Big vs Small Gov't [Derailed SurGen thread] - Page 12

On July 17 2009 01:30 zeppelin wrote:
Also, I really wish you had read the other posts. Your tax dollars are already paying for uninsured people to get healthcare through the ER. You would actually be spending fewer tax dollars if they got preventative medicine because it would greatly lower the risk of catastrophic illness.

What it really boils down to though, is that their will always be "rationing" in health care. It just depends on how you want to ration. In my opinion, it makes more sense to use a regulated free market system in which more productive members of society receive better care. It sounds callous and Darwinian, but compared to the arbitrary and, let's face it, ineffective yoke of a single payer system, it seems the lesser of two evils.

From the interview:
BILL MOYERS: Why is public insurance, a public option, so fiercely opposed by the industry?

WENDELL POTTER: The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so.

BILL MOYERS: Compared to the industry's--

WENDELL POTTER: They spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit. So they don't want to compete against a more efficient competitor.

BILL MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

For example, if one company's medical loss ratio was 77.9 percent, for example, in one quarter, and the next quarter, it was 78.2 percent. It seems like a small movement. But investors will think that's ridiculous. And it's horrible.

BILL MOYERS: That they're spending more money for medical claims.

WENDELL POTTER: Yeah.

BILL MOYERS: And less money on profits?

WENDELL POTTER: Exactly. And they think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that's what-- that is what happens, what these companies do, to make sure that they satisfy Wall Street's expectations with the medical loss ratio.

On July 16 2009 23:33 BisuBoi wrote:
The concept of free market cannot be applied to the health care industry. There is a simple reason for this.

Demand is inelastic!! You don't have a demand/supply curve when it's inelastic!! People pay anything for health care because it's life and death! Why don't republicans understand this??

On July 17 2009 03:18 Caller wrote:

You have got to be kidding me here.
People need food, but the curves for all food products sure as fuck is elastic.

This is basic economics. Stop generalizing off anecdotes.

On July 17 2009 03:25 Koof wrote:
you don't get in a food crash and need to go to the food hospital once in a while

it is very different

On July 17 2009 03:31 Caller wrote:

When do you buy groceries? During a sale or when you're all out of everything?
When would you rather go to the doctor? For a checkup to look for potential future problems or when you need to be resuscitated?

When do you think it's going to be more expensive for you?

On July 17 2009 03:45 Caller wrote:

You can have a random case of water flooding your food or a fire burning all of your food even with all of the food in the world.

Stop using anecdotal rhetoric to discuss something that will apply to more than an anecdotal person.

On July 17 2009 03:45 Caller wrote:

You can have a random case of water flooding your food or a fire burning all of your food even with all of the food in the world.

Stop using anecdotal rhetoric to discuss something that will apply to more than an anecdotal person.

On July 14 2009 07:17 Last Romantic wrote:

And honestly? An overweight person is to dictate to a morbidly obese nation on how to take care of itself?

On July 14 2009 07:39 broz0rs wrote:


I searched Google images after reading this comment. She's a little chub, but not that overweight.

The problem with the obesity issue isn't necessarily about weight, but it's about perception that people have against fat people. I don't see why we need a skinny person to carry this message.

Obviously, I don't know her position is on obesity, but imo an overweight person can deliver the message that being overweight isn't a bad thing, but very unhealthy if a person becomes obese.

There's going to be a long line that's going to make fun of her when she addresses the obesity issue, but if she can overcome this she'll be a great surgeon general. No small task of course.

On July 17 2009 09:29 Trezeguet23 wrote:

I agree with you that she can still be a spokeswoman against obesity, but the whole hypocritical nature of it will get to plenty of people, especially those that already have other beefs with her.

Foucault wrote:
At the same time I can see the obvious positives with universal healthcare, BUT the big question that many people don't seem to understand is whether or not the government should provide healthcare. Why should that be the government’s responsibility? Do we want to live in a society where our government takes care of us like children? No thanks.

