The real problem that no one is discussing

[mchammer187]

Why wouldn't a plan that provides everyone with health insurance without raising taxes pass?

Especially if it at the same time increased corporate profits? Don't Republicans want to increase corporate profits?

I am not going to speak for the Republican party but I have heard things like its is "socialist", takes away freedom etc. Generally conservatives oppose any expansion of government. I'm sure the HI lobby had a lot to do with it as well (this applies to both parties).

 

[dank69]

Haven't you guys heard? Nanobots are coming and we will all be immortal by 2015!

 

[Athena]

How does pretty much every other western country with a single pay system do it?

It is a misconception that all other countries with more efficent healthcare do it through single-payer. Many countries have what's called "all-payer" and pay for care with far less government money than is done in the US.

Whenever healthcare comes up, just about the only systems discussed are single-payer -- UK and Canada. In fact though, there are very successful all-payer and hybrid plans in Australia, Germany, France, Switzerland, etc.

The biggest difference is thatall those other countries have universal coverage -- everyone gets the same deal. In some countries, such as France, individuals (or employers) can purchase add-on plans to cover what's not included in the universal plan, but everyone starts with exactly the same level of care. Compare that to the US where the government pays for a panoply of plans -- the elderly get one plan, military veterans get another, "poor and.."(because it's not enough to be poor to get Medicaid, you have to be poor and something else), prisioners get another plan, etc.,-- alongside a byzantine employer-paid scheme. No one else does that -- universal healthcare means just that universal.

There is nothing whatsoever "universal" about the ACA (nor is it affordable but that's another issue).

The reason other countries can deliver universal care more efficiently -- whether publicaly or privately financed -- is that they start with a different objective. They start by asking what kind of care the citizenry need, then back up to what the components or the delivery system have to be and at what levels, and then they figure out what would be the best way to finance that. In the US, the entire focus has been how to pay providers whatever they ask for.

Think about all the hundreds of articles that were written during the non-debate here. 95% of the pieces started with the need to pay hospitals for unreimbursed care. There wasn't any discussion about the cost structures that make care so expensive here; it was all about paying for emergency room care to bring down insurance premiums. No one questioned why insurance companies should be covering inflated costs that cover building duplicate specialty care centers. It was all about getting them paid. That BTW, was what got Romney interested in Massachusetts: hospitals complaining that too many people couldn't pay them.

 

[mchammer187]

It is a misconception that all other countries with more efficent healthcare do it through single-payer. Many countries have what's called "all-payer" and pay for care with far less government money than is done in the US.

Whenever healthcare comes up, just about the only systems discussed are single-payer -- UK and Canada. In fact though, there are very successful all-payer and hybrid plans in Australia, Germany, France, Switzerland, etc.

The biggest difference is thatall those other countries have universal coverage -- everyone gets the same deal. In some countries, such as France, individuals (or employers) can purchase add-on plans to cover what's not included in the universal plan, but everyone starts with exactly the same level of care. Compare that to the US where the government pays for a panoply of plans -- the elderly get one plan, military veterans get another, "poor and.."(because it's not enough to be poor to get Medicaid, you have to be poor and something else), prisioners get another plan, etc.,-- alongside a byzantine employer-paid scheme. No one else does that -- universal healthcare means just that universal.

There is nothing whatsoever "universal" about the ACA (nor is it affordable but that's another issue).

The reason other countries can deliver universal care more efficiently -- whether publicaly or privately financed -- is that they start with a different objective. They start by asking what kind of care the citizenry need, then back up to what the components or the delivery system have to be and at what levels, and then they figure out what would be the best way to finance that. In the US, the entire focus has been how to pay providers whatever they ask for.

Think about all the hundreds of articles that were written during the non-debate here. 95% of the pieces started with the need to pay hospitals for unreimbursed care. There wasn't any discussion about the cost structures that make care so expensive here; it was all about paying for emergency room care to bring down insurance premiums. No one questioned why insurance companies should be covering inflated costs that cover building duplicate specialty care centers. It was all about getting them paid. That BTW, was what got Romney interested in Massachusetts: hospitals complaining that too many people couldn't pay them.

I agree the cost structure needs reform and the insurance model.

