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jstan
climber
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Mar 23, 2010 - 01:52pm PT
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If you check down through obituaries in the paper focussing on those over age eighty, you will find an oddly high proportion succumbed to pneumonia. My last surviving aunt at 99 1/2 died of pneumonia soon after entering hospital.
In order to obtain extended life through advanced/costly intervention, people of advanced age face a challenge in hospital that seems to exist only there.
The answer to the thorny question we are considering here may be provided
by nature herself.
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apogee
climber
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Mar 23, 2010 - 01:54pm PT
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tarek, if you are a single payer advocate ('through and through'), then you and I are both in the camp of having been practical idealists on the issue of healthcare reform. I share the same disgust that the current bill really isn't true reform like our country needs (no matter what the Repug soundbite fearmongering hacks like Steele & co. keep 'ramming down our throats'.)
There is 'ideal', and there is 'real'. Somewhere along the political process, the option of true reform (single payer/PO) fell by the wayside. It sucks, but it's true. Ultimately, we wound up with the diluted bill we have, that arguably contains the framework within which true reform might eventually come.
But even if it doesn't...let's go back about 3 weeks in time, after the first meltdown that made it appear that the entire HR process might go down in flames, a victim of the GOP's spin machine. If it had, it wouldn't have been picked up by any politician or POTUS for decades. After two utter Democratic failures (Clinton, Obama), that issue would be deemed radioactive, and not touched for generations (literally). Obama's presidency would have been neutered for the remainder of what would surely be his one term, with Romney, Palin, Huckabee and fattrad waiting in the wings.
What do you think should have been done at that time? Scrap the bill altogether because it didn't become exactly what you wanted? That would suit the GOP just fine.
I was pretty conflicted about what should be done with that bill in the last couple of weeks, and there was a strong part of me that wished to see it scrapped altogether. Having seen it pass, though, and now that the positive aspects of it are being heard in the media (why that didn't happen sooner is beyond me), I am glad that something passed, even if it's only 5% of the pie.
Since we both agree the bill is far less than what we would have liked, I'd be interested to hear what you thought should have been done with it in the last few months of it's development.
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Bob D'A
Trad climber
Boulder, CO
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Mar 23, 2010 - 01:59pm PT
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Apogee wrote: Since we both agree the bill is far less than what we would have liked, I'd be interested to hear what you thought should have been done with it in the last few months of it's development.
You really have to take this in a reality base content, not what the bill should or should not be.
Obama and Pelosi just accomplished no other president or speaker of the house could do...pass this type of health care reform.
That is a fact!!
It is a foundation to built upon and tweak as the years go by. I see a PO in the next year or two.
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apogee
climber
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Mar 23, 2010 - 02:00pm PT
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"Until you get tort reform and sensible rules, the costs will explode. This bill did nothing to correct the root issues."
fattrad, you are as much of a perseverating droid as any FauxNews Repug can be. (And I mean that in the kindest sense.)
The GOP just loves to hold up tort reform as the single silver bullet to the whole problem- it's an easy political strategy, since everybody hates lawyers, right?
Over and over it the facts have been placed in front of you about the real impacts that tort reform have on healthcare costs- while they do impact it, it is a very small driver of costs. You shouldn't believe me when I say that, though, but you'd think the CBO might be a source you'd consider, or even the GOP's precious Orrin Hatch.
Nope, you'd prefer to stick to your soundbite, not because it is factual, but because it has potential for political leverage. Weak.
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Bob D'A
Trad climber
Boulder, CO
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Mar 23, 2010 - 02:11pm PT
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Jeff/Fat...FYI
In my email box today!
Good afternoon,
Since the House of Representatives voted to pass health reform legislation on Sunday night, the legislative process and its political impact have been the focus of all the newspapers and cable TV pundits.
Outside of DC, however, many Americans are trying to cut through the chatter and get to the substance of reform with a simple question: "What does health insurance reform actually mean for me?" To help, we've put together some of the key benefits from health insurance reform.
Let's start with how health insurance reform will expand and strengthen coverage:
* This year, children with pre-existing conditions can no longer be denied health insurance coverage. Once the new health insurance exchanges begin in the coming years, pre-existing condition discrimination will become a thing of the past for everyone.
* This year, health care plans will allow young people to remain on their parents' insurance policy up until their 26th birthday.
* This year, insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. This year, restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need.
* This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool.
* In the next fiscal year, the bill increases funding for community health centers, so they can treat nearly double the number of patients over the next five years.
* This year, we'll also establish an independent commission to advise on how best to build the health care workforce and increase the number of nurses, doctors and other professionals to meet our country's needs. Going forward, we will provide $1.5 billion in funding to support the next generation of doctors, nurses and other primary care practitioners -- on top of a $500 million investment from the American Recovery and Reinvestment Act.
