Are you sick of health care threads yet?

[SFP]

It's interesting how someone supposedly reading the bill for herself will find the need to copy and paste scary stuff found on blogs and twitter as if these were her own personally drawn conclusions.

 

But I guess that's one way to get around board rules.

[Julie in Austin]

dangerdad, your comments apply nicely to a situation that is like what bairnmama describes. It doesn't apply too well to the kind of system I would propose, however. I gave examples to Alice of the kinds of things that would prevent the kind of overuse that concerns you. Further, I'm concerned that you are still not "hearing" me, because I have stated several times that I know cost of care would increase as people-who-can't-afford-it-now seek care. But other areas (such as gutting the insurance industry) could offset those costs.

 

Thanks for reasoned, rational comments. I'll take up another of your critiques in another post in just a minute.

 

And, FWIW, I completely agree with you that neglect of tort reform is a huge, huge mistake.

[Julie in Austin]

Another issue that dangerdad brought up: in reference to my (2), he wrote:

 

"From what I've read, only 2-3% of all health costs go to insurance companies."

 

You've made kind of a fun mistake here. The generally accepted figure for Medicaid's overhead is 2-3%. I am aware that some dispute that number, and, frankly, I haven't done enough research to know which side I agree with, but that isn't the issue.

 

The issue is what the overhead is for insurance companies. Recent articles in peer-reviewed journals indicate that 30-35% of our health care dollars go to insurance companies. Google it.

 

Which means that my original point, which was that we can recognize huge cost savings--enough to cover the currently uninsured--by getting insurance companies out of the game is valid.

[Elaine]

It's interesting how someone supposedly reading the bill for herself will find the need to copy and paste scary stuff found on blogs and twitter as if these were her own personally drawn conclusions.

 

But I guess that's one way to get around board rules.

 

I assume this is directed at me?

 

 

When I have something to say I direct it to the person instead of hiding behind sarcasm. But, you go right ahead and keep on belittling me, that says more about you than it does about me.

[SFP]

No, Elaine, you have a tendency to direct your post to the group and tell them you have me on ignore.

 

But as long as we're communicating with one another directly, have you read page 429?

[bairnmama]

dangerdad, your comments apply nicely to a situation that is like what bairnmama describes. It doesn't apply too well to the kind of system I would propose, however.

 

 

I bolded your words because I want to thank you for clarifying this for me. Sure, the kind of system you would propose might work great. I just have a problem with the kind of system the House is proposing in this bill. This bill says nothing about what kind of services will be considered "basic" services, just that the Commissioner (or he and his board) will have the power to decide that... after the bill is passed and we can do nothing about it. I can find no wording about limiting dr visits to only certain kinds of symptoms occuring together or for a certain length of time... which, although sounds great in theory, would itself lead to all kinds of problems as illnesses never quite present themselves the same way in every individual. Also, some individuals are much more susceptible to illnesses turning deadly quite quickly (immune suppressed and other conditions) and you run into having to provide exemptions for certain people. The paperwork on that and who qualifies for what reason would be almost impossible.

 

Also, the situation I described is already happening with a current govt run, single payor system and I have found nothing in the current proposed bill to persuade me that it will be run any differently. That's what scares me about the cost!

[Sara R]

For example, if your office person had said, "the govt health service will only pay for an office visit if your child has had it for 5+ days [or whatever a reasonable standard of care would be], or there are other symptoms, none of which you mentioned when I just asked you about them . . . so the office visit will be $150 . . . did you still want to come in?"

 

Same thing with the specialist: 'The health service covers the cardiologist visit when X, Y, and Z are present . . . since you don't have Z, the visit is $200 . . . did you still want me to schedule that?'

 

The downside I see in this system: micromanaging the need for health care would create a new bureaucracy. How big would the rule book have to be? How long would it take to write the rulebook? I imagine people would debate how high the fever has to be for how many days, with different standards for people of different ages, with or without diarrhea/vomiting, etc. How many hours would we have to pay for employees to learn the rulebook and communicate it to the patients? This seems like it would create a huge new non-productive "industry" within health care.

[Gretchen in NJ]

There already is abuse in the system and people do have tests and use services that are unneccesary because they are perceived as free when they never see the bill and the insurance pays for it. And it goes both ways, doctors order tests and patients request care that is expensive or unneeded. When things are "free" they are overused. When you have to pay for it yourself, suddenly a trip to the doctor for a cold or the flu doesn't seem so necessary. Setting price caps creates a shortage; supply and demand are irrefutable principles of economics. Using an uncomfortable procedure as the standard for not requesting unneccesary services is not a valid argument. If healthcare is perceived as free than people who tweek their back will go to the doctor when he can't really do anything more for you than you can do yourself with a hot pad and some aspirin. No one is going to go in for open heart surgery just because it is "free". That is a ridiculous and illogical argument.

 

We do not have a free market health care system and haven't since medicare, medicaid and HMO's entered the system. Even if you pay cash for your visit, your price is controlled by the insurance company because, in many cases, the doctor cannot charge you less than the insurance pays or the insurance then takes that price as the standard and pays the doctor less. There is no such thing as free. Someone, somewhere has to pay for it.

 

Centralized care is not going to provide you with any more information or better care than the current system. You will have one person telling you what's what, period. The answer is not to put a medical board in charge but to have an ongoing relationship with a family doctor that you trust and who knows you, and to do your own research and to have choices. If you don't trust the information you receive from your own local doctor, why in heaven's name would you trust a medical board run by the state or federal government? You are living in a utopian dreamworld if you believe a centralized system has your best interest in mind more than your local provider.

 

The solution to the financial problem is to have people pay for their own care. Health savings accounts are a good step in that direction. Where did we get the idea that medical care should be cheap or free? Unless you are indigent, in which case your family, church, or community should help you out, medical care is a matter of financial priorities in most cases. For people who have chronic or life threatening conditions, there are catastrophic care policies.

 

If health care is changed to a true free market system, the prices will come down.

 

Central planning never works, never has, never will and the socialists who answer with "well, we just haven't done it right yet" or "the right people haven't been in charge yet" are trying to sell you something.

