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Yep. The high cost of medical care is probably the biggest single piece of the problem. As far as why it is so absurdly high, there are various pieces to that.
Tort reform would be a start, but that will never get passed with all the lawyers in Congress.
It makes absolutely no sense whatsoever for retirees to purchase their own health insurance. Because of the increased use of medical care with advancing age, insurers either do not write such coverage or write it at a price that only the truly rich can afford. That is why MarkG and I (and others) keep talking about strengthening and preserving Medicare. It's mighty odd that you claim to be in favor of the little man and little woman, yet you now advocate ending Medicare, which would cause untold suffering for everybody in this country age 65 and above except the rich! Has Donald Trump now added you to his payroll?
People would not be just starting to purchase their insurance at retirement age, they would have starting purchasing their insurance at a young working age just like we purchase LTC ins, home ins, life ins. The federally funded programs for the really economically poor and disabled indiviudals would be there, especially for those full retirement age (70, as we seem to be aiming for) who fall below the poverty level. Everyone else purchases their own, as those who retire early before Medicare age have to. People just have to be sure that they plan, with their pension and other retirement income, to include the premiums in their monthly expenses. Look, how long can Medicare continue to pay 80% of my or your medical expenses over the course of 20 or 30 years, on the measly $115/month we will pay into it? With the enormous wave of boomers arriving at old age, the Medicare program is clearly going to go bankrupt. There are many people who have expressed disdain for the program, and these are the ones who are no doubt able to pay for private insurance. Why not let them? And by doing so take those millions off the Medicare program? IMO now, "Medicaid" should become "Medicare"....for the genuinely poor, disabled, and very low income seniors, whatever age. They will not be "left behind."
Tort reform would be a start, but that will never get passed with all the lawyers in Congress.
Before I get started here. I want to add a disclaimer. I am attorney. In my my distant past, I did handle three or four malpractice cases. The last malpractice case I've had was seventeen years ago. I gave up taking these cases because they can be extraordinarily difficult. They are always expensive to pursue and the results--even in the good cases--can be extremely unpredictable.
Tort reform would have virtually zero affect on health care costs.
Why is that? For the simple reason that solid evidence exists through reports from the Congressional Budget Office (CBO) that all medical malpractice costs (insurance premiums of doctors, costs of lawsuits, and the cost of "defensive medicine") add somewhere between 1% to 2% annually to healthcare costs. I don't want minimize this. Healthcare is so bloated in this country that even a 1% cost reduction would probably be $10 billion. However, the problem is that healthcare costs increase an average of 6 percent to 8 percent per year. Given that steep increase in costs, no one would even realize a one to two percent reduction had occurred.
Now, keep in mind that to get that 1% to 2% reduction in healthcare costs that you'd have to virtually eliminate the entire tort system in malpractice claims. What would this mean for the average patient or consumer? It would mean there would be absolutely no external controls on the practice of medicine when it comes to quality. The only controls on the quality of medicine would be from within the system. I imagine you'd still have physician peer review. I also imagine you'd have situations where physicians had their privileges revoked by hospitals. However, does this remind you of the old proverb "don't let the fox guard the henhouse?"
The old argument that tort reform would substantially reduce health care costs has been made almost ad nauseam. What is missing from virtually every one of these arguments is facts or statistics that would support it. The study that I have quoted below from the Congressional Budget Office thoroughly analyzes this problem. I doubt anyone can scream "its invalid because the democrats did it" or some such, because if you remember your history in 2004, when this report was released, the republicans were in control of both houses of Congress.
What we really need to be able to do is ask WHY healthcare costs are so high in this country. If its not the tort system than what is it? I think its a function of several things:
1. America is the center of high technology and every technology that has been developed is applied to healthcare. We've moved far beyond CT scans and MRI scans. We now have PET scans. Healthcare is nowadays "technology driven". Technology driven industries are costly.