The New England Journal of Medicine wrote:
A system with multiple insurers is also intrinsically costlier than a single-payer system. For insurers it means multiple duplicative claims-processing facilities and smaller insured groups, both of which increase overhead. Fragmentation also raises costs for providers who must deal with multiple insurance products — at least 755 in Seattle alone — forcing them to determine applicants’ eligibility and to keep track of the various copayments, referral networks, and approval requirements. Canadian physicians send virtually all bills to a single insurer. A multiplicity of insurers also precludes paying hospitals a lump-sum, global budget. Under a global-budget system, hospitals and government authorities negotiate an annual budget based on past budgets, clinical performance, and projected changes in services and input costs. Hospitals receive periodic lump-sum payments (e.g. 1/12 of the annual amount each month).

The existence of global budgets in Canada has eliminated most billing and minimized internal cost accounting, since charges do not need to be attributed to individual patients and insurers. Yet fragmentation itself cannot explain the upswing in administrative costs in the United States since 1969, when costs resembled those in Canada. This growth coincided with the expansion of managed care and market-based competition, which fostered the adoption of complex accounting and auditing practices long standard in the business world.

The article wrote:
People who disenroll from Medicaid or SCHIP programs as a result of programmatic changes are not likely to replace public program insurance with private commercial insurance, because it is unlikely that people who live near the poverty level will be able to afford the premiums that are associated with private commercial health insurance.

[...]

Most states make programmatic changes in their Medicaid/SCHIP programs in an effort to decrease their costs for these programs. However, this study demonstrates that programmatic changes that result in disenrollment actually increase the total health care costs for the community. Most of the health care costs for the uninsured are paid by federal and state governments through Medicare and Medicaid in the form of disproportionate share hospital adjustments and indirect medical education payments in addition to other federal programs, such as funding for community health centers and the Maternal and Child Health Bureau. Indeed, federal and state funds have been estimated to cover 87% of the total costs of uncompensated care.11 Potential savings from programmatic changes in Medicaid/SCHIP also are offset by increased Medicaid medically needy spending, increased tax subsidies to private insurance, and increased costs that are associated with uncompensated care.2 In a previous analysis of Medicaid disenrollment in an agricultural community, we concluded that 10% disenrollment would increase the number of uninsured children by 21% and increase the community’s health care costs as a result of a shift in sites of care from less expensive ambulatory office sites to more expensive [emergency department]s and increased hospitalizations.

Aegraen continues
Secondly, the average American is among the top .05% wealthiest people in the world, so of course it's going to be 'expensive' in comparison to outside the US.

You want to know how you cut down costs? You remove government impediment in the market. Quite frankly, I can't remember a time when government intervention into a market didn't result in disaster.

Not only that, most Americans are HAPPY with their current healthcare.

gchan wrote:
For costs, Europeans always tout that it's a feasible model, etc etc etc. Problem is we are picking up YOUR tab of the health costs. Your governments negotiate in bulk with insurance companies, pharmaceuticals, biotech companies to get below market rates which make it affordable over there. Where do you think these companies make up the lost revenue from EU markets? We pay for it. It's one of the primary reasons why our coverage is so much more expensive than you. If you don't believe me, take a look at the financials of the largest transnational pharmaceutical companies and biotech companies in the world. They all have a disclosure separating out US/international revenues and costs, and the US pays 3-10 times more than the rest of the world combined. This is particularly disturbing considering that almost all the technology is produced in the US and Singapore, which should mean we pay less than everybody else (logistically).

The Public Library of Science wrote:
From this new estimate, it appears that pharmaceutical companies spend almost twice as much on promotion as they do on R&D. These numbers clearly show how promotion predominates over R&D in the pharmaceutical industry, contrary to the industry's claim.

The alternative to this system where the US pays for the rest of the world's health care is a system where, like the EU countries, the US government negotiates in bulk against the insurance/biotech/pharmaceutical companies. But that would dry up all their potential profits and you would be looking at a virtual stagnation of private industry medical advancement...which would mean that the US government would have to also pick up the tab for all medical research.