Problem is most people there is no price sensitivity for people since health care is a lot of times an all you can eat and co-pays etc are not enough to make people not consider the costs. Doctors are a large part of the problem too because often they do not take into account costs either. A lot of times they have no idea what it is actually costs a patient and it is not entirely their fault for not knowing this Designer Drug A over Generic Drug B because the myriad of insurance plans.

There is also the problem with getting paid per procedure model as well because it favors treatment for the doctor and the patient. Doctor gets paid, patient is getting something "for free or very little" insurance company pays. I don't even think insurance companies are inherently bad. If anything they have the most vested interest in keeping someone healthy as long as you can't be dropped.

There are other problems associated with artificial barriers to entry to becoming a doctor in this country as well and compound that with the way the government subsidizes horrible food choices than it is a recipe for disaster and it has shown.

 

[Athena]

I agree the cost structure needs reform and the insurance model.

Problem is ...
There is also the problem...
There are other problems...

All of those problems --and more-- are issues because we do not have an actual healthcare system; we have provider payment programs. We are so inured to the encroachment of the finance sector in every part of our lives, no one even questioned why the discussion two years ago focused on the insurance industry rather than actual care.

 

[schneiderguy]

This is an interesting piece by Milton Friedman on the United States' healthcare system:

http://www.hoover.org/publications/hoover-digest/article/7298

Summary:

The current healthcare situation in the United States is largely a result of wage controls imposed by the government during WW2. In order to attract labor, employers began to offer healthcare benefits to circumvent the maximum wage laws. By the time the government caught on to this, it had become quite popular, and the government decided to make health benefits tax exempt because of political pressure.

Making health benefits tax exempt gives an incentive employees to take more of their earnings as health benefits. This led to the system of health insurance paying for everything, instead of operating like every other type of insurance; as a backup in case something really bad happens. Auto insurance doesn't pay for oil changes, so why is health insurance paying for yearly physicals?

When people aren't spending their own money, they aren't as thrifty with it, so this leads to a massive increase in spending. By Friedman's estimate, half of the cost increase in health insurance in the last half of century is directly attributable to this.

The private sector cannot be relied upon here to adequately cover this country's healthcare needs. They've failed.

The private sector did just fine before the government screwed things up. Look at the increase in average life expectancies against the increase in healthcare costs as percentage of GDP in the first half of the 20th century, which was largely a free market, versus the second half.

 

[nehalem256]

All of those problems --and more-- are issues because we do not have an actual healthcare system; we have provider payment programs. We are so inured to the encroachment of the finance sector in every part of our lives, no one even questioned why the discussion two years ago focused on the insurance industry rather than actual care.

Because the goal of liberals is to implement a single-payer system not make health care cheaper. And if you focus on the actual care instead of the "evil" insurance companies it is hard to do that.

 

[Darwin333]

Yeah, by big businesses that pull in billions year after year. You conveniently left that part out.

Ok, I will try to say this very slowly.....

You....can...take....ALL....of.....the....rich...and....corporate....income....ALL...of..it...and....still...be...woefully....short....very....soon


Got that? ALL of their income will not cover our shortfalls in the very near future.

 

[hal2kilo]

Because the goal of liberals is to implement a single-payer system not make health care cheaper. And if you focus on the actual care instead of the "evil" insurance companies it is hard to do that.

I'm sure that's not even anything close to what he said, but I don't want to put a dent in your rant party. Continue on.

 

[Darwin333]

Because it would never pass even in a majority D house and almost super majority Democratic senate.

There is no way in hell that if Obama came out and even reasonably explain and show how the Feds could cover EVERYONE in the country without raising a single cent of new revenue that it wouldn't pass. People being able to keep the absurd amount they spend on insurance or use some of it to purchase a private "cadillac plan" while still being able to pocket some? Are you kidding? Every last members phones and emails would be blowing up.

 

[Darwin333]

This is an interesting piece by Milton Friedman on the United States' healthcare system:

http://www.hoover.org/publications/hoover-digest/article/7298

Summary:

The current healthcare situation in the United States is largely a result of wage controls imposed by the government during WW2. In order to attract labor, employers began to offer healthcare benefits to circumvent the maximum wage laws. By the time the government caught on to this, it had become quite popular, and the government decided to make health benefits tax exempt because of political pressure.

