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Thread: The health care debate thread.

  1. #61
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    Why chemotherapy that costs $70,000 in the U.S. costs $2,500 in India.

    The battle for how we pay for pharmaceuticals.

    Nothing new, but it highlights the gap between the U.S. and developing nations, and dives into how they are working to keep costs low.

  2. #62
    Living in the past ... FMCoug's Avatar
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    I have been thinking about this and had a thought which would make a big difference to all income earning taxpayers.

    Make all health care expenses 100% tax deductible. No limits, no phasing out based on income, etc. Include everything. Insurance premiums, co-pays, prescriptions, etc.

  3. #63
    That was a large part of John McCain's plan. He wanted to take away the deduction from employers and give it directly to the consumers. (Strictly speaking he wanted to give consumers a $5000 tax credit, but for most people in most years that would be preferable to a 100% tax deduction).

  4. #64
    Sam the Sheepdog LA Ute's Avatar
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    For those who saw the news stories about hospital pricing, this is a very smart breakdown of what really is happening.

    The Rest of the Story about Hospital Pricing

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  5. #65
    Sorta. Medicare actually tells the hospital what percentage of the charge they'll actually pay, and the hospital has to say ok.

  6. #66
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by Diehard Ute View Post
    Sorta. Medicare actually tells the hospital what percentage of the charge they'll actually pay, and the hospital has to say ok.
    Correct. But the hospitals, until now, have made up the difference by charging private insurance and health plans more. I think Medicare covers about 80% of the cost of care, Medicaid much less.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  7. #67
    Quote Originally Posted by LA Ute View Post
    Correct. But the hospitals, until now, have made up the difference by charging private insurance and health plans more. I think Medicare covers about 80% of the cost of care, Medicaid much less.
    Try 60%

    Medicaid is 40% or so in Utah.

    The reality is whatever Medicare sets their prices at is the starting point for negotiations with everyone else. The government is in control of a lot more than they want you to believe. (I worked in billing at the U before going to the force)

    Best paying "insurance" in Utah? Utah State Prison.

  8. #68
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by Diehard Ute View Post
    Try 60%

    Medicaid is 40% or so in Utah.

    The reality is whatever Medicare sets their prices at is the starting point for negotiations with everyone else. The government is in control of a lot more than they want you to believe. (I worked in billing at the U before going to the force)

    Best paying "insurance" in Utah? Utah State Prison.
    LOL. True in CA too. The inmates get very good care. And it's free!

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  9. #69
    Quote Originally Posted by Diehard Ute View Post
    Try 60%

    Medicaid is 40% or so in Utah.

    The reality is whatever Medicare sets their prices at is the starting point for negotiations with everyone else. The government is in control of a lot more than they want you to believe. (I worked in billing at the U before going to the force)

    Best paying "insurance" in Utah? Utah State Prison.
    one quibble... the best paying insurance is auto... meaning you get in an accident that requires health care due to the accident they pay 100% of charges.
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

  10. #70
    Quote Originally Posted by LA Ute View Post
    Correct. But the hospitals, until now, have made up the difference by charging private insurance and health plans more. I think Medicare covers about 80% of the cost of care, Medicaid much less.
    the problem with that statistic is "cost of care". Better way to explain it is Medicare pays about 26% of charges. Insurances around 34-35. Medicaid is 19-20
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

  11. #71
    Quote Originally Posted by Mormon Red Death View Post
    one quibble... the best paying insurance is auto... meaning you get in an accident that requires health care due to the accident they pay 100% of charges.
    Perhaps. But that is a rare instance. I worked in billing for 7 clinics in the hospital, all of which scheduled multiple inpatient stays a week, never once dealt with auto insurance.

    Even in the ER it's somewhat uncommon. I investigate a lot of accidents. Maybe 10% require treatment at a hospital

  12. #72
    Quote Originally Posted by Diehard Ute View Post
    Perhaps. But that is a rare instance. I worked in billing for 7 clinics in the hospital, all of which scheduled multiple inpatient stays a week, never once dealt with auto insurance.

    Even in the ER it's somewhat uncommon. I investigate a lot of accidents. Maybe 10% require treatment at a hospital
    about as often as prison care woudn't you say?
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

  13. #73
    Quote Originally Posted by Mormon Red Death View Post
    about as often as prison care woudn't you say?
    Nope. I saw prisoners several times a week. They were quite common.

  14. #74
    Quote Originally Posted by Diehard Ute View Post
    Nope. I saw prisoners several times a week. They were quite common.
    In California, state prison inmates get best of the best healthcare carte blanche. During the 5 years of my wife's cancer treatments I personally witnessed this. This was at Moores Cancer Center at UCSD, a top 50 center in the U.S. There were one or more of these prisoners EVERY time we went.

    Note that each inmate was transported by two paramedics; and two state guards, all of whom would accompany said inmates during every minute of every hour at the center. I can only imagine the cost. I spoke to many of the guards and paramedics. They were pretty put off that the inmates were afforded this level of care. Many of the prisoners were convicted murderers.
    Desse jeito, não tem jeito.

