Plus ca change, plus c'est pareil...

About CA Single Payer (0.00 / 0)

Just wondering, how does the math add up? Aren't they always running out of money? Who would pay for it?

---

by: Legion @ Thu Mar 11, 2010 at 00:46:06 AM CST

well, as single payer is a cost saver, why couldnt they pay for it better than the current system? (0.00 / 0)

---

by: UplandPoet @ Thu Mar 11, 2010 at 05:15:49 AM CST

[ Parent ]

Single Payer SAVES Money and Lives (0.00 / 0)

Single Payer saves money in terms of the premium costs, the costs of care provided, and if for no other reason that a minimum of 20% of premium dollars off the top go to profit, shareholders, and non-medical expenses.

Single Payer, when implemented with medical checklists, saves lives, as there is an effective "bonus" in decreased complication rates, readmission rates, legitimate malpractice cases, and patient deaths. Further, administrative costs to facilities fall by about 90%.

In terms of business, it improves the economy because premium costs are fixed as a percentage without the unknown increases. Costs to employers are about a third of what they are under private insurance.

Pay for it? In reality, it pays for itself....

---

by: DocJess @ Thu Mar 11, 2010 at 05:58:13 AM CST

[ Parent ]

yep (0.00 / 0)

if it wasnt for the 20% profit, (or more), we might have it already, but when you threaten to take billions of ill gotten gain from very rich people, they tend to put up quite a fight

---

by: UplandPoet @ Thu Mar 11, 2010 at 08:27:18 AM CST

[ Parent ]

Profit (0.00 / 0)

Profit is only 4.40%

I don't know what the solution is, but the current bills going through congress are terrible and will hopefully never pass. All they seem to do is force people to buy private insurance. That will increase demand on services but do nothing to increase the supply which will increase prices all around. The intra-state monopolies will still exist. It's worse than what we have currently.

---

by: Legion @ Thu Mar 11, 2010 at 14:51:24 PM CST

[ Parent ]

Profit and adminstrative costs for PRIVATE HEALTH INSURANCE is 20% (0.00 / 0)

the govt run programs are at about 2%, if we switched tomorrow to 100% VA or Medicare reimbursement style system (single payer) the average american would have another 18% less of a monthly premium, or the company they work for, would have another 18% to try to either buy better coverage, or give the employee as paid compensation, or, at the very least be able to hire more employees, because we would not be competing with industries in other countries that are already saving that 18%.

of course there are a few hundred millionaires and a few thousand who are "only making six figure salaries off the illness and denial of coverage of premium payers who would be devastated, somehow, i dont really care about that last subgroup of americans, robber barons have never been my favorite people.

---

by: UplandPoet @ Thu Mar 11, 2010 at 17:53:18 PM CST

[ Parent ]

For me, these bills are not about lowering costs (0.00 / 0)

I don't believe there are ever any savings to be found off of eliminating profit. It sounds like it should work, but the profit incentive really does do wonders in increasing efficiency.

Unless, that is, the system is corrupt somehow--for example, if there's a cartel, which is what we've got.

But while the combination of greed and competition does pretty well at keeping costs down, it's terrible at ensuring fairness, minimum standards, and the like. Without government intervention, we'd have very cheap TV's, but they'd be hazardous, cause great environmental damage in production, and be made by people who are virtually slaves. (And yes, some of those problems are the case now--we need more government regulation in many places!)

One of the things we need is to impose some basic standards on the industry--no exclusions for pre-existing conditions, no recision, minimum standards in plans, etc..

The current bills manage those things, more or less, and they manage them without jacking up costs too far. I'm not convinced those bills will do much to "bend the cost curve down," but getting basic standards in place is a moral imperative. The costs will have to be addressed in another round.

The next step after this, I think, is to lift the anti-trust exemption. That's a prerequisite for anything like the public option to have a chance of being effective.

---

by: SarahLawrence Scott @ Thu Mar 11, 2010 at 20:45:16 PM CST

[ Parent ]

scott, the problem is we have the two systems now (0.00 / 0)

so we can compare, and while i have always bought the efficiency from profit line in the past, it doesnt apply hear, because in almost every state we have an effective monopoly, so there isnt the competition that is needed to keep the private system efficient. we know the govt run health insurance systems that cover nearly half of america already are very efficient and we know the private ones are very inefficient, so where's the problem?

if 85% of america is covered right now, either through a crooked monopolistic private system, or the govt system for fed employees, medicare, medicaid, va, and department of defense, and if we could save 18% by going to govt, then we cover 100 of americans, and have 3% of the money left over to fund better technologies or lower the national debt

---

by: UplandPoet @ Thu Mar 11, 2010 at 20:57:14 PM CST

[ Parent ]

Good point (0.00 / 0)

I like that way of framing it. Medicare, Medicaid, VA, DOD, etc. do health care more cheaply than the cartel. I think that's better than focussing on the profit per se.

Really, I think the 18% underestimates what the crooked monopolistic system is costing us, because of all the crazy kickbacks and deals that are associated with it.

