Health care pt5

[wildcatlh]

Originally Posted by Birrman54

So physicians are just supposed to absorb a 21% reduction in payment?

I'm sure that won't affect supply at all.

I think the point is that while the CBO's proclimation that the deficit will fall assumes that the 21% payment reduction will actually happen, the chances that it will actually happen are pretty doubtful. So the payment reduction is in there to make the budget numbers look better, but that's not going to be reality.

[Sdallnct]

Originally Posted by Superboy

Those are accounting losses, not economic losses. Those are two very different concepts. Those losses aren't generated by expenditures that aren't met by profit; they're met by expenditures that are given tax benefits.

For that matter, what do you think their "losses" were from? the health insurance and pharm industries are incredibly profitable for two reasons:

1. Their goods/services are inelastic

2. Their costs are mostly variable costs.

These two factors put together cook up the perfect recipe for a monopoly, or its slightly less attractive but still massively profitable sister, the oligopoly.

Please, at least do a little looking,

Insurance companies have two essential way to determine profit/loss. 1) Underwriting 2)Net.

Underwriting = the business of insurance. Basically is the total of premiums coming in minus claims going out + the expenses associated with those.

Net = Underwriting profit or loss + taxes (paid or credits) + Investments.

The investments is an interesting one. Most insurance companies are willing to break even or have a small underwriting profit and make much of their money on investments (which hasn't worked so well recently - some companies have lost 1/3, 1/2 or more of their net worth, but it has worked over the long haul). So will the government be investing premiums? Part of the reason insurance companies try to make money on investments is to keep premiums down and be more competitive. Will the government do that? How will that work?

Several pages ago or even in part 3 or 4 it was noted that a government option would save the typical person 10% to 20% of what they are currently paying. Wow...with all those zillions that health insurance companies make and all the quadbillions that the CEO's make, you would think eliminating those (because I'm assuming the government will get people to work for them for free), would do better than 10% to 20% savings over what we have now. And that was from a PROPONENT of the plan! So in reality...I doubt there would be any savings.

[Save Ferris]

Will this affect the idea of private hospitals? When I lived in England and had to have my wisdom teeth removed I didnt want to go to a national dentist. Instead I went to a private hospital to have the procedure done.

I dont know about all the new legislation here these days but a friend mentioned to me that her worry was private hospitals:

Whats to keep all the BEST doctors from joining a private practice that accepts no insurance or government aid and just charges rich patients for the best service?

The idea being that the worst doctors that accept the lowest pay will be what national people get.

[Birrman54]

Originally Posted by wildcatlh

I think the point is that while the CBO's proclimation that the deficit will fall assumes that the 21% payment reduction will actually happen, the chances that it will actually happen are pretty doubtful. So the payment reduction is in there to make the budget numbers look better, but that's not going to be reality.

Oh I get that point, but I'm wondering how anyone can think financing this expansion of care by cutting the payments of the care-providers by 1/5 is a good plan.

[DeputyDave]

Has anyone been discussing how the plan will force states to remove the caps they placed on malpractice payouts? Gee, I wonder what special interest group got that slipped in?

[wildcatlh]

Originally Posted by DeputyDave

Has anyone been discussing how the plan will force states to remove the caps they placed on malpractice payouts? Gee, I wonder what special interest group got that slipped in?

What section is that? Couldn't find it in my quick search of the 1990 page tome.

The section I'm curious about is Section 2572 of Title V, on page 1510 of the legislation. That clause would require a nationwide imposition of the same costly menu labeling requirements that have been shown to be completely ineffective since they were first introduced in New York City.

[Venusian]

Is there a site that has the bill up in an easy to search/read format like someone did for the stimulus bill?

[orangecrush]

Originally Posted by wildcatlh

What section is that? Couldn't find it in my quick search of the 1990 page tome.

The section I'm curious about is Section 2572 of Title V, on page 1510 of the legislation. That clause would require the same costly menu labeling requirements that have been shown to be completely ineffective since they were first introduced in New York City.

Has it been in effect long enough in New York to show its effectiveness either way?

[DeputyDave]

Originally Posted by wildcatlh

What section is that? Couldn't find it in my quick search of the 1990 page tome.

The section I'm curious about is Section 2572 of Title V, on page 1510 of the legislation. That clause would require a nationwide imposition of the same costly menu labeling requirements that have been shown to be completely ineffective since they were first introduced in New York City.