 

There is no one in the US who has to go without medical treatment and a major percentage of the people without insurance have made that choice themselves. Statists are using a percieved crisis to make a power grab. Some people are honestly trying to help, but their help comes in the form of thinking you are to stupid to take care of yourself and they are more intelligent and better educated and just smarter and will take of you.

 

Life expectancy in other countries is not a valid arguement for centralized or government run health care. First, the difference in life expectancy for the 20 or so countries immediately above the US is statistically meaningless. The countries at the top of the list have significantly longer lives and healthier life styles in general and live longer lives even when they come to the US. The US has a high homicide/suicide/auto accident rate which factors into life expectancy averages. Averages are generally meaningless numbers anyway. If you don't die young from murder or accident, then your life expectancy is just as high in the US as in the countries with government care. And the long term life expectancy for cancer and other life threatening diseases is much higher in the US than other countries. Men with cancer in Europe have a 47% chance of living five years or more, while US men have a 66% chance. Most of the statistics come from the Natl. Center for Policy Analysis.

 

Finally, have you seen the costs? Even the government admits that the cost per citizen will go up, way up. Taxes to cover all of this will be through the roof and damage the economy as a whole. The tax, as most taxes are, will be regressive and affect the lowest levels of income the hardest. Have you seen the required taxes, premiums, and the penalties for not signing up? Common sense points to the fact that sending money to Washington, having them skim off their portion and then sending you back the portion they believe you are entitled to is going to be more expensive than keeping the money and using it locally. Central planning by bureaucrats is never more efficient or cost effective.

 

Yes, I do expect my (my, as in works at my request and for me) to read the bill and be completely familiar with every word of it and what it will do. If they are to busy, then they are passing too many bills and doing too many power lunches. As our good governor/senator Laxalt said, every time the congress is in session, you lose some of your liberty. Maybe they need to do less.

 

This whole business of so cavalierly giving away freedom, choice, and other peoples money really makes me sad for the direction this country is headed.

:iagree:I think would should go back to when HMO's entered the system and roll back that bill. That is when health care costs started to rise.

[Elaine]

No, Elaine, you have a tendency to direct your post to the group and tell them you have me on ignore.

 

 

 

What? I have no idea what you are talking about.:confused: I don't have you on ignore and I don't think that I ever said I did.

 

 

Oh, and p. 429 sounds an awful lot to me like euthanasia. You have to read the preceding information but, basically, if you get sick between your 5 year consultation appointment, AKA, end of life counseling, the government will help you decide how to end your life so that you are not a drain on society.

Edited July 23, 2009 by Elaine

[dangerdad]

The issue is what the overhead is for insurance companies. Recent articles in peer-reviewed journals indicate that 30-35% of our health care dollars go to insurance companies. Google it.

 

I was unable to find anything like this (despite much searching). Can you point to something specific?

 

 

I'd be interested to hear also what you have to say about the efforts of Massachusetts and Canada.

 

ETA: Also, it seems that you're more interested in the discussion of gov't health care generally, rather than HR 3200 specifically. Is that right?

Edited July 23, 2009 by dangerdad

[OHGrandma]

Alice, I appreciate your thoughts.

However, I think a well-designed single-payer system could compensate for some of the problems that you name--and actually do a better job of it than the current system does.

 

For example, if your office person had said, "the govt health service will only pay for an office visit if your child has had it for 5+ days [or whatever a reasonable standard of care would be], or there are other symptoms, none of which you mentioned when I just asked you about them . . . so the office visit will be $150 . . . did you still want to come in?"

 

Same thing with the specialist: 'The health service covers the cardiologist visit when X, Y, and Z are present . . . since you don't have Z, the visit is $200 . . . did you still want me to schedule that?'

 

To the larger issue, however: I think I glossed over an important part of this argument in my response to dangerdad: the best evidence that free health resources don't create endless consumer demand for health care would be found in every single one of the other industrialized countries--all of which have universal health care and in none of which is the national past time lining up outside the doctor's office for freebies.

 

The current medicare/medicaid system in place now, run by the gov't, is going bankrupt. It provides medical care for those below a certain income. I have first-hand knowledge of a doctor prescribing glasses for children because they profit more by doing so. If the gov't can't keep fraud out of the current system, how do they intend to keep it out of such a wide ranging system that is being proposed?

Currently the medicare tax is 2.9% of wages, and going broke. How much is this health care bill proposing to tax employers?

[theresatwist]

Just wait! It won't be long! LOL

 

This article, though, is full of fallacies.

 

One reason the US ranks high in infant mortality (although I did notice a number wasn't reported in the article) is that some countries only report "infants" as children who live past one-two years. The US counts all babies in our infant mortality rate. In other words, a country may lose many children under 1 year old, but it doesn't report them until the children are over 1 or 2 years old. (I hope I'm explaining this so it's easy to understand.)

 

Another fallacy: Guam is listed as a country that surpasses the US. Why wouldn't a US territory be counted as part of the US and not as a country? I mean, *many* US tax dollars are sent there, and many Guam residents are eligible for military health care, courtesy of the USA. As an aside, when we lived there 8 years ago, the public hospital didn't offer women epidurals.

 

It was 13.7 for Black Americans, the same as Saudi Arabia.

 

“It really reflects the social conditions in which African American women grow up and have children,†said Dr. Marie C. McCormick, professor of maternal and child health at the Harvard School of Public Health. “We haven’t done anything to eliminate those disparities.â€

 

This disparity could be because white women have more abortions. There are no numbers reported on who has abortions or why, so this argument is difficult to refute. And what are the *social* conditions that would cause a higher infant mortality rate? Isn't this article saying that infant mortality is related to health care? No, wait. "It's not that easy." My personal favorite from this paragraph..."We haven't done anything to eliminate those disparities." Really? Nothing, huh? hmmmmmm

 

The numbers that jumped out at me the most are the highest life expectancy, which is 83.5 years, and the US LE, which is 78 years. Not a HUGE difference. It may be when I'm 77years old, though. :)

 

I also wonder if our military was counted as part of this. We obviously have a very active military compared to, say, Andorra and San Marino.

