The Obama Presidency - 2008 & 2012

[ISiddiqui]

Because we can't regulate any companies. Oh no. That's why our industrial food production is exactly like Upton Sinclair said it was (not saying its good, but its a far sight better than "The Jungle").

[Arles]

No, what I am saying is this:

You (with your PPO) and a medicare patient come in for a MRI. Medicare sets a cap on how much that doctor/hospital can charge for the MRI. So, to offset that cost, the hospital charges your private PPO (and potentially you) more to makeup the cost difference on the medicare patient.

Another big issue is the payment process by the government on these poverty plans. They have been notoriously late/under pay causing many doctors not to accept them. It's better to just setup guidelines for private insurance and have regulations for people who take the stipend for coverage.

[DaddyTorgo]

insurance companies are fucking scum. insurance is a massive fucking racket.

when i was looking for jobs i had very little i said i wouldn't do, but one thing i said was that i'd never work for an insurance company.

[molson]

Originally Posted by SteveBollea

Yes, why should we mistrust the insurance companies?
Bill Moyers Journal . Transcripts | PBS

I'm sure the insurance companies have their hands in the new bill as well. That might explain why the public option is so relatively small and restrictive.

[Arles]

Originally Posted by SteveBollea

Yes, why should we mistrust the insurance companies?
Bill Moyers Journal . Transcripts | PBS

A public option will kill most of the private companies. They can't compete with a public option because money costs less for the government (ie, they don't need a business loan, the government just prints more money), the government can underbid without consequence (no profit) and a public system will eventually lead to a government monopoly - not more competition. And, at that point, all we have is a government option and all its warts (as seen in Canada and the UK).

[DaddyTorgo]

Originally Posted by SteveBollea

Pretty much. You assume liberals like me _loooooove_ this bill. We don't. We believe it's a moderate first step.

very moderate first step towards the ultimate nirvana which would be single-payer

[RainMaker]

Originally Posted by Arles

No, what I am saying is this:

You (with your PPO) and a medicare patient come in for a MRI. Medicare sets a cap on how much that doctor/hospital can charge for the MRI. So, to offset that cost, the hospital charges your private PPO (and potentially you) more to makeup the cost difference on the medicare patient.

Another big issue is the payment process by the government on these poverty plans. They have been notoriously late/under pay causing many doctors not to accept them. It's better to just setup guidelines for private insurance and have regulations for people who take the stipend for coverage.

The same thing happens with insurance companies.

Insurance companies dictate to the doctor what they will pay for treatment. Those who don't have insurance have to pay much more to cover that cost. Find out one day what the insurance company actually paid for your treatment as opposed to what they billed you.

I'm also pretty sure part of the reform for Medicare was a system for faster payments to doctors. Another thing you want in this bill that you oppose.

[molson]

Originally Posted by Arles

A public option will kill most of the private companies. They can't compete with a public option because money costs less for the government (ie, they don't need a business loan, the government just prints more money), the government can underbid without consequence (no profit) and a public system will eventually lead to a government monopoly - not more competition. And, at that point, all we have is a government option and all its warts (as seen in Canada and the UK).

I thought that until I saw how few people the public option is apparently going to cover. If a middle class person loses their job, or if their employer drops health care, they'll have to pay out of pocket for a private company - they can't get the public option. (I think, my understanding of this changes every day).

[ISiddiqui]

Originally Posted by SteveBollea

People freak out when we try to limit executive compensation in companies we've given billions in taxpayer money too. Actual regulation like many European countries where profits are limited have zero chance to pass.

This interview is from a former Cigna VP. It isn't some dirty fucking hippie like me.

You mean like set levels for how much of premiums go to medical claims, LIKE IN THIS BILL?

I realize that you really just want a single payer system, but considering that it has a 0% chance of passing, you just need to get over that.

[ISiddiqui]

Originally Posted by SteveBollea

Even if that's true (which it's not), let me ask you a question. What _value_ does a private health insurance company has? I mean, there's a value to a hospital, doctors, and even pharmaceutical companies. I just don't understand what great value a private insurance company with 30% overheads over a Medicare-type public option with 4-6% overhead.

I'd rather have private competition with a strong public regulatory layer over a one-size-fits-all single payer government controlled medical system.

Basically, more Switzerland, less UK.