Making health benefits tax exempt gives an incentive employees to take more of their earnings as health benefits. This led to the system of health insurance paying for everything, instead of operating like every other type of insurance; as a backup in case something really bad happens. Auto insurance doesn't pay for oil changes, so why is health insurance paying for yearly physicals?

When people aren't spending their own money, they aren't as thrifty with it, so this leads to a massive increase in spending. By Friedman's estimate, half of the cost increase in health insurance in the last half of century is directly attributable to this.



The private sector did just fine before the government screwed things up. Look at the increase in average life expectancies against the increase in healthcare costs as percentage of GDP in the first half of the 20th century, which was largely a free market, versus the second half.

I completely agree with this (other than the actual numbers only because I just don't know for sure) but your auto insurance versus health insurance line is spot on. We have absolutely NO clue what our healthcare costs. All we know is we pay the specialist $30 to see us which is, imho, in and of itself very cheap to see a neurosurgeon. Granted I might now really really need to see him but for $30, why the hell not.

The next major issue, imho, is the insane amount of cost shifting that goes on. This isn't just hospitals and doctors either, it goes all the way up to pharmaceuticals and medical devices due to the fact that we subsidize other nations who basically say "you want $5 per pill, we will give you $.25 for it or we will simply ignore your patent and make it ourselves". So we end up paying $7.50 a pill in order to make up the difference.

This is always a fun exercise, look up the medical imagining places in your local phone book. Call each one of them and ask for the type of CT scanner or MRI they have and the cash price. You will find that most of them have the same or very similar equipment but the costs are WILDLY different. I did this myself and with two places the difference was 600% and the MRI machine was the exact same type!

 

[Athena]

Because the goal of liberals is to implement a single-payer system not make health care cheaper. And if you focus on the actual care instead of the "evil" insurance companies it is hard to do that.

I'm not in a position to speak for "liberals" -- most of whom don't seem to actually know any more than conservatives about the healthcare market. My impression though, is most want adequate coverage for everyone and they've fallen into the trap of using faux economics to advance their cause. For example, the whole notion of depending upon competition in the insurance market to lower the cost of care is a fallacy that has no basis whatsoever in the way markets work. Insurance companies don't set prices, providers do.

If you focus on actual care rather than third party payers (which is what insurance companies are) though the costs of care could indeed fall. In Germany, everyone has his own private insurance. There are hundreds non-profit "sickness funds" that play the role of insurers. The funds negotiate as a group with providers regionally so they are all paying the same fee for a given procedure. Contrast that with the US where the same insurance company is has hundreds of different rates for the same procedure in the same state. Add more insurance companies, each one negotiating with hundreds of providers, and you get even higher rates.

 

[Athena]

The next major issue, imho, is the insane amount of cost shifting that goes on. This isn't just hospitals and doctors either, it goes all the way up to pharmaceuticals and medical devices due to the fact that we subsidize other nations who basically say "you want $5 per pill, we will give you $.25 for it or we will simply ignore your patent and make it ourselves". So we end up paying $7.50 a pill in order to make up the difference.
!

Sorry, but that's not an accurate depiction of the situation. It is a myth that the US is somehow subsidizing drug development. What the US is subsidizing, is outsized pharmaceutical profits; and it is doing it voluntarily. The drug companies spend more on advertising in the US than they do on research worldwide.

When conservatives talk about "gifts" to constituencies, they might want to remember Medicare Part "D"; which was a gift to both seniors and the pharmaceutical industry. The ability to negotiate drug prices just as the VA does would make a huge difference in the sustainability of the program.

 

[JEDIYoda]

Because the goal of liberals is to implement a single-payer system not make health care cheaper. And if you focus on the actual care instead of the "evil" insurance companies it is hard to do that.

I thought that was the goal of conservatives...hmmmmmm

 

[sandorski]

Sorry, but that's not an accurate depiction of the situation. It is a myth that the US is somehow subsidizing drug development. What the US is subsidizing, is outsized pharmaceutical profits; and it is doing it voluntarily. The drug companies spend more on advertising in the US than they do on research worldwide.

When conservatives talk about "gifts" to constituencies, they might want to remember Medicare Part "D"; which was a gift to both seniors and the pharmaceutical industry. The ability to negotiate drug prices just as the VA does would make a huge difference in the sustainability of the program.