 

I'm not as interested in what the article says about infant mortality rates as it does the elderly/ life expectancy. My lack of interest isn't because I don't think infants are important, but because as a nation we spend such a huge amount of money on healthcare in the very last years, months, and weeks of life. The question I have is whether we are getting as much medical bang for our buck as we could be in those last years of life. When other countries spend trillions less than we do and yet have very similar (slightly higher or slightly lower) life expectancy rates, to me, that points to a problem in our system.

 

As for the quote about African-Americans, while I agree with you that we've made some progress as a nation and that we should give credit where credit is due, the statistics do show that there are still huge differences in the amount and quality of care African-Americans receive compared to their white counterparts. I do think that disparity indicates that we are still not doing enough.

[BalanceSeeker]

The downside I see in this system: micromanaging the need for health care would create a new bureaucracy. How big would the rule book have to be? How long would it take to write the rulebook? I imagine people would debate how high the fever has to be for how many days, with different standards for people of different ages, with or without diarrhea/vomiting, etc. How many hours would we have to pay for employees to learn the rulebook and communicate it to the patients? This seems like it would create a huge new non-productive "industry" within health care.

 

Sara R, you are so right. I've had experience with micromanaging when I was head of triage for an HMO. I had a rule book, literally. It was a 300 page manual that addressed as many calls as they could imagine. People tried to book appts, and they would transfer the call to my triage dept. We were encourgaed to give them home-care advice when they really should be seen. I broke the rules so much by bringing them in to be seen that they were always lecturing me. You know why we had to ration? Because they took on SO MANY patients that they couldn't manage a decent patient to Dr. ratio. You CANNOT make health care decisions without seeing the patient!!!! How can a rule book or govt protocol know if this headache you state is the worst you've ever had in your entire life is a migraine or a subdural hematoma???? I didn't last but 18 months at that job because I felt like I did a huge disservice to my fellow man.

 

Our proposed system will not work unless we deal with the illegal population and the fact that they aren't contributing a dime to the system, yet the system is bleeding cash to take care of them. Other countries with UHC apparantly don't have the same problem we do, unless I'm completely misinformed.:leaving:

 

ETA: Obama made his intentions very clear tonight in his speech. He literally said, "I'll give you a very good example. Doctors are taking tonsils out because they will get paid more." By the grace of God, that reasoning had not gone into effect while my dd was having 10 second pauses in her breathing every night for a year, or else she would have serious health problems right now. "It could just be allergies" was the most ridiculous statement I've heard from this President, yet. Reminded me of my dark days working at an HMO. As far as I'm concerned, if I was ever on the fence, that statement alone would have sealed the deal for me.

 

I would trust an insurance company to sniff out fraud like unnecessary tonsillectomies over the federal govt ANY day.

Edited July 23, 2009 by BalanceSeeker

[Julie in Austin]

I was unable to find anything like this (despite much searching). Can you point to something specific?

 

 

I'd be interested to hear also what you have to say about the efforts of Massachusetts and Canada.

 

ETA: Also, it seems that you're more interested in the discussion of gov't health care generally, rather than HR 3200 specifically. Is that right?

 

I'm trying not to violate the board rules on linking to things, but this is one article: New England Journal of Medicine article titled "Cost of Health Care Administration in the Us and Canada." They put the US at 31% for insurance administrative costs.

 

I haven't read a lot about MA, but my understanding is that they really screwed up and what you have happen now is people buy into the system only when they have an impending need and then they buy out again. Obviously, insurance costs will go sky high in a system like that. But I haven't read much about it.

 

I can't point to anything I hate about what I know about Canada's program. They spend much less and get the same--or more--than we do on aggregate (not anecdotal data).

 

Re your ETA: as I said in the OP, I favor a single-payer system. The current legislation is not that. From what I can tell, the bill currently under consideration will do a good job getting everyone covered, but not nearly as good of a job controlling costs as they could if they were single-payer and had tort reform and other cost-cutting tweaks.

[Julie in Austin]

 

Our proposed system will not work unless we deal with the illegal population and the fact that they aren't contributing a dime to the system, yet the system is bleeding cash to take care of them. Other countries with UHC apparantly don't have the same problem we do, unless I'm completely misinformed.:leaving:

 

The Cato Institute, which is very conservative (libertarian), found that on the whole, immigrants pay more into the system than they take out (Simon, 1995).

[JWSJ]

The Cato Institute, which is very conservative (libertarian), found that on the whole, immigrants pay more into the system than they take out (Simon, 1995).

 

The past studies I've seen suggest illegal immigrants are a net drain on the system.

 

Can you provide a link to your information?

 

Thanks

[BalanceSeeker]

The Cato Institute, which is very conservative (libertarian), found that on the whole, immigrants pay more into the system than they take out (Simon, 1995).

 

Okay, I'll bite. How are illegals paying INTO the system if they're not paying taxes like the rest of us ? :001_huh:

[keptwoman]

Just wait! It won't be long! LOL

 

This article, though, is full of fallacies.

 

One reason the US ranks high in infant mortality (although I did notice a number wasn't reported in the article) is that some countries only report "infants" as children who live past one-two years. The US counts all babies in our infant mortality rate. In other words, a country may lose many children under 1 year old, but it doesn't report them until the children are over 1 or 2 years old. (I hope I'm explaining this so it's easy to understand.)

 

 

I've stayed out of this because this is not my fight, not my country. However I'd like to ask something. I've seen this claim SO many times in relationship to this argument. But the post you were answering to was referring to the life expectancy in modern European nations. Most of the nations with better infant mortality stats than the US are places like Europe, Australia, Britain, New Zealand. Do you REALLY think that 1st world countries are under-reporting infant mortality? Because I can categorically tell you that Australia, New Zealand, Canada and Britian call a still birth a still birth and everything else an infant death, and yes that includes very premature babies.

 

I'd really like to see proof of this claim, along with a list of countries it pertains to because I think most of them would have WORSE infant mortality rates than you anyway.