[larrymcg421]

I'm amused that we're going all the way back to The Jungle, which is somehow supposed to trump the very recent examples of intense corruption in the private sector.

[DaddyTorgo]

Originally Posted by Arles

A public option will kill most of the private companies. They can't compete with a public option because money costs less for the government (ie, they don't need a business loan, the government just prints more money), the government can underbid without consequence (no profit) and a public system will eventually lead to a government monopoly - not more competition. And, at that point, all we have is a government option and all its warts (as seen in Canada and the UK).

good...because for-profit insurance companies in the healthcare space have no fucking business being in business.

are you really comfortable with your healthcare being at the whim of Wall Street and subject to corporate profits? the insurance companies now are trying to get the reimbursement rate changed to a 35% floor - so you'd be paying 35% of your own healthcare costs out of your own pocket!!

wouldn't you much rather have a not-for-profit entity overseeing it that didn't have an economic motive to minimize the amount of money spent on your care?

honestly, not trying to belittle anybody, but i don't understand how, when looking at it that way, anyone could ever pick the "for profit" option. there's absolutely no benefit to it.

[RainMaker]

Originally Posted by Arles

A public option will kill most of the private companies. They can't compete with a public option because money costs less for the government (ie, they don't need a business loan, the government just prints more money), the government can underbid without consequence (no profit) and a public system will eventually lead to a government monopoly - not more competition. And, at that point, all we have is a government option and all its warts (as seen in Canada and the UK).

You can't just buy the public option out of the blue. You have to qualify and it's a small percent of the public that do. For the most part it's just people who can't get insurance right now so you aren't stealing any business away.

[ISiddiqui]

Originally Posted by DaddyTorgo

good...because for-profit insurance companies in the healthcare space have no fucking business being in business.

are you really comfortable with your healthcare being at the whim of Wall Street and subject to corporate profits?

wouldn't you much rather have a not-for-profit entity overseeing it that didn't have an economic motive to minimize the amount of money spent on your care?

honestly, not trying to belittle anybody, but i don't understand how, when looking at it that way, anyone could ever pick the "for profit" option. there's absolutely no benefit to it.

Mostly because they'd rather not the government control 100% of health care. Considering there are already very successful private/public partnerships in the would out there.

[ISiddiqui]

Originally Posted by SteveBollea

You realize in Switzerland, they're not allowed to have any profit on basic care. They're limited to I believe, 5 or 10% profit on extra care. I'm smart enough to realize that yes, single-payer won't pass tomorrow. But, I also realize that there's too many bought off and ideological opposition to anything like that.

You realize what the term "more Switzerland" means, yes?

[molson]

Originally Posted by DaddyTorgo

good...because for-profit insurance companies in the healthcare space have no fucking business being in business.

are you really comfortable with your healthcare being at the whim of Wall Street and subject to corporate profits?

wouldn't you much rather have a not-for-profit entity overseeing it that didn't have an economic motive to minimize the amount of money spent on your care?

honestly, not trying to belittle anybody, but i don't understand how, when looking at it that way, anyone could ever pick the "for profit" option. there's absolutely no benefit to it.

Looking at it that way, sure. But you're just taking the best aspects of government and the worst of private. There's also the worst of government and the best of private. Maybe government wins out with healthcare, it's possible, but it's the complete invalidation of any drawbacks or risks that make me wonder if there's too much idealism here and not enough reality.

[DaddyTorgo]

yeah. we'll never get good regulation like that to limit profits because too many lobbyists and senators are bought and paid for by insurance companies. so single-payer or an "anybody opt-in" public option (eventually) is the only possible solution that we'll see

[Arles]

Originally Posted by RainMaker

You can't just buy the public option out of the blue. You have to qualify and it's a small percent of the public that do. For the most part it's just people who can't get insurance right now so you aren't stealing any business away.

But if that's the case, why not just outsource it to the current private companies we have? Less bureaucracy needed in Washington and you give the government the ability to "fire" companies if they don't meet cost/quality restrictions. Less initial capital is needed and you are putting people in a currently existing system. Why go through all the effort/cost of setting up a government system if the goal is just to cover a sliver of the current population?

It's cheaper just to set requirements and outsource it.