2. High salaries for the people who work in the healthcare field. I had a brother-in-law who was earning approximately $400,000 a year as an orthopedic surgeon. The guy owned a 5,000 acre ranch in addition to his home. Even nurses salaries are high. Nurses working in critical care may earn as much as a $100,000 a year. One person earning that much would be nothing. Multiply that across every city and town in this country and you have a healthcare system that is consuming every resource in its path.
3. An aging population. Older people require more healthcare than younger people. 'Nuff said there'.
4. Pharmaceutical companies that are just out of control. One of the worst things that probably ever happened was allowing these companies to engage in "direct-to-consumer" marketing. All those commercials on t.v. telling consumers that viagra is better than levitra do nothing, but drive up costs. The advertising must be paid for. Consumers nag their doctors for products they know nothing about. Doctors cave in and give the patient what he wants just to get him out of the office.
5. A system or reimbursement centered on "for profit" private health insurance. Administrative costs and profit typically consume somewhere between 10% and 20% of all insurance premiums paid.
Eventually, if healthcare costs are to be contained we can go two routes:
1. The free enterprise model where the solution is to let millions of people who can't afford healthcare system die or do without; or
2. We can ration healthcare. This is what I advocate because its the fairest and most equitable solution to the problem.
If you believe that malpractice costs are responsible for much of the increase in healthcare expenditures than please read this article carefully. Make your decision based on evidence and not based on what you hear down at the "coffeeshop".
I don't think anyone has actually visited the subject of what the doctors charge versus what the insurance actually pays. We frequently get blood work done - earlier this year my blood work for a single visit amounted to $2100. Our insurance paid something like $200 and we paid around $12 - that was our total cost. I am not on Medicare but my husband is - we both have Blue Cross insurance.
I guess if someone without insurance has that some blood work done, they would have to pay the full $2100. But the lab was willing to settle for $212 (I understand that there is an agreement between some doctors/medical groups and insurance companies as to a payment scale). We notice a substantial disparity between what is charged versus was is actually paid on all medical bills and statements that we receive.
No one is picking up the tab - this payment agreement is based upon a contract between the insurance company and the service provider - I am simply pointing out that the example I gave is what the doctors/labs are willing to settle for based on a contractual agreement. My dental insurance works the same way. The high fees charged by doctors that everyone is talking about are not always what is ultimately paid because of contractual agreements between the service provider and the insurance companies - which is great when you have good insurance - not great when you don't.
I don't think anyone has actually visited the subject of what the doctors charge versus what the insurance actually pays. We frequently get blood work done - earlier this year my blood work for a single visit amounted to $2100. Our insurance paid something like $200 and we paid around $12 - that was our total cost. I am not on Medicare but my husband is - we both have Blue Cross insurance.
I guess if someone without insurance has that some blood work done, they would have to pay the full $2100. But the lab was willing to settle for $212 (I understand that there is an agreement between some doctors/medical groups and insurance companies as to a payment scale). We notice a substantial disparity between what is charged versus was is actually paid on all medical bills and statements that we receive.
We have a PPO insurance plan not an HMO.
I wonder what the response would be if the health care provider billed $212 to start? Since the insurance company only paid about 10% of the $2100, would they offer to pay only $21 (10%) if the more realistic $212 were billed? Currently, there is no logical or fair relationship between actual cost and amount reimbursed.
1. America is the center of high technology and every technology that has been developed is applied to healthcare. We've moved far beyond CT scans and MRI scans. We now have PET scans. Healthcare is nowadays "technology driven". Technology driven industries are costly.
2. High salaries for the people who work in the healthcare field. I had a brother-in-law who was earning approximately $400,000 a year as an orthopedic surgeon. The guy owned a 5,000 acre ranch in addition to his home. Even nurses salaries are high. Nurses working in critical care may earn as much as a $100,000 a year. One person earning that much would be nothing. Multiply that across every city and town in this country and you have a healthcare system that is consuming every resource in its path.