  15. #75

    The health care debate thread.

    Quote Originally Posted by San Diego Ute Fan View Post
    In California, state prison inmates get best of the best healthcare carte blanche. During the 5 years of my wife's cancer treatments I personally witnessed this. This was at Moores Cancer Center at UCSD, a top 50 center in the U.S. There were one or more of these prisoners EVERY time we went.

    Note that each inmate was transported by two paramedics; and two state guards, all of whom would accompany said inmates during every minute of every hour at the center. I can only imagine the cost. I spoke to many of the guards and paramedics. They were pretty put off that the inmates were afforded this level of care. Many of the prisoners were convicted murderers.
    In Utah all care for both the Utah State Prison and Salt Lake County Jail occurs at The University of Utah Medical Center.

    Now, they do take much of the basic care to the prison, and they do some consuls via video.

    The jail has nurses and doctors (on call), but serious things do come to the hospital.

    Inmates who are transported have 2 guards. This changed as I was leaving due to Curtis Algier killing his guard at a U clinic and leading SLCPD on a chase after.

    There are no medics.

    Healthcare for people accused or convicted is an interesting issue I see from the law enforcement side now. I have a lot to say, but can't.

  16. #76
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    Quote Originally Posted by LA Ute View Post
    For those who saw the news stories about hospital pricing, this is a very smart breakdown of what really is happening.

    The Rest of the Story about Hospital Pricing
    I guess I didn't catch the "rest of the story" portion of this.

    As he said, the Medicare pricing has been known for a long time. So nothing new there.

    The only bit of new information was an unsubstantiated prediction that as people ask for pricing information, the market will follow. Well, that is dependent on some provider making the first leap. Making that first leap doesn't necessarily lend itself to new customers as they will have relatively solid numbers on what it will cost at hospital A, whereas hospitals B, C, and D won't tell you. It could be more. It could be less. Either way, it is a total crapshoot and doesn't really help in decision making, and it probably doesn't help hospital A one bit as I believe the sticker shock from hospital A will probably drive them to B, C, or D, not knowing that the prices are just as high.

    Until a third actually mines this information and makes it public, it is rather pointless. Given HIPPAA regulations, the chances of this happening are pretty slim.

    Because of the discussion here, last month I tried asking Primary Children's how an endoscope procedure on my son would cost. They couldn't tell me. What do I do? Tell them no?

  17. #77
    Sam the Sheepdog LA Ute's Avatar
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    So does Congress want an Obamacare waiver?

    http://live.wsj.com/video/opinion-co...A-33C7E986F610

    Looks like some of them do.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  18. #78
    Quote Originally Posted by LA Ute View Post
    So does Congress want an Obamacare waiver?

    http://live.wsj.com/video/opinion-co...A-33C7E986F610

    Looks like some of them do.
    They already treat themselves better than the common folk employees. I'm sure they'll find a way to make their healthcare better too.

  19. #79
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by Diehard Ute View Post
    They already treat themselves better than the common folk employees. I'm sure they'll find a way to make their healthcare better too.
    Some have the right attitude. Richard Burr, one of North Carolina's senators: “I have no problems with Congress being under the same guidelines,” Burr said. “I think if this is going to be a disaster — which I think it’s going to be — we ought to enjoy it together with our constituents.”

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  20. #80
    Quote Originally Posted by LA Ute View Post
    Some have the right attitude. Richard Burr, one of North Carolina's senators: “I have no problems with Congress being under the same guidelines,” Burr said. “I think if this is going to be a disaster — which I think it’s going to be — we ought to enjoy it together with our constituents.”
    Just like the few (such as Matheson) who try to stop the yearly pay raise.

    Sadly they're few and far between

  21. #81
    Because the IRS will be in charge of enforcing Obamacare, this is something to worry about:

    http://www.courthousenews.com/2013/03/14/55707.htm
    "Ninety feet between home plate and first base may be the closest man has ever come to perfection." - Red Smith

  22. #82
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    Quote Originally Posted by Mormon Red Death View Post
    So Obamacare is going to cost a lot more than thought. Its nice that the hardest hit states are the ones who voted for Obama.
    So far, that does not seem to be the case.

    Obamacare premiums in California lower than predicted

  23. #83
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by U-Ute View Post
    So far, that does not seem to be the case.

    Obamacare premiums in California lower than predicted
    It's early yet.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  24. #84
    Sam the Sheepdog LA Ute's Avatar
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    There is more to the California story.

    Rate Shock and Awe in California

    I have to say I was surprised with the press reports last week that there wasn’t “rate shock” in California when the California exchange offered preliminary information about their new plans and rates. At least one prominent health actuarial group had predicted a 30% baseline increase in costs for California’s new health insurance exchange plans under the Affordable Care Act (ObamaCare”). As the director of the California exchange put it, “These rates are way below the worst-case gloom-and-doom scenarios we have heard.”