[DaddyTorgo]

Originally Posted by molson

Looking at it that way, sure. But you're just taking the best aspects of government and the worst of private. There's also the worst of government and the best of private. Maybe government wins out with healthcare, it's possible, but it's the complete invalidation of any drawbacks or risks that make me wonder if there's too much idealism here and not enough reality.

i don't think i'm taking the best of one and worst of the other.

i think i'm making a broad statement about each of their respective motives for providing health insurance.

[DaddyTorgo]

Originally Posted by Arles

But if that's the case, why not just outsource it to the current private companies we have? Less bureaucracy needed in Washington and you give the government the ability to "fire" companies if they don't meet cost/quality restrictions. Less initial capital is needed and you are putting people in a currently existing system. Why go through all the effort/cost of setting up a government system if the goal is just to cover a sliver of the current population?

It's cheaper just to set requirements and outsource it.

because you'll never get the regulations due to all the congresspeople being bought-off

[Arles]

Assuming we have a federal budget, there's no difference in motives. Both want to provide the most coverage options possible by staying within budget. The difference is that the government can change the rules as we go to fit its paradigm whereas individual private companies have to meet a certain set of regulations/quality/cost or they lose patients.

[molson]

Originally Posted by DaddyTorgo

i don't think i'm taking the best of one and worst of the other.

i think i'm making a broad statement about each of their respective motives for providing health insurance.

Still a very idealistic view of government. On the individual level, they're just looking to advance their careers, just like those in the private sector. Corporations are tainted by profit-seeking, government is tainted by politics. Neither are looking out for your best interest.

[molson]

Originally Posted by DaddyTorgo

because you'll never get the regulations due to all the congresspeople being bought-off

You sound like someone who wouldn't trust the government....

[ISiddiqui]

And, as someone who works for the federal government, I think we do a Hell of a better job regulating abuses than we do in running things.

[ISiddiqui]

Originally Posted by molson

You sound like someone who wouldn't trust the government....

LOL! Priceless .

[molson]

Originally Posted by ISiddiqui

And, as someone who works for the federal government, I think we do a Hell of a better job regulating abuses than we do in running things.

Though one of their gigantic failures is regulating medicaid fraud. Seriously, if you commit medicaid fraud for less than say $50k, nobody will bat an eye.

[ISiddiqui]

Btw, one thing. I know there have been some on the left who yell, "Why can't we be on your plan" to Congressmen and the like... y'all do know that the federal plan is through insurance providers right?

The Federal Employees Health Benefits Plan is basically like any other employer. The US Government negotiates with insurance companies for a number of different health plans and then offers them up to government employers for them to pick the one that works for them.

So for those who believe the federal government has a self-funded plan. That isn't the case. Even the federal government realizes it is better to be an insurance broker and provide individual workers with a choice than a one-size-fits-all.

[DaddyTorgo]

Originally Posted by SteveBollea

I trust government bureaucrats who get paid a nice middle-class wage w/ union benefits fine. I don't trust congresspeople taking legalized bribes from various health care industries.

pretty much what Steve said here.

[molson]

Originally Posted by SteveBollea

Either they're stuck with the insurance company they have through their job or if they don't have employer-based insurance, one of three or so that dominate their state (mosts states have only 2 or 3 insurance companies that control the vast majority of private insurance in the state).

Will Obama's plan address that? I don't see the public option as true competition anymore, since it's apparently uber-restricted.

[Arles]

Originally Posted by SteveBollea

Medicare (5% approximate) has less BUREAUCRACY~! than private insurance (20-30%).

Currently, private insurance subsidizes many of the Medicare costs and Medicare is massively over budget. The only reason it is currently running is because it has unlimited funding and government resources.

If it were a private company in its current state, it would be filing for bankruptcy. So, you can throw around 5% vs 20% or any numbers cherry picked, but that's the cold reality. Medicare spending has grown from $250 billion in 2002 to $440 billion in 2007 without significantly increasing the number of people covered. If a private company had a 75% increase in costs over 5-6 years without significantly increasing the revenue coming in, it would be out of business. Right now, Medicare amounts to 16% of our entire federal budget and you act like it's some kind of roaring success.

When you can print money, you can cover up all kinds of cost issues. I just don't want to see Medicare (covers 43 million people) on a 300 million person scale. That has a chance to setup a debt we will never be able to pay off and kill our economy.

[ISiddiqui]

Originally Posted by SteveBollea

Except in health care, that's false. Medicare runs at 5% administrative costs and has better "approval ratings" from their "consumers" than private insurance companies do with 20-30% administrate costs.