Health insurance reform will also curb some of the worst insurance industry practices and strengthen consumer protections:
* This year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.
* This year, discrimination based on salary will be outlawed. New group health plans will be prohibited from establishing any eligibility rules for health care coverage that discriminate in favor of higher-wage employees.
* Beginning this fiscal year, this bill provides funding to states to help establish offices of health insurance consumer assistance in order to help individuals in the process of filing complaints or appeals against insurance companies.
* Starting January 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers who don't meet those thresholds will be required to provide rebates to their policyholders.
* Starting in 2011, this bill helps states require insurance companies to submit justification for requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges.
Reform immediately begins to lower health care costs for American families and small businesses:
* This year, small businesses that choose to offer coverage will begin to receive tax credits of up to 35 percent of premiums to help make employee coverage more affordable.
* This year, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning January 1, 2011, Medicare will do the same.
* This year, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and retirees age 55-64.
* This year, this bill starts to close the Medicare Part D 'donut hole' by providing a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. And beginning in 2011, the bill institutes a 50% discount on prescription drugs in the 'donut hole.'
Thank you,
Nancy-Ann DeParle
Director, White House Office of Health Reform
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Fat Dad
Trad climber
Los Angeles, CA
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Mar 23, 2010 - 02:17pm PT
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On the issue of tort reform, an exerpt from a 2006 press release from the Harvard School of Public Health is illustrative:
"In a separate study released May 10 by the Robert Wood Johnson Foundation’s Synthesis Project, Mello examined the effects of the recent increases in malpractice insurance premiums on the delivery of health care services and the impacts of state tort reforms. Reviewing existing studies, the report concluded that the deteriorating liability environment has had only a modest effect on the supply of physician services. “The best evidence shows, at most, a small overall decrease in the number of physicians practicing in high-liability states compared to lower-risk states, though some rural areas have been more affected,” Mello said. Aside from caps on noneconomic damages, most tort reforms adopted by states in response to malpractice crises have not been effective in boosting physician supply or reducing insurance or litigation costs. Damages caps “help constrain growth in litigation costs and insurance premiums over time, but disproportionately burden the most severely injured patients.” The study is available at http://www.rwjf.org/publications/synthesis/reports_and_briefs/issue10.htm"
I guess the Republicans reject such studies as a biased product of liberal academia.
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apogee
climber
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Mar 23, 2010 - 02:20pm PT
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fattrad, can you give a few specific examples of elements in the bill that are truly socialist?
Don't give a weak 'the whole thing is socialist' kinda answer, either. Be specific.
Any other ST Repubs are welcome to cite some examples, too.
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apogee
climber
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Mar 23, 2010 - 02:22pm PT
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Tort Reform Unlikely to Cut Health Care Costs
Studies Show Malpractice Awards Are Not Big Driver of Skyrocketing Costs
By Daphne Eviatar 8/19/09
(Excerpts)
Amid the obstructionists’ claims that health care reform is “socialist” or a means of speeding Grandma towards her deathbed, a large focus of the conservative position on health care reform has been that frivolous lawsuits drive up health care costs and require doctors to practice “defensive medicine” that’s costly and wasteful.
The health economists and independent legal experts who study the issue, however, don’t believe that’s true. They say that malpractice liability costs are a small fraction of the spiraling costs of the U.S. health care system, and that the medical errors that malpractice liability tries to prevent are themselves a huge cost– both to the injured patients and to the health care system as a whole.
“It’s really just a distraction,” said Tom Baker, a professor at the University of Pennsylvania Law School and author of “The Medical Malpractice Myth.” “If you were to eliminate medical malpractice liability, even forgetting the negative consequences that would have for safety, accountability, and responsiveness, maybe we’d be talking about 1.5 percent of health care costs. So we’re not talking about real money. It’s small relative to the out-of-control cost of health care.”
http://washingtonindependent.com/55535/tort-reform-unlikely-to-cut-health-care-costs
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apogee
climber
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Mar 23, 2010 - 02:23pm PT
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Letter from Congressional Budget Office to Orrin Hatch, (R) Utah
(Excerpt)
CBO estimates that the direct costs that providers will incur in 2009 for medical malpractice liability—which consist of malpractice insurance premiums together with settlements, awards, and administrative costs not covered by insurance—will total approximately $35 billion, or about 2 percent of total health care expenditures. Therefore, lowering premiums for medical liability insurance by 10 percent would reduce total national health care expenditures by about 0.2 percent.
http://www.cbo.gov/ftpdocs/106xx/doc10641/10-09-Tort_Reform.pdf
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Fat Dad
Trad climber
Los Angeles, CA
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Mar 23, 2010 - 02:31pm PT
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On a related point, if the Republicans are so interested in reducing the cost of health care, why did they rebuff Democratic efforts when Bush was in office to allow Medicare to negotiate with pharmaceutical companies to reduce prescription drug costs?