Indeed. I am so tired of the Subsidizing argument, as presented anyway. If the Drug Corps were not making a Profit in Foreign Markets, they simply would not be Selling into those Markets in the first place. If there is any Subsidy, it is the US Government allowing such high prices in the US in order to keep those Corps headquartered in the US.

 

[buckshot24]

Clearly we're moving toward a single payer system. There's really no other way to dramatically bring costs down across the board.

The private sector cannot be relied upon here to adequately cover this country's healthcare needs. They've failed.

The private sector hasn't been able to operate in the health care industry.

 

[Tom]

The government already pays 50% of health costs. You are essentially arguing it can cover everyone with private insurance without spending any additional money...

All healthcare costs are paid now by someone.

Including the cost of healthcare for all the uninsured which is paid in lots of hidden and indirect ways.

And because a lot of the healthcare for these people is coming in irrational and expensive ways, the hope is that covering those people in a more rational and sensible way would actually cost less.

 

[Darwin333]

Sorry, but that's not an accurate depiction of the situation. It is a myth that the US is somehow subsidizing drug development. What the US is subsidizing, is outsized pharmaceutical profits; and it is doing it voluntarily. The drug companies spend more on advertising in the US than they do on research worldwide.

When conservatives talk about "gifts" to constituencies, they might want to remember Medicare Part "D"; which was a gift to both seniors and the pharmaceutical industry. The ability to negotiate drug prices just as the VA does would make a huge difference in the sustainability of the program.

I completely disagree with the first paragraph, I will dig up some articles on it. As far as their advertising campaigns, what relevance does that have to the discussion? Obviously they are getting a return on their investment so why shouldn't they advertise (strictly from a monetary aspect)? Its not like they advertise because they have to much money, they do it to make more.

As far as Medicare part D, I agree completely. Republicans seem to forget that their party is responsible for the biggest expansion of entitlements in decades. As far as negotiating drug prices, didn't Obama sell us out on that one too?

 

[Darwin333]

Indeed. I am so tired of the Subsidizing argument, as presented anyway. If the Drug Corps were not making a Profit in Foreign Markets, they simply would not be Selling into those Markets in the first place. If there is any Subsidy, it is the US Government allowing such high prices in the US in order to keep those Corps headquartered in the US.

When other countries will violate your patent and rip off your product making something is better than nothing, especially when they can jack our prices up to cover the loss.

Its not like the pill costs that much to actually produce, so they aren't taking an actual loss selling the pill itself. Its the R&D and cost of bringing the drug to the market that the rest goes to which has already been spent.

 

[werepossum]

All healthcare costs are paid now by someone.

Including the cost of healthcare for all the uninsured which is paid in lots of hidden and indirect ways.

And because a lot of the healthcare for these people is coming in irrational and expensive ways, the hope is that covering those people in a more rational and sensible way would actually cost less.

Problem is, when something desirable is free people want more of it. That's just human nature.

As for myself, I'm done worrying about it. The proggies are in charge and will be pretty much from now on due to changing demographics, and their position is that the debt ceiling should be raised to infinity because government literally cannot borrow and spend enough money to ever cause a problem. Indeed, the problem has been conservative efforts to limit how much we borrow and spend. If the proggies are right there will not be a problem; we'll simply borrow and print more money. If the proggies are wrong, there's nothing I can do to stop the crash, and personally I don't see the Republicans doing anything more than slightly delaying the crash anyway. Either way, why worry?

The new American creed is to get as much as you can from others any way you can and the Devil take the hindmost - and the future. Medicare Part D suggests that the Republican Party recognized this long ago, so the rest of us just need to get with the program.

 

[Pr0d1gy]

Ok, I will try to say this very slowly.....

You....can...take....ALL....of.....the....rich...and....corporate....income....ALL...of..it...and....still...be...woefully....short....very....soon


Got that? ALL of their income will not cover our shortfalls in the very near future.

OK Papa John, you're telling me that insuring your entire workforce for 4 cents extra per large pizza is going to kill everything. Certainly sounds reasonable....wait, what?

http://www.huffingtonpost.com/2012/11/13/papa-johns-obamacare_n_2123207.html

Go learn something you fucking douchenozzle.