[dangerdad]

The Cato Institute, which is very conservative (libertarian), found that on the whole, immigrants pay more into the system than they take out (Simon, 1995).

 

A note here: Libertarian isn't the same as conservative. In fact, the party Libertarian line is open borders, allowing free flow of goods and labor. Therefore, it supports Libertarian philosophy to show that illegal aliens are a net positive. The Simon study you mention uses the term "undocumented" alien years before that term started being used commonly in the press, and the data it presents is from 1975.

 

Even the LA Times (which has a sob-story about illegal aliens every week it seems) reported a cost just to California of $4 to $6 Billion per year (with whatever is paid in taxes unknown). FAIR (a better study IMO, based on the methodology, etc.) estimates the current net cost of illegal immigration at $13.1 Billion / year. And that's just California.

 

(Side note: What board rule about links?)

[usetoschool]

I've stayed out of this because this is not my fight, not my country. However I'd like to ask something. I've seen this claim SO many times in relationship to this argument. But the post you were answering to was referring to the life expectancy in modern European nations. Most of the nations with better infant mortality stats than the US are places like Europe, Australia, Britain, New Zealand. Do you REALLY think that 1st world countries are under-reporting infant mortality? Because I can categorically tell you that Australia, New Zealand, Canada and Britian call a still birth a still birth and everything else an infant death, and yes that includes very premature babies.

 

I'd really like to see proof of this claim, along with a list of countries it pertains to because I think most of them would have WORSE infant mortality rates than you anyway.

 

I have been doing some looking around regarding this because it doesn't make sense to me and here is what I have found. Other modern countries report births the same way we do, as you said. The statistic is real but there are some reasons for it. Some of the reasons I have found are that the US has a high rate of teen pregnancy, especially among girls who are low income or minorities and these lead to high infant mortality. I was in Rotheram, England a couple of years ago and was shocked (!) by the high numbers of very young, single, women pushing around baby strollers. They have access to health care and the babies survive but, yikes, there were a lot of them. Nice example of how when things are free or subsidized they tend to be abused. No, I do not mean that the babies should die - it was just an observation about how many of them there are! Also, there is a high rate of mortality in in minority populations as a whole in the US. There are several reasons for it - poverty, lack of education, drug abuse, and lack of recognition of the need for prenatal care. There are prenatal clinics for poor women all over the place though, so lack of resources is not the problem.

 

Secondly, it seems that infertility treatment and all of its associated risks is much more common in the US than other countries and leads to higher risk pregnancies and more infant mortality.

 

Finally, the birth rate in the US is higher than most European countries so the number of deaths is, to some degree, proportionally higher.

[KidsHappen]

In fact, the party Libertarian line is open borders, allowing free flow of goods and labor.

 

 

Ok, can you please document this? I am a Libertarian and I don't recall any of our canidates being in favor of open borders. I don't know that I have ever heard this is the party line but it is possible that I missed something as this is not one of my top issues (in other words I might not have paid as close attention to this).

[dangerdad]

Most of the nations with better infant mortality stats than the US are places like Europe, Australia, Britain, New Zealand. Do you REALLY think that 1st world countries are under-reporting infant mortality? Because I can categorically tell you that Australia, New Zealand, Canada and Britian call a still birth a still birth and everything else an infant death, and yes that includes very premature babies.

 

I heard a story on this recently (it's a few years old, but it reached my attention in the last few weeks). It's from the US News & World Report

First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.

 

Infant mortality in developed countries is not about healthy babies dying of treatable conditions as in the past. Most of the infants we lose today are born critically ill, and 40 percent die within the first day of life. The major causes are low birth weight and prematurity, and congenital malformations. As Nicholas Eberstadt, a scholar at the American Enterprise Institute, points out, Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in weight at birth.

[Lovedtodeath]

I would trust an insurance company to sniff out fraud like unnecessary tonsillectomies over the federal govt ANY day.

I am one of the people who is getting belittled for choosing not to have insurance. The fact is that in the past when I have had insurance, they have somehow found a way to deny 90% of my claims. I have had about 6 different companies and only one was any good at all. I am not going to pay for insurance that is useless.

 

Okay, I'll bite. How are illegals paying INTO the system if they're not paying taxes like the rest of us ? :001_huh:

They do pay taxes. Wierd, I know. When they get a job, they submit their forged documents and the employer uses that to pull taxes out and send them in throughout the year. What the illegals don't do is file taxes at the end of the year. I know some illegals who are honest on their paperwork and others who claim that they have 10 kids when they have none.

 

(Side note: What board rule about links?)

Yes. It seems a lot has changed. Is there a new posting we should be aware of?

[dangerdad]

Ok, can you please document this? I am a Libertarian and I don't recall any of our canidates being in favor of open borders. I don't know that I have ever heard this is the party line but it is possible that I missed something as this is not one of my top issues (in other words I might not have paid as close attention to this).

 

From the Libertarian Party Platform, principle 3.4:

3.4 Free Trade and Migration

 

We support the removal of governmental impediments to free trade. Political freedom and escape from tyranny demand that individuals not be unreasonably constrained by government in the crossing of political boundaries. Economic freedom demands the unrestricted movement of human as well as financial capital across national borders. However, we support control over the entry into our country of foreign nationals who pose a threat to security, health or property.

 

(Emphasis mine)

 

Note that I'm not currently affiliated with any party, but the Libertarian philosophy is closest to my own. This kind of free flow of immigrants would only be possible after taxpayer-funded services were drastically curtailed.

 

(edit follows)

Before 9/11, the party statement was a bit more strident. As recent as July 2000, no provision for safety was mentioned, and the party called for abolishing the INS and Border Patrol. Here's what I found on the Internet Archive:

We hold that human rights should not be denied or abridged on the basis of nationality. We condemn massive roundups of Hispanic Americans and others by the federal government in its hunt for individuals not possessing required government documents. We strongly oppose all measures that punish employers who hire undocumented workers. Such measures repress free enterprise, harass workers, and systematically discourage employers from hiring Hispanics.