What's the story Fatty?
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happiegrrrl
Trad climber
New York, NY
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Mar 23, 2010 - 02:33pm PT
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Fattrad - You said the guy from Kaiser you met with was named Hal(when someone quipped "How's George?")
On their website, it lists the Chairman and CEO as being named George C. Halvorson, with an indication he spoke for the company as recently as 11/09. Has this changed recently? What is the full name of this Hal perosn you refer to, and their title?
http://xnet.kp.org/newscenter/aboutkp/ceocorner.html
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dirtbag
climber
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Mar 23, 2010 - 02:52pm PT
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Tort lawyers tend to be pro-Democrat.
That's why righties like Fatty tend to make tort reform something it is not.
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dirtbag
climber
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Mar 23, 2010 - 02:54pm PT
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Whenever a government forces citizens to conduct their lives in a certain way, that is socialism.
Gee fatty can you get any more broad?
Traffic lights = socialism by your not-so-useful definition.
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Bob D'A
Trad climber
Boulder, CO
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Mar 23, 2010 - 02:57pm PT
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Fat wrote: happie,
I was wrong
Seems to be a recurring theme...the election, health care reform passage.
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reddirt
climber
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Mar 23, 2010 - 02:58pm PT
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please pardon my ignorance & know I pose this question in earnest.
An insurance applicant walks in w/ a pre-existing condition. The insurance co approves the policy w/ an industry standard 50% markup on the premiums (eg non preexisting applicant pays $300/month, preexisting dude pays $450/month). Preexisting dude can't afford it, but legally has to get insurance...
then what happens?
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dirtbag
climber
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Mar 23, 2010 - 03:01pm PT
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Still a silly definition, Fatty.
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apogee
climber
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Mar 23, 2010 - 03:02pm PT
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"It's not just the premiums paid or lawsuits, it's the preventive medicine practiced that significantly adds to the overall costs."
For you, fattrad:
Health Reform's Taboo Topic
By Philip K. Howard
Washington Post
Friday, July 31, 2009
(Excerpts)
Even more compelling, expert health courts would eliminate the need for "defensive medicine," thereby helping to save enough money for America to afford universal health coverage.
Defensive medicine -- the practice of ordering tests and procedures that aren't needed to protect a doctor from the remote possibility of a lawsuit -- is ubiquitous. A 2005 survey in the Journal of the American Medical Association related that 93 percent of high-risk specialists in Pennsylvania admitted to the practice, and 83 percent of Massachusetts physicians did the same in a 2008 survey. The same Massachusetts survey showed that 25 percent of all imaging tests were ordered for defensive purposes, and 28 percent and 38 percent, respectively, of those surveyed admitted reducing the number of high-risk patients they saw and limiting the number of high-risk procedures or services they performed.
Defensive medicine is notoriously hard to quantify, but some estimates place the annual cost at $100 billion to $200 billion or more.
Containing costs, as Rep. Jim Cooper (D-Tenn.) noted on "Face the Nation" recently, requires overhauling the culture of health-care delivery. Incentives need to be realigned. That requires a legal framework that, instead of encouraging waste, encourages doctors to focus on what's really needed. One pillar in a new legal framework is a system of justice that is trusted to reliably distinguish between good care and bad care. Reliable justice would protect doctors against unreasonable claims and would expeditiously compensate injured patients. The key is reliability. Traditional "tort reform" -- merely limiting noneconomic damages -- is not sufficient to end defensive medicine, because doctors could still be liable when they did nothing wrong.
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/30/AR2009073002816.html
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apogee
climber
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Mar 23, 2010 - 03:05pm PT
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"Whenever a government forces citizens to conduct their lives in a certain way, that is socialism."
So I assume that you are against helmet laws, too? Even though those who sustain serious head injuries wind up socializing most of the costs of their care onto the rest of us?
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Ksolem
Trad climber
Monrovia, California
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Mar 23, 2010 - 03:24pm PT
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I'm against helmet laws.
I think that being in support of laws regulating other people's high risk behaviors is pretty thin ice for a climber...
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Fat Dad
Trad climber
Los Angeles, CA
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Mar 23, 2010 - 03:25pm PT
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First fattrad writes:
Until you get tort reform and sensible rules, the costs will explode. This bill did nothing to correct the root issues.
Then when he's tagged on that, he shifts and claims:
It's not just the premiums paid or lawsuits, it's the preventive medicine practiced that significantly adds to the overall costs.
First, what's the official story. I'd love to hear a consistent claim from you, not this make it up as you go BS.
Second, if that's what the right believes is the reason for costs, why did their version of the bill completely fail to address the "preventive medicine" issue?
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