Based on 40 quarters of "premiums". I'm betting if private insurance had that much built up cash that they were mandated to spend on care, they'd have much higher approval ratings too, I'd bet.

Of course, even then Medicare is in danger of running out of money (being, like Social Security, the beneficiaries getting paid for by the future beneficiaries). It's a retirement health plan based by current working Americans. As much a ponzi scheme as Society Security. You think a single payer or public health plan is going to have that much cash?!!

[ISiddiqui]

Originally Posted by Arles

When you can print money, you can cover up all kinds of cost issues. I just don't want to see Medicare (covers 43 million people) on a 300 million person scale. That has a chance to setup a debt we will never be able to pay off and kill our economy.

Exactly. At some point we may want to realize that we have a massive debt and need to do something about. Health care is something important and needs to be done, but not at the expense at leaving us permanently in massive debt up to our eyeballs.

[molson]

Originally Posted by SteveBollea

Well, people forget that Obama's plan isn't just, "can't find a plan? Here's the public option." The plan is for a health insurance exchange (kinda like the one federal employees use) where the public option is one of the choices.

I don't understand that part very well, but I like what I've read about it. (though still can't figure out how much of an "option" the public option is - how many people are allowed to buy in, and how much will it cost). Facilitating choice is an easy reform with zero drawback or risk.

[ISiddiqui]

I've heard all these people say the "public option" will keep "insurance companies honest" on price and coverage (with limitless resources and not caring about debt, I guess you can cover everything and keep the price low, but I digress)... if its SOOO restricted as I've heard here, how is it going to keep anything honest as the spin is?

[ISiddiqui]

Originally Posted by SteveBollea

Also, it's not a Ponzi scheme.

It is quite assuredly a Ponzi scheme. It's the definition of one. Current beneficiaries get paid by those who are promised benefits in the future. Not saying that's a bad thing, but its a Ponzi scheme.

As far as Medicare goes, I've never said it's not perfect. But, I'd rather spend time on reforming it and figuring out to pay for it or everybody instead of regulating every trick a profit-based insurance company would try. It'd be cheaper in the long-term for a variety of reasons.

And I'd rather not have the government become the sole health provider and try to institute a one-size-fits-all policy, but have various heavily regulated insurance companies provide choice to individuals.

[Arles]

Originally Posted by SteveBollea

Except Medicare costs have gone up less than private insurance costs over the past decade. That's even with the fact that Medicare is full of old sick people.

That's because medicare sets cost. What you're basically saying is that their costs haven't gone up much, but their spending has increased from $250 billion to $440 billion in 5 years. You really think this is a good thing and model for a public health care system?

If you extrapolate spending on medicare to 300 million people, you get a cost of roughly $3 trillion. That's equal to our entire federal budget for 2009.

[RainMaker]

Originally Posted by Arles

But if that's the case, why not just outsource it to the current private companies we have? Less bureaucracy needed in Washington and you give the government the ability to "fire" companies if they don't meet cost/quality restrictions. Less initial capital is needed and you are putting people in a currently existing system. Why go through all the effort/cost of setting up a government system if the goal is just to cover a sliver of the current population?

It's cheaper just to set requirements and outsource it.

Government doesn't have to worry about making profits and impressing shareholders. You're better off hiring some gurus who ran health insurance companies and have them run the government plan but in a non-profit setting.

[RainMaker]

Originally Posted by Arles

Assuming we have a federal budget, there's no difference in motives. Both want to provide the most coverage options possible by staying within budget. The difference is that the government can change the rules as we go to fit its paradigm whereas individual private companies have to meet a certain set of regulations/quality/cost or they lose patients.

Private companies don't really lose patients. They are virtual monopolies in most regions. Tough to lose a customer when you're the only game in town. Especially if that insurance is tied into the company you work for.

[RainMaker]

Originally Posted by Arles

That's because medicare sets cost. What you're basically saying is that their costs haven't gone up much, but their spending has increased from $250 billion to $440 billion in 5 years. You really think this is a good thing and model for a public health care system?

If you extrapolate spending on medicare to 300 million people, you get a cost of roughly $3 trillion. That's equal to our entire federal budget for 2009.

You don't seem to understand that insurance companies do the same thing. They all have deals with the hospitals where they have set the price they will pay for procedures. Next time you're in the hospital, find out what you were billed and what your insurance company actually paid from that bill. It's astounding.

