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Thread: AMA opposes Obama's Health Care plans...

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    Re: AMA opposes Obama's Health Care plans...

    But that's not what I'm asking. Sure, some places give you a list of prices and you'll know exactly what things cost. Other places though don't have that. The doctors that only take insured patients will have absolutely no idea how much things cost.

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    Re: AMA opposes Obama's Health Care plans...

    I had an experience that opened my eyes. I was stuck between Liberty Mutual not paying for an MRI that they should have paid for and my wife's family plan. I suffered the pain until it got too bad and used my wife's plan. Right after BC&BS covered the MRI at a cost of over $1200, Liberty Mutual decided that I was correct and said they would pay for it. I went to the MRI place and told them that I needed the bill for the MRI I had so I could give it to Liberty Mutual. The bill they gave me was for $672. I figured they were screwing BC&BS, so I called them and told them about the difference. They told me it was their schedule of payements and Ins Co may get a better price.

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    Re: AMA opposes Obama's Health Care plans...

    Quote Originally Posted by celticlord View Post
    Your first sentence is patently false. There are clear economic incentives in preventative care when the patient pays the full cost of care that do not exist in the current health insurance model. Yes, people are reluctant to go to the doctor--and when there is no incentive to do so, that reluctance is not countered and thus predominates in the choices patients make...Some people would make that choice. However, others do not. I know people who go to the doctor at the first sneeze.
    You continue to fail to deal with the fact that this is not an ordinary demand issue, as would exist with something intrinsically desirable. Even as a threat it has no certain consequence for a given individual, and given our cultural love affair with risk, the obvious consequence should be apparent even to you.

    Quote Originally Posted by celticlord View Post
    Actually, perfect knowledge of the costs of care would only be scary in a "sticker shock" manner. Fear is primarily a response to an unknown/unknowable phenomenon. Very little that is well known is much feared.
    Exactly, you agree, but then force yourself into the wrong conclusion again because, as before, you ignore the differences in the psychology between car-buying and medical care. Even if you discount the vanity aspect of car-buying, and focus purely on the necessity of it, the consequences of not having a car for a commuter are much more obvious than skipping medical check-ups. I know of no vanity, no social appeal, of having essential medical care, either. So the market is very different for a good chunk of the population.

    There is even an occurence of ideology-based refusal of medical care also, often publicized in the media, - clear cases in which a person would live with treatment and quickly die without, so the extent to which people will sometimes go to avoid reasonable care clearly extends beyond financial reason. Obviously, few people are that irrational, but not everyone has to be that extreme to be unconsciously pulled into similar self-deluding rationales and avoidance behaviors. Almost anything can and will be used by some people to avoid care, so the only way to mitigate that is to remove those excuses at the point of decision.

    Quote Originally Posted by celticlord View Post
    Again, you are presuming incentives do not change. That is an irrational and unsupportable position to take. Incentives most assuredly would change.
    Not at all, the whole basis of my commentary is about incentives which will work. I am simply pointing out that the incentives you are citing are not fully functional in the medical market, and therefore potentially detrimental to public health.

    Moreover, you naively assume any given medical cost is a simple one-time payment, as for a single procedure, that people can easily shop around. That is only possible in a limited number of situations, and most of the time costs keep accruing unexpectedly as issues, unique to the individual, keep cropping up. There is virtually no way an ordinary person can ever account for every possible future need and then budget for it, other than for the barest of routine services. Even medical professionals themselves can't forsee individual needs sometimes, so how are non-medical consumers going to achieve this?

    Quote Originally Posted by celticlord View Post
    Those factors do not invalidate my hypothesis. I am not claiming people will be perfect in pursuing preventative care, merely that they will be incented to do so, and that the incentives will have significant impact on their consumption patterns regarding healthcare.
    Well that's the whole point, your incentives only affect a portion of the market. Such incentives alone may improve health care compliances for some, but because they don't help the entire market, therefore they are not the best solution for this market.

    Quote Originally Posted by celticlord View Post
    True enough, but you are talking about a small sliver of overall healthcare cost and consumption. Also, given the problematic nature of serious disease, it is a markedly different economic discussion. Cost of cancer treatment is not what drives the cost of "normal" healthcare through the roof.
    You are clearly wrong here, as care of serious chronic disease constitutes the majority of health care spending. It is only a smaller proportion by population, not cost. So your solution would be simply to allow 10+% of the population simply die prematurely, unnecessarily? You have not thought this through in any way that has a basis in humane reason.

