketing costs that do no arise in the public systems of most OECD countries. According to the McKinsey report private ownership in the US health care system adds another $75 billion of cost (in profits) that isn’t incurred in the publicly owned systems of the comparison OECD countries.

Europeans actually smoke and drink more than Americans.

Not true in the Scandinavian countries. They smoke less and exercise more than UnitedStateseans. The big defect in the American lifestyle is the lack of exercise.

ruveyn

I voted yay as I'm not against it but, the chances are high that, if it doesn't go well at all since it's not the real deal health care reform, it'll make chances of getting the real thing in our country slim. We are the only 1st world country that pays for our health care. Other 1st world countries laugh at us for that. What we need is a health care that covers the entire nation!

I think its going to be longer waits for simple tests and procedures. The only good that comes from it will be existing conditions will be covered no matter what when you get new insurance.

for the working class, it is surely better than the absolute nothing which is the pre-reform status quo.

Why? It is health care reform.

Granted it's reform that makes things worse rather than better, but that's what reform often does.

In most states preexisting conditions were already covered if you maintained continuous insurance. Since the new plan requires everyone to maintain insurance, it isn't making things better even in that respect.

I know I stated my opinion before on it, but since I was reading about it again it yesterday, I'll go over it again.

This is not a REFORM bill. It's reform in name only. It's another prop up of the current system and won't really make anything better and at most, more expensive.

It grants private insurance companies federally guaranteed customers. They can't deny anyone though. However since they will have to cover high risk persons now, persons who of course, couldn't afford coverage anyway, will mean rates will likely have to go up across the board to cover these risk risk persons. You're living in a fantasy world if you think rates will go down from this bill.

And it's illegal if you don't want to be a part of this. That's choice you can believe in.

It's a great deal for the insurance companies. If the high risk pool starts costing too much, just raise the premiums. People will have to pay it. Otherwise, face a fine, jail time, and the government just pays the companies to cover them. Win-win for the insurance companies.

The bill just doesn't fix the real problems. The real problem is that health care is just too damn expensive across the board and this does absolutely nothing about that.

I'm telling you, the people really lost out on this bill. The things that would have been good for the people got weeded out piece by piece until all that was left was the good stuff for the insurance companies.

Here's the problem. A hundred years ago a doctor could stitch up cuts. set broken bones and deliver babies. That was about all.

If you had a fever or smallpox or an infection then either you lived or you died.

Now we can do so much more but it is increasingly expensive. Hospital waiting rooms are filled with geriatrics.

What if a senile 80 year old needs a heart transplant which would cost $100,000?
Should we pay for it?

Babies with once fatal defects are now kept alive for years at vast cost. They will still die but only after years of anguish for the parents, pain and suffering for the child, and hundreds of thousands of dollars in medical costs.

So what should we do?

the recent health care reform package is but a stopgap solution. it is better than nothing, but there still will be a day of financial reckoning. for now though, many poor folk put-off seeking treatment for ailments until they become acute conditions, and are penalized for lacking the money for earlier primary treatment. tertiary care is much more expensive than primary care, and is the only care available to much of the working class in this country who are turned away from doctor's offices due to inability to afford insurance. so rationing by stressing broad-based public funding of the most well-established cost-effective treatments would be fairer and less cruel than the current system of economic rationing, i.e., if you're rich you get extravegant care but if you're working class poor [if you are lucky] you are given a choice between a lifetime of indebted servitude/financial ruin [from last minute ER care], and disability/death. if cities can fund billion-dollar luxury sports statium obscenities, they can also fund public health care for the uninsured.
alternately, if the hospital/medical establishment continues to deny treatment to the uninsured,, then they should be empowered to treat themselves via the democratization of medical information/treatment wisdom and over-the-counter availability of medicines- this is mexico's "solution." let us borrow from this as well as enabling a combination of enhanced pharmacists and nurse practitioners administering more medical care at MUCH lower cost.
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just my 2-cents' worth, adjusted for inflation

I'm putting my physician hat on now, and I am going to relate a real tale of two patients.

Last week I had two patients referred up from ER, presenting virtually identical conditions. Both were out of province, one from another Canadian province and one from the United States.

The Canadian patient was admitted within 15 minutes, in a bed within two hours, and treatment was underway. At no time were my treatment orders subject to inquiry from her province's medical insurance system.

The American patient declined to be admitted until he could confirm that his admission would be covered by his insurer. He issued a blanket instruction refusing treatment until pre-approved by his insurer. It took us six hours to get him admitted, including two phone calls between me and his insurer. It took a full 24 hours for approval of some of my treatment orders (including more phone calls between the insurer and the attending on the following day). As a physician, I am powerless to help without my patient's consent, and my patient's consent was tied up in his insurance concerns.

Which patient received the superior care in this case? Well, if we subscribe to the theory that prompt care is effective care (which is not always the case, but that's a discussion for another day), it was the patient who came from the single-payer insurance scheme. The patient from the dynamic, market driven, no-government-involved insurance scheme was subjected to stress, financial worry and delayed treatment.

the typical amuuurrican swiftian fix would be to convert the rest of the world to our mercenary ways, IOW eat the excess poor- just cook 'em well done to kill any bugs. oh wait, they ARE the bugs, so never mind- bring out the flit! no sense paying for bug doctors to heal the bugs when they're gonna be DDT'd anyways. just keep a few around for slave labor, as any self-respecting tea partier knows the poor are only good for disposable menial laborers.

Which patient behaved irrationally under the circumstances? Obviously, the U.S. patient. If I got sick in Canada I would take full advantage of the Canadian system.

ruveyn