[ISiddiqui]

Originally Posted by SteveBollea

There's a good bill from Ron Wyden called the Free Choice Act that would basically do that along with a couple of other nice things.

You mean the Healthy Americans Act, by Wyden (D-OR) and Bennett (R-UT). I actually prefer this bill. Very much so. For one it is revenue neutral as the CBO has evaluated it.

Also, it has no public option .

[DaddyTorgo]

LOL - so this "Lewin Group" that is providing all the facts and figures to anti healthcare reform Republicans - is a subsidiary of a wholly-owned subsidiary of United Health (2nd largest healthcare corporation in the country).

No bias there though, right?

[JPhillips]

Originally Posted by Arles

That's because medicare sets cost. What you're basically saying is that their costs haven't gone up much, but their spending has increased from $250 billion to $440 billion in 5 years. You really think this is a good thing and model for a public health care system?

If you extrapolate spending on medicare to 300 million people, you get a cost of roughly $3 trillion. That's equal to our entire federal budget for 2009.

That cost number is very misleading. In that time they added prescription drug coverage. It didn't go up that much just due to inflated costs.

[JPhillips]

Watch out you Canuck bastards, David Vitter is out to destroy you.

Vitter was asked at a town hall meeting about the fact that he opposes government health care, but supports re-importing prescription drugs from, as a constituent said, "countries that have socialized medicine." Vitter has campaigned in the past on re-importing drugs from Canada.

"My ultimate goal," Vitter explained, "is to use that (re-importation) to cause that (pricing) system to collapse."

[Autumn]

That market share report is interesting. It has meant everything in the states I've lived in in recent years, #4 and #6 on that list. Prices have gone through the roof and up every year because there's essentially one supplier in the state. It's horrendous.

[RainMaker]

Originally Posted by JPhillips

Watch out you Canuck bastards, David Vitter is out to destroy you.

He's not out to destroy them, he's out to stop us for having to subsidize the pharmaceutical industry.

[rowech]

Originally Posted by SteveBollea

Point One - Good Article from the "creator" of the public plan Jacob Hacker titled, ""Public Plan Choice In Congressional Health Plans: The Good, The Not-So-Good, And The Ugly""

http://www.ourfuture.org/files/Hacke...ugust_2009.pdf



2. Support for Public Option still very high when you don't remove word 'choice' from polling question.

SurveyUSA News Poll #15699

Q2: "In any health care proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance--extremely important, quite important, not that important, or not at all important?"

1200 Adults
Margin of Sampling Error: ± 2.9%
Extremely Important - 58%
Quite Important - 19%
Not That Important -7%
Not At All Important - 15%
Not Sure - 1%

All that shows is people don't want to lose what they have and they fear the government is trying to take it.

[SteveMax58]

Originally Posted by Autumn

That market share report is interesting. It has meant everything in the states I've lived in in recent years, #4 and #6 on that list. Prices have gone through the roof and up every year because there's essentially one supplier in the state. It's horrendous.

Funny...I was thinking the exact opposite thing...how I've lived in # 33, 41, & 42 (mostly #42) over the past 15+ years of adulthood.

For those that disagree with allowing for inter-state competition between insurance companies...what is the feared scenario(s) of this? And is that not correctable via new regulations?

[Mizzou B-ball fan]

Good article clarifying that Obama's claim that you can keep your current insurance if you want to do so isn't as accurate as he'd lead you to believe...........

Keep Your Insurance? Not Everyone. | FactCheck.org

[JPhillips]

I don't have much fear that businesses will start shedding their insurance plans, especially with all the restrictions on the public option. Why don't businesses shed health plans now when they don't face a fine?

[SteveMax58]

Originally Posted by SteveBollea

Basically, what happened with credit cards. Notice how all of them are based out of South Dakota? The fear is that the insurance companies will find a state with a pliable legislature that will thrown out many regulations that aren't in the current health care bill because, pretty much all states require certain stuff.

I understand that concern but similar to the way mant (most?) companies are incorporated in Delaware...why can't states also insist that insurance companies offering policies in their state must also adhere to their own regulations? Or if that isn't plausible enough (or loopholes still exist), why not federally mandate this?

I definitely see the issue with lack of competition but also don't see why we can't try this step first.