    But a few days later there is lots more information coming out and it would appear we have a case of apples to oranges to grapefruit. And, we have a pretty good case of rate shock....

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  25. #85
    Quote Originally Posted by LA Ute View Post
    There is more to the California story.

    Rate Shock and Awe in California
    So, because the new health law will outlaw many of the existing plans, it would seem that many won't be able to keep their existing plan. And folks may not be able to keep their doctor. More Obama lies. No surprise.

    And isn't it great that people will be denying consumers a choice? Wow! No wonder the jackasses who forced this on the American people are trying to find a way to opt out of it.

    And as if it wasn't enough, taxes will go up. Hooray nationalized health care!
    Last edited by GarthUte; 05-29-2013 at 04:03 PM.
    "Ninety feet between home plate and first base may be the closest man has ever come to perfection." - Red Smith

  26. #86
    Quote Originally Posted by San Diego Ute Fan View Post
    In California, state prison inmates get best of the best healthcare carte blanche. During the 5 years of my wife's cancer treatments I personally witnessed this. This was at Moores Cancer Center at UCSD, a top 50 center in the U.S. There were one or more of these prisoners EVERY time we went.

    Note that each inmate was transported by two paramedics; and two state guards, all of whom would accompany said inmates during every minute of every hour at the center. I can only imagine the cost. I spoke to many of the guards and paramedics. They were pretty put off that the inmates were afforded this level of care. Many of the prisoners were convicted murderers.
    Unfortunately, the mental health care in the California correctional systems is abysmal. I believe that the Los Angeles County Jail (?) is one of the largest mental health care providers in the USA and its mental health care system is notoriously bad. The MH care at the Utah State prison is inadequate and often when inmates act out, and the behavior is a product of their MI, they are placed in 23 hour lockdown at Uintah 1 and receive minimal mental health treatment. The Uintah units are the most secure units at the Draper prison.

  27. #87
    Quote Originally Posted by LA Ute View Post
    I listened to a presentation yesterday by a human resources/benefits consultant and can confirm that based on what he taught us, this guy is absolutely right:

    To sign up for Obamacare, start filling out the forms now and hire a good accountant

    As presently structured, on a consumer and employer level this is going to be a nightmare. I am hoping that pushback from the public will get the government to simplify the process. I am doubtful that my hopes will be realized.
    What seems to be missing from this thread is the discussion of the balance between a system that is less costly for those who can presently access it v. a system that is open to all that need it. Everything government costs money. The question is whether it is appropriate, and whether the cost meets the objective. I think everyone here feels that adequate health care is critical, and everyone should have access to it. As a number of you have pointed out, it is unclear whether it will cost much more than the legislation predicts. Given the incredible need, we should at least see whether or not it is cost prohibitive. The data from California is encouraging, if not complete. Medicare Part C was confusing as hell at first, and may still be so, but it is working, and I doubt there are many seniors who wish it was never created.

  28. #88
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by Irving Washington View Post
    What seems to be missing from this thread is the discussion of the balance between a system that is less costly for those who can presently access it v. a system that is open to all that need it. Everything government costs money. The question is whether it is appropriate, and whether the cost meets the objective. I think everyone here feels that adequate health care is critical, and everyone should have access to it. As a number of you have pointed out, it is unclear whether it will cost much more than the legislation predicts. Given the incredible need, we should at least see whether or not it is cost prohibitive. The data from California is encouraging, if not complete. Medicare Part C was confusing as hell at first, and may still be so, but it is working, and I doubt there are many seniors who wish it was never created.
    I have knowledgeable friends and colleagues (with deep health care industry experience) who are on both sides of Obamacare. A few think it is going to be wonderful, and a few think it will be a total disaster. The great majority in the middle seem to think it is a mess simply by virtue of its sheer size and complexity, and recognize that as presently designed it simply will not work. As Obamacare is implemented it will have to be tweaked in major and minor ways -- some of which we can anticipate now, and some of which we haven't even discovered yet. I'm in that middle group. We would be looking at big bumps in the road and hiccups anyway, with any policy change this massive, but in this case the outrageous way the legislation was written and enacted ensures even more of that. (That last sentence is my own opinion.)

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  29. #89
    More info on the cost of health insurance in California: http://www.forbes.com/sites/theapoth...ums-by-64-146/
    "Ninety feet between home plate and first base may be the closest man has ever come to perfection." - Red Smith

  30. #90
    I wonder if we're going to see more doctors do what this doctor has done in Maine.

    Prices for services provided.

    Of course, if one needs major surgery, is there some sort of catastrophic insurance to cover that kind of care available? I'm not familiar enough with all of this to know the answer, but I will admit that I like the idea of paying the doc out of pocket for services rendered.
    "Ninety feet between home plate and first base may be the closest man has ever come to perfection." - Red Smith

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