[blackshoe]

billw55, on 2013-October-08, 07:01, said:

Profits are waste in a sense, because those dollars provide no care.

Depends on where those profits go, doesn't it? If they go to improved infrastructure (more beds, more doctors, more nurses, new equipment, etc.) then they do provide care.

[kenberg]

The ercent posts of mikeh and billw are both of great interest to me. I have some work to do so i will comment only briefly for now.

The $125,000 op. First, I am glad to hear that it worked out. Also, it reminds me of something I said earlier about how if medicare was not going to pay for something, I would. But of course not everyone is in a position to say such a thing. And Bill is right, that the posted prices are often totally unreal. my favorite was some procedure, I forge what it was, that Medicare said it would not pay for but also said that it seemed as if I didn't realize it wouldn't pay for so I didn't have to pay for it either and the doc could just go whistle for his money. It didn't put it exactly that way, of course.

Mike says: "Few of us are able to adequately inform ourselves of the relative merits of those who compete for our business, whether we be buying a car or cancer treatment.". You got that right. Double and re-double. And tthen it has to be properly implemented. Some years back when health insurance was first becoming widely used, I had something where I first had to pay, then I supposedly got money back. No matter which form I filled out, I would get a letter explainging that it was the wrong form. I would then send in a different form and I would get a letter back saying that it was now too late to file. So I switched to an HMO. Different doc every time I went in. When one of them asked me if I remembered what my form had on it because she couldn't find their copy, I moved on to something else.

Well, I hope we get this right. but I do value the option of saying "Buzz off, you clowns, I want what I want and I'll pay for it".

[billw55]

blackshoe, on 2013-October-08, 07:58, said:

Depends on where those profits go, doesn't it? If they go to improved infrastructure (more beds, more doctors, more nurses, new equipment, etc.) then they do provide care.

Well, in that case they show on the balance sheet as expenses. By "profits" I mean strictly those dollars which leave the organization for enrichment of the owners/stockholders. Hospitals are very good at keeping the money in - they can't have too much profit, and still maintain their non-profit tax status. So the successful ones keep building and expanding, which can indeed be good for care. Insurers are a different animal however. Those (large) profits provide little towards care.

[ArtK78]

kenberg, on 2013-October-08, 08:23, said:

Well, I hope we get this right. but I do value the option of saying "Buzz off, you clowns, I want what I want and I'll pay for it".

That is all well and good, but the vast majority of the people cannot afford that option.

Oh, wait. I forgot. The Republicans don't represent the vast majority of the people (except for the wall street people, the oil people, the banking people, the insurance people, etc.).

[Winstonm]

blackshoe, on 2013-October-08, 07:58, said:

Depends on where those profits go, doesn't it? If they go to improved infrastructure (more beds, more doctors, more nurses, new equipment, etc.) then they do provide care.

Let me tell you a true story from my time working as an RN at St. John's in Tulsa. I asked a cardiologist what significance a certain blood test had on cardiology. He answered that the test had allowed him to buy a 100-foot yacht instead of the 60-foot one he had his eye on.

He was not kidding.

[Winstonm]

billw55, on 2013-October-08, 08:34, said:

Well, in that case they show on the balance sheet as expenses. By "profits" I mean strictly those dollars which leave the organization for enrichment of the owners/stockholders. Hospitals are very good at keeping the money in - they can't have too much profit, and still maintain their non-profit tax status. So the successful ones keep building and expanding, which can indeed be good for care. Insurers are a different animal however. Those (large) profits provide little towards care.

Salaries and business spending can be ridiculously high in a non-profit as long as the monies are shown on paper to be plowed back into the "non-profit" business.

[barmar]

In a healthcare system where the majority of fees are paid by insurance companies rather than out of pocket, high list prices aren't unexpected. It's similar (but to an absurd extent) to the high prices for business class airfares and hotels at conference sites: they know that the costs will be passed on to the employer, who can afford higher prices.

BTW, don't forget that study that found vast differences in prices for the same procedures in different hospitals, sometimes an order of magnitude. So if she shopped around, maybe that $125K procedure could have been done for $50K elsewhere (but probably not $6500).

[mikeh]

barmar, on 2013-October-08, 11:37, said:

In a healthcare system where the majority of fees are paid by insurance companies rather than out of pocket, high list prices aren't unexpected. It's similar (but to an absurd extent) to the high prices for business class airfares and hotels at conference sites: they know that the costs will be passed on to the employer, who can afford higher prices.

BTW, don't forget that study that found vast differences in prices for the same procedures in different hospitals, sometimes an order of magnitude. So if she shopped around, maybe that $125K procedure could have been done for $50K elsewhere (but probably not $6500).