 

We welcome all refugees to our country and condemn the efforts of U.S. officials to create a new "Berlin Wall" which would keep them captive. We condemn the U.S. government's policy of barring those refugees from our country and preventing Americans from assisting their passage to help them escape tyranny or improve their economic prospects.

 

Undocumented non-citizens should not be denied the fundamental freedom to labor and to move about unmolested. Furthermore, immigration must not be restricted for reasons of race, religion, political creed, age, or sexual preference.

 

We therefore call for the elimination of all restrictions on immigration, the abolition of the Immigration and Naturalization Service and the Border Patrol, and a declaration of full amnesty for all people who have entered the country illegally. We oppose government welfare and resettlement payments to non-citizens just as we oppose government welfare payments to all other persons.

Edited July 23, 2009 by dangerdad
(July 2000 statement)

[KidsHappen]

From the Libertarian Party Platform, principle 3.4:

 

 

 

(Emphasis mine)

 

Note that I'm not currently affiliated with any party, but the Libertarian philosophy is closest to my own. This kind of free flow of immigrants would only be possible after taxpayer-funded services were drastically curtailed.

 

 

Thanks.

[Lovedtodeath]

Yes. It seems a lot has changed. Is there a new posting we should be aware of?

 

Pssst... dangerdad... I found the new rules ;)

[KidsHappen]

Yes. It seems a lot has changed. Is there a new posting we should be aware of?

 

In the political restriction post at the top of the the general board:

 

2. Links to outside sites, except for those to federal or state government web resources, will be deleted.

 

It has been this way since they lifted the political ban entirely.

[keptwoman]

I heard a story on this recently (it's a few years old, but it reached my attention in the last few weeks). It's from the US News & World Report

 

I heard a story on this recently (it's a few years old, but it reached my attention in the last few weeks). It's from the US News & World Report

Quote:

First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.

 

Infant mortality in developed countries is not about healthy babies dying of treatable conditions as in the past. Most of the infants we lose today are born critically ill, and 40 percent die within the first day of life. The major causes are low birth weight and prematurity, and congenital malformations. As Nicholas Eberstadt, a scholar at the American Enterprise Institute, points out, Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in weight at birth.

 

Thanks, that was interesting :) So yes, based on that some babies that are counted as a live birth in the US would not be counted in other countries. Not babies that are days or weeks old, but certainly some of the preemies. But .. but I wonder if the difference is actually between still births and "miscarriages" surely any baby that ends up in NICU would end up considered a live birth?

 

 

I have been doing some looking around regarding this because it doesn't make sense to me and here is what I have found. Other modern countries report births the same way we do, as you said. The statistic is real but there are some reasons for it. Some of the reasons I have found are that the US has a high rate of teen pregnancy, especially among girls who are low income or minorities and these lead to high infant mortality. I was in Rotheram, England a couple of years ago and was shocked (!) by the high numbers of very young, single, women pushing around baby strollers. They have access to health care and the babies survive but, yikes, there were a lot of them. Nice example of how when things are free or subsidized they tend to be abused. No, I do not mean that the babies should die - it was just an observation about how many of them there are! Also, there is a high rate of mortality in in minority populations as a whole in the US. There are several reasons for it - poverty, lack of education, drug abuse, and lack of recognition of the need for prenatal care. There are prenatal clinics for poor women all over the place though, so lack of resources is not the problem.

 

Secondly, it seems that infertility treatment and all of its associated risks is much more common in the US than other countries and leads to higher risk pregnancies and more infant mortality.

 

Finally, the birth rate in the US is higher than most European countries so the number of deaths is, to some degree, proportionally higher.

 

Thanks. It's interesting isn't it.

 

As for the teen pregnancy thing, a quick Google brings up this:

http://www.nationmaster.com/graph/hea_tee_pre_percap-health-teenage-pregnancy-per-capita I don't know how accurate it is. It shows the US as the highest in the world. It is my understanding (and please correct me, I may well be wrong) that women who give their children up for adoption sometimes? get their birth/medical bills paid for by the adoptive parents. I wonder if the fact that many teens can't afford to pay the bills mean the adoption rate is higher there. I know for instance that in NZ that has a teen pregnancy rate not far below the US, it's very hard to adopt a baby because the mothers generally keep the baby. I wonder if part of the reason is that they are not facing health care bills for the pregnancy and birth. (and of course actually GET the pre-natal care because it's free) That's purely speculation on my part. Sorry, it's a bit off topic though.

Edited July 23, 2009 by keptwoman
because I never remember to preview

[Lovedtodeath]

 

It has been this way since they lifted the political ban entirely.

Thanks. You know what is funny? I didn't know that the political ban was lifted and was :001_huh: about these threads surviving at all. :lol:

[JWSJ]

They do pay taxes. Wierd, I know. When they get a job, they submit their forged documents and the employer uses that to pull taxes out and send them in throughout the year. What the illegals don't do is file taxes at the end of the year. I know some illegals who are honest on their paperwork and others who claim that they have 10 kids when they have none.

 

Most illegals work under the table. There are no taxes involved.

 

Illegals that FORGE documents/paperwork are NOT HONEST.

[Lovedtodeath]

 

Illegals that FORGE documents/paperwork are NOT HONEST.

LOL touche'

[JennC]

I agree with what you wrote above in every single case and market I can think of--except health care. The reason for that, as I stated in the OP, is that health care is a PITA, and no one would get "extra" just because it is free.

 

Do this thought experiment: if you are up-to-date on your screenings, and your doctor was offering free colonoscopies today, would you go get one just because it was free?

.

 

 

I am not trying to assume anything about your position in life. However, had you lived in the public assistance HUD housing where I did live when ds was 1-4 years old, I do not think you would hold this belief. People WILL go in for treatment "just because it's covered." Medicaid covered EVERYTHING, and if you weren't sure - "heck, just go to the ER."

For those of you with employee health plans at work: How many of you know people who had 10 different appointments in December because "the insurance pays for 1 a year in all ten categories?"

I tend to disagree with you all on most points in regards to health care.

[JennC]

 

 

For example, if your office person had said, "the govt health service will only pay for an office visit if your child has had it for 5+ days [or whatever a reasonable standard of care would be], or there are other symptoms, none of which you mentioned when I just asked you about them . . . so the office visit will be $150 . . . did you still want to come in?"