Not sure (I actually think I heard it said it was in the 1600's). Just something I heard on the radio late last night when I couldn't sleep. They were saying it requires all caps to be removed if states want to receive funding.

[Venusian]

I'd guess it's in this section:

SEC. 208. OPTIONAL OPERATION OF STATE-BASED HEALTH INSURANCE EXCHANGES.


wildcat, i couldn't find what you're talking about.

I'm looking here: http://www.opencongress.org/bill/111-h3200/text

SEC. 2572. ONLINE HEALTH WORKFORCE TRAINING PROGRAMS. That doesn't seem to be what you're addressing

[wildcatlh]

Originally Posted by DeputyDave

Not sure (I actually think I heard it said it was in the 1600's). Just something I heard on the radio late last night when I couldn't sleep. They were saying it requires all caps to be removed if states want to receive funding.

I did a global search using the word "malpractice". This is what was found...

Section 261, page 149: States that the implementation of guideline or standards under the bill doesn't establish a standard of care for malpractice actions

Section 262, page 151: Talking about antitrust issues

Section 1125(a)(6)(A)(ii), page 411 -- A California-specific clause related to fee schedules

Section 3400(d)(1)(D)(iv), page 1452 -- Talks about the non-expansion of medical malpractice liability protection under the Federal Torts Claims Act for federally dunded qualified health centers under that section

Section 2537(c), page 1465 -- Establishes medical-legal partnerships "to assist patients and their familites to navigate health-related programs and activities". The specific section prohibits those funds from being used "for any medical malpractice or other civil action or proceeding"

Not saying you're incorrect, but that's all I could find.

[wildcatlh]

Originally Posted by Venusian

I'd guess it's in this section:

SEC. 208. OPTIONAL OPERATION OF STATE-BASED HEALTH INSURANCE EXCHANGES.


wildcat, i couldn't find what you're talking about.

I'm looking here: http://www.opencongress.org/bill/111-h3200/text

SEC. 2572. ONLINE HEALTH WORKFORCE TRAINING PROGRAMS. That doesn't seem to be what you're addressing

You're not lookng at the correct bill. The new bill is HR3962.

[Venusian]

d'oh!

here is a pdf of the real bill: http://docs.house.gov/rules/health/111_ahcaa.pdf

[Birrman54]

Originally Posted by orangecrush

Has it been in effect long enough in New York to show its effectiveness either way?

Calorie postings don't change habits, Study finds

[JasonF]

There's something ironic about someone with a Milton Friedman quote in his signature posting a link that says that giving people more data won't affect their consumption choices. So much for information economics!

Switching subjects completely ... over the weekend, I learned about the way hospital reimbursements are handled in Maryland. Basically, for the last 30 years, Maryland has had price controls.

In most states, every insurer will bargain with every hospital to set those rates. So Blue Cross will go to a hospital and they'll agree that Blue Cross will pay $5,000 per appendectomy. Cigna may wind up paying $12,000 per appendectomy. It has a lot to do with how many patients are in the hospital's area -- if Blue Cross has 10,000 subscribers in the area and Cigna has 500, the hospital will cut Blue Cross a huge discount to get those 10,000 subscribers in the door and make up for it by charging Cigna a lot. As a result, a lot of insurance companies have pulled out of markets where they are not the top one or two insurers.

Maryland does it completely differently. In Maryland, there's an administrative agency that tells every hospital what to charge for every test, pill, or procedure. It's done on a hospital by hospital basis and varies to account for the different overhead costs (rural hospitals vs. urban, teaching hospitals vs. non-teaching, etc.), but basically, if the commission decides that Johns Hopkins will charge $6,000 for an appendectomy, then that's what Blue Cross pays and that's what Cigna pays, and that's what everyone else pays. They've had this system since 1977.

Here's the bottom line from the article I found on this

The system has largely reined in hospital costs. In 1976, Maryland hospital costs were 25% more per case than the national average; by 2007, the latest year for which data are available, Maryland’s costs were 2% less than the national average. Maryland also saw the nation’s second-slowest increase in hospital costs during the same period, said Robert Murray, the commission’s executive director.

On average, Maryland hospitals charged patients 20% above the cost to treat them in 2007, compared with a national average of 182%, according to the American Hospital Association.