Think about it in terms of political messaging. Suppose someone came along and offered you a new cell phone carrier that was 18% cheaper, or to swap your car for one with 18% lower payments, or your kid's college for one with 18% lower tuition. Unless you're in financial difficulties, that's probably not quite enough to get you to switch, assuming you're satisfied with whatever you've got now.

There are other, very good, arguments for single payer, but I don't think 18% is going to sell many people who aren't already sold.

---

by: SarahLawrence Scott @ Fri Mar 12, 2010 at 02:29:34 AM CST

[ Parent ]

Wow, 18% cheaper would mean a lot to a lot of people for a lot of things (0.00 / 0)

I think an 18% discount on a $1000/month health insurance premium would be welcome by most people. (or how about an 18% raise in salary? or an 18% reduction in taxes?)  I'd happily take an 18% discount on almost anything if all other things were equal. It surprises me, Scott, that you don't think that would sway anyone.

---

by: Etucson @ Fri Mar 12, 2010 at 19:05:25 PM CST

[ Parent ]

18% is borderline for people voting with their feet (0.00 / 0)

Which of the following would you do for an 18% savings, assuming you're otherwise happy with what you currently have?

--Move

--Change schools/colleges

--Change cell phone providers

--Change cable/satellite providers

--Change jobs (18% raise in this case)

--Change doctors

--Swap cars

--Switch brands of breakfast cereal

--Switch car insurance companies

18% is borderline for motivating behavior in those areas. There's more to satisfaction than just cost, and switching always runs the risk of things getting worse in some unanticipated way. That's why people quite reasonably  will stay at a job they like even when they have a chance of making more elsewhere, for instance.

Supporters of health care reform are mostly in it for reasons other than cost: access, or security, or fairness, for instance. If any of you reading this support health care reform primarily because you think it will save you 18%, please chime in!

---

by: SarahLawrence Scott @ Tue Mar 16, 2010 at 18:01:04 PM CDT

[ Parent ]

Lowering Costs (0.00 / 0)

One of the best ways to lower hospital costs is to use the checklist system used by Geisinger: MUCH cheaper costs, and MUCH better outcomes. Post on that here: http://www.demconwatchblog.com...

And don't forget the monopoly problem: http://www.demconwatchblog.com... With stats like those shown on the map and related table, anti-trust is not the problem, "the deal" is the problem.

None of the existing legislations directly affect costs EXCEPT Single Payer...but a robust public option would EFFECTUALLY lower costs as more hospitals would adopt the Geisinger system.  

---

by: DocJess @ Fri Mar 12, 2010 at 03:15:33 AM CST

[ Parent ]

"The deal" (0.00 / 0)

Wouldn't "the deal" violate anti-trust laws if there wasn't an exemption?

---

by: SarahLawrence Scott @ Fri Mar 12, 2010 at 07:07:12 AM CST

[ Parent ]

Not exactly... (0.00 / 0)

You're a company that wants to buy health insurance for its workers. Two companies offer you policies that are virtually identical, but one company costs half the price of the other one. Which would you choose? All else being equal, the cheaper one, of course.

If you are a hospital and an insurer says to you that they will drop you from their program unless you agree to their reimbursement rates, that has nothing to do with anti-trust, that's just basic extortion.

So long as that insurance company can pay lower reimbursement rates, it can charge lower premiums. Anti-trust doesn't affect it -- "anti-trust" involves collusion between competitors.

And the cycle continues. No one has yet been able to give me a clear and detailed enough explanation of how anti-trust reform improves "the deal" problem.  

---

by: DocJess @ Fri Mar 12, 2010 at 08:14:23 AM CST

[ Parent ]

tmess2? (0.00 / 0)

Can you help us out here, tmess2?

I know antitrust can also be used for "anti-competitive practices," and that includes some issues like this. Microsoft, for instance, got in trouble be making computer manufacturers who wanted to include Windows cheaply also feature things like Explorer. That's not collusion between competitors, it's also a kind of extortion.

But I know very little about the law in that area, and so await enlightenment. :)

---

by: SarahLawrence Scott @ Fri Mar 12, 2010 at 10:21:03 AM CST

[ Parent ]

Antitrust (0.00 / 0)

Antitrust isn't my expertise but my memory with Microsoft is that anti-trust law contains some restrictions on add-on type deals (am trying to recall the legal term but it's not coming to me).

Microsoft's violation was using their market advantage in the operating system to require people to include explorer, outlook, and microsoft word as software on their computers.

In the insurance industry, it would be like requiring people who wanted to purchase health care insurance to also have to buy auto insurance and fire insurance from the same company at the same time.  You could still go out and buy your preferred auto coverage elsewhere but your basic auto coverage from Blue Cross would be included in the price for your health insurance.

---

by: tmess2 @ Fri Mar 12, 2010 at 19:37:03 PM CST

[ Parent ]

good to hear from you again (4.00 / 1)

---

by: UplandPoet @ Thu Mar 11, 2010 at 05:14:54 AM CST