 

Same thing with the specialist: 'The health service covers the cardiologist visit when X, Y, and Z are present . . . since you don't have Z, the visit is $200 . . . did you still want me to schedule that?'

 

So you are advocating a receptionist having the authority to diagnose over the phone? Why not just have people make their appointments through their congressmen/women's outreach offices. Surely, those people have read the legislation, and know the requirements for when my 6 month old should be allowed to see a doctor.

[Lovedtodeath]

So you are advocating a receptionist having the authority to diagnose over the phone? Why not just have people make their appointments through their congressmen/women's outreach offices. Surely, those people have read the legislation, and know the requirements for when my 6 month old should be allowed to see a doctor.

 

Why not just set it up like private insurance? You go to the doctor and file insurance, everyone expecting that they will pay the bill, and 30-60 days later you find out that it was denied. This being about 60-80% of the claims (like private insurance) would save a ton of money.

[JennC]

Why not just set it up like private insurance? You go to the doctor and file insurance, everyone expecting that they will pay the bill, and 30-60 days later you find out that it was denied. This being about 60-80% of the claims (like private insurance) would save a ton of money.

 

This is why I appreciate my "personally chosen, not mandated, and paid for by ME" high deductible health plan. I pay a premium based on the fact the the insurance pays NOTHING until I reach $10,000. *I* decide when/whether my family sees the doctor of our choice and then *I* pay for it (with the money I save by not have a $900/mo premium for an insurance plan that pays 60% of what they deem necessary and usual after I reach a certain deductible on the first tuesday after a full moon.)

Now under universal/obamacare/whatever-they-call-it, I will possibly not have this choice any more, but should I choose to try to continue to be in charge of my family's health care, I can pay a penalty to the US government in the form of a tax, so I can get 'free' health care (because we would probably qualify with under 300 percent of poverty as income) where the receptionist will decide whether or not my child should be seen by a doctor. Yeah, sign me up.

 

Sorry (somewhat) for the tongue in cheek sarcasm. I am really tired of being "told" by the most corrupt group of people in America telling me that they can manage my life better than I can. I am not the only one - Congress currently has a 22% approval rate. Think: fannymae, acorn, aig, gm, citigroup, etc., and then think "Wow, congress, who didn't even read the bill (although now I find out here that they're not even supposed to) can do such a great job at _________________"

 

Now, lovedtodeath, it is late and I an being somewhat thick. Were you slamming me?:001_huh:

[dangerdad]

I'm trying not to violate the board rules on linking to things, but this is one article: New England Journal of Medicine article titled "Cost of Health Care Administration in the Us and Canada." They put the US at 31% for insurance administrative costs.

 

Having read the article now, I have some objections to their methods. In particular:

In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable.

Pharmacy costs dominate the total health care costs in our family. Without even a first-order estimate of total costs including pharmacy, that's a big flaw in the study.

We calculated the administrative costs of U.S. physicians by adding the value of the physicians' own time devoted to administration to estimates of the share of several categories of office expenses that are attributable to administrative work. We determined the proportion of physicians' work hours devoted to billing and administration from a national survey and multiplied this proportion by physicians' net income before taxes. We calculated the costs of administrative work by nurses and other clinical employees in doctors' offices by assuming that they spent the same proportion of their time on administration as did physicians. We calculated the value of this time on the basis of total physicians' revenues and survey data on doctors' payroll costs from the American Medical Association. We attributed all of physicians' expenses for clerical staff to administration. Although administrative and clerical workers accounted for 43.8 percent of the work force in physicians' offices (unpublished data), we attributed only one third of office rent and other expenses (excluding medical machinery and supplies) to administration and billing. Accounting, legal fees (excluding the cost of malpractice insurance), the costs of outside billing services, and other such costs are subsumed in "other professional expenses," half of which we attributed to administration.

 

I've bolded the statements I have concerns with. But a biggie is:

Both nations' figures exclude insurance-industry personnel.

 

So the big question is whether the study 1) makes good assumptions, and 2) is measuring what we think it's measuring.

 

One reply to the study (from a Harvard Ph.D.) objects to the omission that "the Canadian single-payer system results in chronic shortages of medical services because of underfunding. The underfunding problem is usually considered to be a separate issue from the single-payer system itself, but the very structure of the single-payer system may cause the problem."

 

The Canadian model spends less (in this study) percentage on administration, but also dramatically less per-capita (57% according to the authors of the study) on total care (I wonder how this would change if retail pharmacy was considered). The result of the model is a massive shortage of care, resulting in rationing and excessive wait times (the "Waiting Your Turn" angle).

 

 

There are so many conflating factors, I don't think one can conclude that a single-payer system is objectively better. Many of the changes you advocate could be implemented right now without shifting the whole system. Then (after tort reform for one thing!) we could reevaluate the situation.

[funschooler5]

I am one of the people who is getting belittled for choosing not to have insurance. The fact is that in the past when I have had insurance, they have somehow found a way to deny 90% of my claims. I have had about 6 different companies and only one was any good at all. I am not going to pay for insurance that is useless.

 

 

Thanks for posting this...I thought I was the only one.

[Alice]

However, I think a well-designed single-payer system could compensate for some of the problems that you name--and actually do a better job of it than the current system does.

 

For example, if your office person had said, "the govt health service will only pay for an office visit if your child has had it for 5+ days [or whatever a reasonable standard of care would be], or there are other symptoms, none of which you mentioned when I just asked you about them . . . so the office visit will be $150 . . . did you still want to come in?"

 

Same thing with the specialist: 'The health service covers the cardiologist visit when X, Y, and Z are present . . . since you don't have Z, the visit is $200 . . . did you still want me to schedule that?'

 

 

I'm not sure if this kind of thing is being proposed but it would help to hold down costs.

 

As a physician though, the thing that makes me cringe about these kind of ideas is that it removes the art of medicine. I know that things like checklists as described by Gawande and other forms of evidence-based medicine are proven to make doctors more effective and make less mistakes.