    Even if hospitals continued emergency treatment regardless of a patient's ability to pay, that still would not cover chronic illness and lead to a much higher mortality rate in the general population. Moreover, how does a person "shop around" when they are having a medical emergency, if they are unconscious no less? It is an absurdity to remotely suggest that.

    Quote Originally Posted by celticlord View Post
    Prices would fall because the current price models are only sustainable with insurance, and are in fact driven by the insurance distortion. When the economic concern regarding healthcare is a lack of health insurance for some, rather than access to the services themselves, that alone is proof of an irrational pricing mechanism. Prices could not do anything but fall if health insurance were withdrawn from the equation.
    Again you falsely assume that installing a rational pricing mechanism will magically induce rational consumption of this particular "product". Also, as pointed out earlier, medicine is not a single product price which a consumer can easily shop around except in limited cases, even if they were perfectly rational. Even professional knowledge doesn't guarantee the ability to fully predict costs for a given individual.

    Quote Originally Posted by celticlord View Post
    Further, while it is true that healthcare is not a pure commodity, there is competition among physicians just as there is in many service industries--chiefly on the basis of skill/knowledge/competence. Doctor "A" competes with Doctor "B" on the basis of who's "better". A non-distorted market mechanism would leverage even that competition to push prices down overall.

    In a functional free market, pricing pressures for such compel both Doctor "A" and Doctor "B" that they are worth the higher fee; their economic incentive is to argue the value of their services and justify whatever fee they seek to assess. The value argument is also part of what would moderate patient behavior and shift the perception of healthcare in a positive direction. People are not troubled by price when they perceive value.
    Actually, that is not true. It is illegal in many states for doctors to make claims of better medical treatment. Presumably, the standard of care is just that, and no one therefore can claim to be better without implying another is involved in malpractice. It is a violation of every ethics code I know of.

    The only way in which doctors can legitimately compete is in providing a more appealing staff and cosmetically beautiful office, and that obviously has little to do with the quality of medical care. Competition on pricing typically would be on the few common procedures patients understand, a kind of loss leader. It is not a good model to build the best health care on.

    It works very well for cosmetic procedures, but then, that kind of medicine is somewhat antagonistic to good health care.
    Last edited by metreon; 06-12-09 at 03:52 PM.

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    Unhappy Re: AMA opposes Obama's Health Care plans...

    Quote Originally Posted by donsutherland1 View Post
    BWG,

    You are correct that I'm only talking about single-payer in reply to a member's posted message.

    Without doubt there are major issues with respect to the current system. Some major issues include:

    1. Persistent high incidence of uninsured persons. This situation imposes costs on the nation's economy.
    2. Persistent situation where costs are rising faster than nominal economic growth, an unsustainable situation in the long-term.
    3. Procyclicality of a largely employer-based private system.

    Any credible health reform efforts will need to tackle those issues. Until I have a chance to examine the actual details of what is on the table, rather than reports of what might be in the works, I will hold off on commenting in any great detail.
    Oh I agree it's hard to discuss details that aren't there. You can get into a major distraction on an issue that isn't.

    I agree that your three points are present now and they need to be addressed.

    How do we fix them? As you can tell, ask ten different people and you'll get ten different answers.

    Is there a magic wand that we can wave and all is right? Of course not and no matter what plan does or does not come to be, it's not going to be perfect, some are going to be unhappy and those that don't get their version implemented are going to point fingers and say, 'I told you so'.

    I think the current proposals that allow those that are happy with what they have, keep it and those that aren't, a choice to opt into a public plan is the way to go. I don't believe anything that forces anyone to give up the status quo has any chance at all of passing either congress or public support.

    One thing that is speaking loudly, with their silence, is the rest of the industrialized nations that have some type of UHC the fact that are not demanding that their government switch to a United States type of health care system.
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    Re: AMA opposes Obama's Health Care plans...

    The federal government has not run anything that stayed in budget yet,how do you expect them to run health care.

    Will the federal people use the same doctors I don't think so.

    We all will be giving up a lot,personally I don't want have to go to Wallmart doctor,with substandard treatment and health care.

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    Re: AMA opposes Obama's Health Care plans...