 

[Exterous]

OK Papa John, you're telling me that insuring your entire workforce for 4 cents extra per large pizza is going to kill everything. Certainly sounds reasonable....wait, what?

http://www.huffingtonpost.com/2012/11/13/papa-johns-obamacare_n_2123207.html

Go learn something you fucking douchenozzle.

Before you want to tell someone to 'go learn something' you might want to take a second and actually educate yourself first. The 4 cents figure has already been debunked

Interesting that he decided to look at total revenue and total expenses. Why is he trying to calculate total cost per pizza by basing his calculations on a number that includes drink, bread etc sales, royalty and franchise fees here and overseas? By doing so his math is clearly going to be off on a per pizza calculation

Forbes may not be left wing but that does not mean the analysis gives the complete accurate picture

I imagine that Papa John's did the math to figure out what the total cost would be if just absorbed by pizza sales. I take issue with him saying the math is wrong when it could very well be right and his comparison is a poor one because he uses total revenue to calculate cost per pizza

As for the cost being less - we don't know that. There may be many static agreements (EX: negotaited and contractually agreed on Franchise fees) in place that do not allow PJ to increase their revenue from that source, increasing the need for higher cost per pizza calculations. The real answer, when taking in to account the avenues that Papa John's can use to increase revenue, likely lies in the middle

Oh please, the author isn't trained or experienced in finance.

I've been a CPA for 30 yrs and I looked up the SEC filing for PJ's. The author's analysis is deeply flawed. I crunched his numbers too and basically it's utter crap.

He used total revenue figure to spread-out the increased cost of Obamacare. That's absurd because about 60% of that revenue doesn't come from food sales at all, much less pizza sales. Most of PJ's revenue comes from it's franchisees. Franchisees much pay royalties. Franchisees must purchase all their inventory products (food, paper etc.) from PJ.

His methodology is so far off it's not worth discussing his results. They are meaningless.

If you could break down revenue into specific food sales (e.g., pizza sales) you might be able to get a decent 'rule of thumb' estimate. But the author didn't even do that.

The proper way to determine the correct cost increase, which I expect the company actually did, is to use the cost data: specifically the labor cost per pizza. And I guarantee you they know exactly how many labor hrs, and the cost, go into each pizza. You take that labor amount, add in additional cost for Obamacare and you'll get the necessary price increase to maintain your profit margin.

I used to own a franchise pizza restaurant.

Oh, did I mention the author is an clueless idiot?

Fern

The evidence is very clearly there to see should you bother to take the time and look at their public filings. Of course that would require you to present factual information instead of biased sound bites - which we already know is not your strong point

 

[biostud]

In some cases it's good to have a government regulating a market by laws. Health care is one of them.

 

[Pr0d1gy]

Before you want to tell someone to 'go learn something' you might want to take a second and actually educate yourself first. The 4 cents figure has already been debunked





The evidence is very clearly there to see should you bother to take the time and look at their public filings. Of course that would require you to present factual information instead of biased sound bites - which we already know is not your strong point

OK, so where's your link then? I would think Forbes would know how to break down a cost v sales analysis, but you know maybe Fern knows more than Forbes does...pfft

Whether the cost is 4 cents, or 9.5, the simple fact is that same $11 pizza was $7 less than a decade ago...so where is all that money going and why have wages remained stagnant whilst sales have steadily grown? Why is it that when a tiny 10 cent bump in prices could provide insurance for the entire fucking corporation that that has not already been given to the employees?

Oh, that's right, gotta pay for that golf course in Papa Douche's backyard. Of course. Way to care about your country. But you just keep trying to pretend like I am speaking out of the side of my neck about this. Biased sound bites, pfft. You obviously have not been paying attention in class. Wake up kid.

 

[Hayabusa Rider]

In some cases it's good to have a government regulating a market by laws. Health care is one of them.

Nixon did something like that and it didn't work out very well. Despite that no one has done more than invoke faith based arguments that have nothing to do with our situation, the flying spaghetti monster of heath care isn't going to save them and the US political system of the uneducated making complex decisions doesn't work I'd be wary of imbeciles with unlimited powers "fixing" things.

The politicians are too proud, their supporters too ignorant to care if it takes forethought to trust any of them.