 

BUT...there is still a certain amount of judgment needed and the more rules and checklists we have to go by the more that gets removed.

 

Here's an example...I had a kid recently in the hospital with fever for 9 days and no real other symptoms. After talking to the parents it seemed that maybe he had some stomach pain (he was 2 yr so he wasn't able to clearly tell me). It was difficult to tell by exam as he screamed if I looked at him. But my gut feeling was that something was going on in his belly. He had already had an ultrasound that was negative but I ordered a CT scan. The scan showed that his appendix was enormous (the size of a hot dog) and consistent with appendicitis.

 

I could easily imagine a scenerio where I wasn't able to order that CT scan or it wouldn't be paid for if I did order it because it didn't meet criteria on a checklist.

 

I'm sure every doctor has stories of how they had a gut feeling about a patient that turned out to be right. Those are all anecdotal and like I've said before, don't make good broad policy. But I already feel that the system we have discourages me to use my judgment less and less and instead to follow a cookbook. A single-payer system doesn't necessarily mean that it will be worse, just someone different writing the cookbook.

 

That's probably my biggest hope with whatever health care system we have or end up with..that I'll still be able to look at a patient and make decisions based on my experiences and my judgment and what that individual patient's needs and desires are.

 

I realize that's not particularly helpful in solving a lot of the problems in health care. That's why I'm a doctor who practices medicine and not one who writes the policy.

[Renee in NC]

This is why I appreciate my "personally chosen, not mandated, and paid for by ME" high deductible health plan. I pay a premium based on the fact the the insurance pays NOTHING until I reach $10,000. *I* decide when/whether my family sees the doctor of our choice and then *I* pay for it (with the money I save by not have a $900/mo premium for an insurance plan that pays 60% of what they deem necessary and usual after I reach a certain deductible on the first tuesday after a full moon.)

Now under universal/obamacare/whatever-they-call-it, I will possibly not have this choice any more, but should I choose to try to continue to be in charge of my family's health care, I can pay a penalty to the US government in the form of a tax, so I can get 'free' health care (because we would probably qualify with under 300 percent of poverty as income) where the receptionist will decide whether or not my child should be seen by a doctor. Yeah, sign me up.

 

Sorry (somewhat) for the tongue in cheek sarcasm. I am really tired of being "told" by the most corrupt group of people in America telling me that they can manage my life better than I can. I am not the only one - Congress currently has a 22% approval rate. Think: fannymae, acorn, aig, gm, citigroup, etc., and then think "Wow, congress, who didn't even read the bill (although now I find out here that they're not even supposed to) can do such a great job at _________________"

 

Now, lovedtodeath, it is late and I an being somewhat thick. Were you slamming me?:001_huh:

 

What company do you have your policy with? I have looked in the past and even the $10K deductible policies were $575+ per month!

[OHGrandma]

.....

ETA: Obama made his intentions very clear tonight in his speech. He literally said, "I'll give you a very good example. Doctors are taking tonsils out because they will get paid more." By the grace of God, that reasoning had not gone into effect while my dd was having 10 second pauses in her breathing every night for a year, or else she would have serious health problems right now. "It could just be allergies" was the most ridiculous statement I've heard from this President, yet. Reminded me of my dark days working at an HMO. As far as I'm concerned, if I was ever on the fence, that statement alone would have sealed the deal for me.

 

I would trust an insurance company to sniff out fraud like unnecessary tonsillectomies over the federal govt ANY day.

As I keep telling people, this type of thing already happens under medicare/medicaid. I know of two children prescribed glasses needlessly, but the dr got paid more for doing it under medicare/medicaid. The gov't can't stop the fraud in the current system, why do people think it can do better by expanding the system?

[Lovedtodeath]

This is why I appreciate my "personally chosen, not mandated, and paid for by ME" high deductible health plan. I pay a premium based on the fact the the insurance pays NOTHING until I reach $10,000. *I* decide when/whether my family sees the doctor of our choice and then *I* pay for it (with the money I save by not have a $900/mo premium for an insurance plan that pays 60% of what they deem necessary and usual after I reach a certain deductible on the first tuesday after a full moon.)

Now under universal/obamacare/whatever-they-call-it, I will possibly not have this choice any more, but should I choose to try to continue to be in charge of my family's health care, I can pay a penalty to the US government in the form of a tax, so I can get 'free' health care (because we would probably qualify with under 300 percent of poverty as income) where the receptionist will decide whether or not my child should be seen by a doctor. Yeah, sign me up.

 

Sorry (somewhat) for the tongue in cheek sarcasm. I am really tired of being "told" by the most corrupt group of people in America telling me that they can manage my life better than I can. I am not the only one - Congress currently has a 22% approval rate. Think: fannymae, acorn, aig, gm, citigroup, etc., and then think "Wow, congress, who didn't even read the bill (although now I find out here that they're not even supposed to) can do such a great job at _________________"

 

Now, lovedtodeath, it is late and I an being somewhat thick. Were you slamming me?:001_huh:

Not at all! I was slamming insurance. :) I actually copied your post, as I would like to look into your plan...

 

What company do you have your policy with? I have looked in the past and even the $10K deductible policies were $575+ per month!

and I want an answer to this too!

[Colleen]

 

It's interesting how someone supposedly reading the bill for herself will find the need to copy and paste scary stuff found on blogs and twitter as if these were her own personally drawn conclusions.

Yes, it's a scare tactic: passing around such snippets, conveniently taken out of context) and inevitably conveyed in what I can only presume is Twitter shorthand.

 

[JennC]

Not at all! I was slamming insurance. :) I actually copied your post, as I would like to look into your plan...

 

and I want an answer to this too!

 

:)I shouldn't stay up so late. My high deductible insurance is through blue cross blue shield. It is about $150/mo for me and 5 children. My husband's policy is already mandatory from his employer in the sense that because they use the same company as I do, he cannot opt out of their plan and join us - though last year he was able to. Adding another adult would essentially double the amount (depending on age) because most of the premium is for the adult - not the children. I believe that in order to have the high deductible plan, one also must have a Health Savings Account. This is an account at the financial institution of your choice where you may deposit money pre-tax up to 5200 per year per family ($?). If you take this money out for any health related expense, you do not pay taxes on it. The money may also be used to pay the premiums of your high deductible insurance. Many banker do not know about this. A Lot do. IMO all families should have an HSA - the money is always yours, there is no use it or lose it, you determine what you pay with it. At retirement age there are different rules for withdrawing it - it is essentially an IRA.