3. An aging population. Older people require more healthcare than younger people. 'Nuff said there'.
4. Pharmaceutical companies that are just out of control. One of the worst things that probably ever happened was allowing these companies to engage in "direct-to-consumer" marketing. All those commercials on t.v. telling consumers that viagra is better than levitra do nothing, but drive up costs. The advertising must be paid for. Consumers nag their doctors for products they know nothing about. Doctors cave in and give the patient what he wants just to get him out of the office.
Most nurses do NOT make 100,000/year. And, to cut nurses salaries from what they are is really asking for trouble. You don't want the barely competent working anywhere in a hospital, let alone ICU. Good people require good salaries. And, good RN's are the backbone of hospitals--much of health care. Without that, the system would deteriorate faster than I can say Jackrabbit.
Do agree pharm. companies are beyond out of control. The drug commercials are such manipulations and for that type of person who looks to a commercial rather than their health care provider, wow, a mine field. And, for the hypochondriacs the same.
Physicians ought to be paid well--they go to school many years--but not at the rip off rate now. Like I said earlier, everytime they come into your hospital room to say "hello", it's a minimum of hundreds of dollars. ANd, add up 5-6 hello's/day (example, primary, cardiologist, cardiac surgeon, inf. control doc. and throw in maybe a hematologist and liver guy from all of the side effects you get from the strong meds).
Collaborative, ego-less medicine is the way to go, but American physicians and the AMA will never allow it. Also, integrative medicine thats been researched is a less expensive ways to help people, but docs make no money that way.
Last edited by Nanny Goat; 09-25-2011 at 09:19 AM..
People would not be just starting to purchase their insurance at retirement age, they would have starting purchasing their insurance at a young working age just like we purchase LTC ins, home ins, life ins. The federally funded programs for the really economically poor and disabled indiviudals would be there, especially for those full retirement age (70, as we seem to be aiming for) who fall below the poverty level. Everyone else purchases their own, as those who retire early before Medicare age have to. People just have to be sure that they plan, with their pension and other retirement income, to include the premiums in their monthly expenses. Look, how long can Medicare continue to pay 80% of my or your medical expenses over the course of 20 or 30 years, on the measly $115/month we will pay into it? With the enormous wave of boomers arriving at old age, the Medicare program is clearly going to go bankrupt. There are many people who have expressed disdain for the program, and these are the ones who are no doubt able to pay for private insurance. Why not let them? And by doing so take those millions off the Medicare program? IMO now, "Medicaid" should become "Medicare"....for the genuinely poor, disabled, and very low income seniors, whatever age. They will not be "left behind."
It doesn't matter at what age people start purchasing their health insurance, because as we get older the premiums go up - not up a little bit but up astronomically. You can't compare this to home insurance or car insurance. Just because Medicare is facing a financial squeeze does not mean everything is hopeless. And the funding comes not only from the monthly Part B premium we pay but also from the FICA taxes which pay for Part A. So the whole system is running on much more than the "measly $115/month". Your advocacy of an all or nothing approach seems bizarre to me (doing away with Medicare except for the documented poor). The present system can be tweaked and still made to work, even if the senior entitlement fanatics squeal like stuck pigs that they may have to pay a little more. It may come down to paying a little more or paying so much more that we cannot afford medical care at all, which is what you are advocating even if you don't realize it. Your theoretical plan for how things can work in the "free market" of health insurance has no connection to the real world.
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years, on the measly $115/month we will pay into it? With the enormous wave of boomers arriving at old age, the Medicare program is clearly going to go bankrupt. There are many people who have expressed disdain for the program, and these are the ones who are no doubt able to pay for private insurance. Why not let them? And by doing so take those millions off the Medicare program? IMO now, "Medicaid" should become "Medicare"....for the genuinely poor, disabled, and very low income seniors, whatever age. They will not be "left behind."