The article also notes that this system winds up costing Medicare more than it would otherwise pay (which makes sense, since Medicare has a lot of bargaining power in other states, so can get lower rates than the average insurance company).

http://www.passionforsubro.com/healt...setting-rates/

The other thing this made me wonder is whether this system had any effect on the quality of care in Maryland. So I found this link:

http://www.statehealthfacts.org/comp...?ind=689&cat=8

This is a list of doctors per capita by state. Maryland ranks number three -- behind DC and Massachusetts, and tied with New York and Vermont. Note that these are all liberal states (or districts, as the case may be). Price controls (and, in the case of Massachusetts, universal coverage), don't seem to have caused an exodus from the state.

So ... what would people think of a federal agency charged with setting prices? A federal mandate for states to establish their own Maryland-style rate-setting agencies?

[Ranger]

Well, that is interesting, but I don't think it's something the feds would be able to do well. But the feds telling other states to be more like Maryland to help insurance competition seems feasible.

[DeputyDave]

Originally Posted by wildcatlh

What section is that? Couldn't find it in my quick search of the 1990 page tome.

Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.

http://biggovernment.com/2009/10/30/...rs/#more-23042

Like I said last night:

Originally Posted by DeputyDave

Well, I guess this proves the Democratic party is still in the pocket of the trial lawyers. Any hope of real reform goes out the window.

[wildcatlh]

Originally Posted by JasonF

There's something ironic about someone with a Milton Friedman quote in his signature posting a link that says that giving people more data won't affect their consumption choices. So much for information economics!

Score one for... completely misstating facts? Or are you purposefully being obtuse here? I can't really tell.

[wildcatlh]

Originally Posted by DeputyDave

Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.

http://biggovernment.com/2009/10/30/...rs/#more-23042

Like I said last night:

There's a very large leap from "the states won't get money for this one incentive program" to "it's forcing states to do this", isn't there? If the program is to adopt alternatives to litigation, a state with caps really wouldn't need that, now would they?

[JasonF]

Originally Posted by wildcatlh

Score one for... completely misstating facts? Or are you purposefully being obtuse here? I can't really tell.

I'm being unitentionally obtuse, I guess.

Information economics holds that people make "better" choices -- in the sense that they increase their utility -- when they have more information.

The data from New York is that when people have more information about nutrition, they make the same choices.

This suggests that information economics is wrong, at least when applied to this specific scenario.

Milton Friedman is a famous economist and proponent of information economics (I assume he is, anyway -- pretty much every economist I'm aware of is a proponent of information economics).

Therefore, there's an irony (however slight) in the juxtaposition of the Friedman quote with the counter-example to the postulates of information economics.

What am I missing?

[DeputyDave]

Originally Posted by wildcatlh

There's a very large leap from "the states won't get money for this one incentive program" to "it's forcing states to do this", isn't there? If the program is to adopt alternatives to litigation, a state with caps really wouldn't need that, now would they?

I don't see it saying that at all. Also, in my opinion, threatening to withhold money in order to get a state to follow along (like speed limits) is in the same ball park as "force

[orangecrush]

Originally Posted by Birrman54

Calorie postings don't change habits, Study finds

I especially like

Originally Posted by From the Article

It found that about half the customers noticed the calorie counts, which were prominently posted on menu boards. About 28 percent of those who noticed them said the information had influenced their ordering, and 9 out of 10 of those said they had made healthier choices as a result.

But when the researchers checked receipts afterward, they found that people had, in fact, ordered slightly more calories than the typical customer had before the labeling law went into effect, in July 2008.

[orangecrush]

Originally Posted by JasonF

So ... what would people think of a federal agency charged with setting prices? A federal mandate for states to establish their own Maryland-style rate-setting agencies?

I agree with Ranger that if this sort of thing were to be implemented, it would be better to have each state set prices in lieu of a federal level control. It seems like direct control over prices has been implemented w/ some success. May as well look at it as an option.

[Sdallnct]

Originally Posted by orangecrush

I agree with Ranger that if this sort of thing were to be implemented, it would be better to have each state set prices in lieu of a federal level control. It seems like direct control over prices has been implemented w/ some success. May as well look at it as an option.

But I thought one of the ways the government was going to be less than private is thru efficiency? If each state is doing its own thing, isn't that rather inefficient?

[kvrdave]

Originally Posted by JasonF

So ... what would people think of a federal agency charged with setting prices? A federal mandate for states to establish their own Maryland-style rate-setting agencies?

I think it would end up being 1200 pages and in the end not do what it is suppose to. I would rather see states do this on their own because I believe the feds will fuck it up.