 

If a person really wanted to fix health care this would be a good start. Just knowing that you pay for everything makes you shop around (we primarily use a CNP - nurse practitioner nowadays) for the best price, only get care when you need it, Get care when you do need it and not worry about going bankrupt should something disastrous happen.

With everyone doing this, doctors will eventually see that they must offer the best service at a good price to keep their customers. Consider LASIK surgery. Everyone used to go to Canada to get the surgery because it was miles cheaper - even with the trip (2x) expenses - and the care was good. Now doctors here said "Hmmm, if I want to keep these clients, I must lower my prices and provide great service." The local price has gone down about 80%.

If no insurance or government is negotiating a lower price, dictating the market, price will reflect cost and EVERYONE will pay the same. Now medicaid is billed amount a, insurance is billed amount b and joe no insurance is billed amount c - FOR THE EXACT SAME THING.

 

My son needed stitches in his lip after a bball accident - $500. Why? Thread? The PA's 20 minutes? The sterile needle ($4 btw)? No. Malpractice insurance and the fact that I just paid for the guy who won't pay his bill because he didn't have $500 for stitches. Why not just charge what the price - make it what it COSTS. (note please that I am all for doctors making a good living, but we all know this money (the$500) is not going to the doctor in the first place but to levels of bureaucracy)

NONE of this requires government intervention. I would venture to say that it what started this in the first place with Medicaid/Medicare -just -bill -them -to -the -moon- it's- the -government plans. What this requires is free market. Safety regulations might be fine and oversight against discrimination is good, but quit paying the clinic, doctor, lab, hospital, Fedex, and the parking guy for the same service that was done once by one person and prices will go down.

 

as an aside: do we really need a bridge from Las Vegas to LosAngeles?

 

ETA: It appears I have it backwards - In order to have an HSA, you must be covered by a High Deductible Health Plan. Which I would still recommend. Go to the link in OhGrandma's post

Edited July 23, 2009 by JennC
brain is faster than hands; brain is not too fast either

[Lovedtodeath]

Medicaid/Medicare -just -bill -them -to -the -moon- it's- the -government plans.

I used to bill the insurance companies, Medicare/caid and individuals and ITA

 

I thought that my employer had to be involved in the process of a HSA, which is why we don't have one. :glare: I would love to get my health care costs deducted from my income. That doesn't happen now. I was told that a HSA works the same way as insurance, in that there is a deductible and an approval process?

[JennC]

I used to bill the insurance companies, Medicare/caid and individuals and ITA

 

I thought that my employer had to be involved in the process of a HSA, which is why we don't have one. :glare: I would love to get my health care costs deducted from my income. That doesn't happen now. I was told that a HSA works the same way as insurance, in that there is a deductible and an approval process?

 

A High Deductible Insurance Plan is what you said and if your employer offers a health insurance plan, you may not opt out (in MT, anyway) to purchase your own HD plan from the same company. I seem to recall that we could have taken to whole family to a different company. Call a reputable insurance agent in your area or your favorite insurance company - they will know for sure.

A HEALTH SAVING ACCOUNT on the other hand is "just" a bank account.

An interest bearing, tax free bank account with preset deposit limits. You can have an HSA even if you just have traditional employer provided health insurance. Our local bank didn't have the information, so we had to find a bank that did. Many people use out of state banks that advertise their HSA's on the web. I prefer local convenience.

[Lovedtodeath]

A High Deductible Insurance Plan is what you said and if your employer offers a health insurance plan, you may not opt out (in MT, anyway) to purchase your own HD plan from the same company. I seem to recall that we could have taken to whole family to a different company. Call a reputable insurance agent in your area or your favorite insurance company - they will know for sure.

A HEALTH SAVING ACCOUNT on the other hand is "just" a bank account.

An interest bearing, tax free bank account with preset deposit limits. You can have an HSA even if you just have traditional employer provided health insurance. Our local bank didn't have the information, so we had to find a bank that did. Many people use out of state banks that advertise their HSA's on the web. I prefer local convenience.

So I can spend my money in a HSA on any medical expenses that can be counted on a tax return? And I can take the money out for the first $200 expense for an eye doctor appt? Sorry to be daft, but I was told differently, and want to make sure that I understand.

[OHGrandma]

I have an HSA. Here is a helpful website to answer questions about it. http://www.ustreas.gov/offices/public-affairs/hsa/faq.shtml

[JennC]

So I can spend my money in a HSA on any medical expenses that can be counted on a tax return? And I can take the money out for the first $200 expense for an eye doctor appt? Sorry to be daft, but I was told differently, and want to make sure that I understand.

 

From a qualified HSA you can pay for tylenol at Costco if you want. Keep your receipts and you can use it for any medical expense. I do not have a copy of the eligible expenses, but it includes dental, opto, ped, midwife, nurse pract., OTC, prescriptions for sure that I know of.

[Perry]

So I can spend my money in a HSA on any medical expenses that can be counted on a tax return? And I can take the money out for the first $200 expense for an eye doctor appt? Sorry to be daft, but I was told differently, and want to make sure that I understand.

 

 

Our HSA covered ANY medical expenses. We were told to put things like otc ibuprofen on the card.

[JennC]

I have an HSA. Here is a helpful website to answer questions about it. http://www.ustreas.gov/offices/public-affairs/hsa/faq.shtml

 

Thank you for this. I was wrong about everyone having one. I was sure I was right, but according to this you must be covered by a HD health plan. I will have to look into this, because my dh DOES have an HSA and he is not covered by a personal HD plan. He has an employer provided HD health plan.

I'm truly sorry for the misinformation, as I was not trying to be misleading, I'm also sorry that anyone cannot have one:D