    Quote Originally Posted by WI Crippler View Post
    Don't you already negotiate your rates with insurance companies for procedures? Are insurance companies really asking you to charge them more, for a procedure?
    In general, we don't negotiate rates. Insurance companies tell us what they will allow, take it or leave it. The consistency amongst companies is atrocious. BC/BS for example, authorizes twice the amount for the exact same procedure as Cigna. And BC/BS's rate is nearly half of what is the going rate, out of pocket. Further, Cigna hasn't changed their rate in 10 years...imagine not getting a raise in 10 years. I could tell you many, many stories of insurance company abuses and manipulations. This is why I strongly favor the healthcare industry being highly regulated.
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    Re: AMA opposes Obama's Health Care plans...

    Imagine that. Doctors who make most of their money buying into the system that the insurance agency has setup to make its own money rejecting a system that attacks its bread and butter.

    You don't say. Celticlord (along with others) is correct that the insurance industry has got to go. How many doctors are arguing for that?
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    Re: AMA opposes Obama's Health Care plans...

    In Message #13 in this thread, I noted:

    If health costs rise persistently faster than the economy grows, there will be a scarcity of funds at some point. The situation would be analogous to an asset bubble, except in this case it would be an expenditures bubble. At some point, the costs would become so great that immediate hard rationing would occur out of necessity, as defaults on payments would increase rapidly, government would cap its expenditures due to competing priorities/inability to borrow unlimited sums of money, etc. That situation would be disruptive, both economically and with respect to those whose health needs would not be accommodated.

    It is highly unlikely that foreigners would be willing to lend to the U.S. to finance those excess costs absent reforms that contain the growth of such costs. Otherwise, they would be concerned that they might never be repaid.


    Today, CNBC reported:

    New research from Citigroup...adds another specter to the list: the U.S. health-care industry. A pair of economists at the bank, Steven Wieting and Shawn Snyder, note that “functioning market price competition barely exists” in the health industry, whose per-capita spending is now nearly twice that, on average, of other developed nations.”

    ...This helps explain how health-care spending has grown 2.5 times faster than incomes over the past three decades. “The health-care system in the U.S. reminds us somewhat ominously of the bubble in housing finance, [also] a ‘public/private’ partnership,” cautions Citi.


    IMO, the bottom line is:

    1. The continuing excessive health expenditures trajectory is unsustainable.
    2. The need for health care reform that addresses the unsustainable health cost issue remains unaddressed and continues to grow in urgency.

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    Re: AMA opposes Obama's Health Care plans...

    I was looking to see who dared bump a 3 year old thread, and it turned out to be Don, and it turned out to be a worthwhile bump. Thanks for sharing some fascinating information. The question I think is not whether something needs to be done, but what needs to be done. The law before SCOTUS did not really address the cost issue, which is the big issue.
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    Re: AMA opposes Obama's Health Care plans...

    Quote Originally Posted by donsutherland1 View Post
    In Message #13 in this thread, I noted:

    If health costs rise persistently faster than the economy grows, there will be a scarcity of funds at some point. The situation would be analogous to an asset bubble, except in this case it would be an expenditures bubble. At some point, the costs would become so great that immediate hard rationing would occur out of necessity, as defaults on payments would increase rapidly, government would cap its expenditures due to competing priorities/inability to borrow unlimited sums of money, etc. That situation would be disruptive, both economically and with respect to those whose health needs would not be accommodated.

    It is highly unlikely that foreigners would be willing to lend to the U.S. to finance those excess costs absent reforms that contain the growth of such costs. Otherwise, they would be concerned that they might never be repaid.


    Today, CNBC reported:

    New research from Citigroup...adds another specter to the list: the U.S. health-care industry. A pair of economists at the bank, Steven Wieting and Shawn Snyder, note that “functioning market price competition barely exists” in the health industry, whose per-capita spending is now nearly twice that, on average, of other developed nations.”

    ...This helps explain how health-care spending has grown 2.5 times faster than incomes over the past three decades. “The health-care system in the U.S. reminds us somewhat ominously of the bubble in housing finance, [also] a ‘public/private’ partnership,” cautions Citi.


    IMO, the bottom line is:

    1. The continuing excessive health expenditures trajectory is unsustainable.
    2. The need for health care reform that addresses the unsustainable health cost issue remains unaddressed and continues to grow in urgency.
    And herein is the problem:

    functioning market price competition barely exists” in the health industry
    Forcing everyone into third-party paying is only going to make this worse.
    “Offing those rich pigs with their own forks and knives, and then eating a meal in the same room, far out! The Weathermen dig Charles Manson.”-- Bernadine Dohrn

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