In fairness, I should have mentioned that we did 'shop around' and the cheapest we found was in Oklahoma, where the price was $12,500. In addition, the bios of the doctors at Cleveland Clinic were very impressive, while all the Oklahoma doctors either had their degrees and speciality designations from Oklahoma or, in the case of one of them, from New Delhi. Make no mistake: I understand that the standards of training in India are pretty good and I wouldn't have any qualms about having that doctor be the one doing the procedure...I mention it only as what seemed to me to be a partial explanation for the price discrepancy. The CC could rip people off because they could claim to have the best, and the best expect and are entitled to be well paid, while Oklahoma would be less competitive for a host of reasons.

[y66]

Why do some posters say that Obamacare represents a government takeover of healthcare? Do you know something Politifact does not know? What are your information sources?

Quote

Myth #5: The Affordable Care Act Is "Socialized Medicine" And A "Government Takeover" Of Health Care

Fox News' Monica Crowley: "You Don't Surrender The Nation To Socialized Medicine Just Because You Think That You Can't Win The PR Battle." Fox News' Monica Crowley pushed the idea that Congress should consider a government shutdown unless a resolution funding the government included defunding the Affordable Care Act. When faced with opposition to that opinion from a Fox colleague, Crowley explained that, "You don't surrender the nation to socialized medicine just because you think that you can't win the PR battle." [Fox News, Happening Now, 9/20/13, via Media Matters]

Fox Quotes Heritage Foundation's Jim DeMint: Politicians Need To Stop "The Government Takeover Of Healthcare." According to a September 20 piece on FoxNews.com by Fox News Radio reporter Todd Starnes, Heritage Foundation president Jim DeMint defended a decision to cause a government shutdown over funding the Affordable Care Act claiming it was worth it to"take a risk" in order to stop "the government takeover of healthcare":

"If there's ever been a time for politicians to take a risk on their next election, it's stopping the government takeover of healthcare," said Jim DeMint, president of the Heritage Foundation. "This is not about political party or political calculation." [FoxNews.com, 9/20/13]

FACT: The Affordable Care Act Is Not Socialized Medicine Or A Government Takeover Of Health Care

PolitiFact Named "Government Takeover Of Health Care" As Its 2010 "Lie Of The Year." In its article declaring "a government takeover of health care" to be the Lie of the Year, PolitiFact explained how the law "relies largely on the free market" and "private companies":

"Government takeover" conjures a European approach where the government owns the hospitals and the doctors are public employees. But the law Congress passed, parts of which have already gone into effect, relies largely on the free market:

Employers will continue to provide health insurance to the majority of Americans through private insurance companies.

Contrary to the claim, more people will get private health coverage. The law sets up "exchanges" where private insurers will compete to provide coverage to people who don't have it.

The government will not seize control of hospitals or nationalize doctors.

The law does not include the public option, a government-run insurance plan that would have competed with private insurers.

The law gives tax credits to people who have difficulty affording insurance, so they can buy their coverage from private providers on the exchange. But here too, the approach relies on a free market with regulations, not socialized medicine.

PolitiFact reporters have studied the 906-page bill and interviewed independent health care experts. We have concluded it is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers.

It's true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.

Republicans who maintain the Democratic plan is a government takeover say that characterization is justified because the plan increases federal regulation and will require Americans to buy health insurance.

But while those provisions are real, the majority of Americans will continue to get coverage from private insurers. And it will bring new business for the insurance industry: People who don"t currently have coverage will get it, for the most part, from private insurance companies. [PolitiFact, 12/16/10]

[y66]

Why do some posters characterize the current health care market as a free market? Have you not read your Milton Friedman or Kenneth Arrow? Have you not heard of the AMA? Do you think price differentials of the types mentioned by mikeh can persist in a free market? Come on. And how come free market people are not calling for a repeal of the tax code exemption for employer provided medical care?

[Winstonm]

barmar, on 2013-October-08, 11:37, said:

In a healthcare system where the majority of fees are paid by insurance companies rather than out of pocket, high list prices aren't unexpected. It's similar (but to an absurd extent) to the high prices for business class airfares and hotels at conference sites: they know that the costs will be passed on to the employer, who can afford higher prices.

BTW, don't forget that study that found vast differences in prices for the same procedures in different hospitals, sometimes an order of magnitude. So if she shopped around, maybe that $125K procedure could have been done for $50K elsewhere (but probably not $6500).

The problem is this is actually backwards from reality - it is the insurance companies because of their purchasing power who get the discounted rates. The person who pays his own way is penalized. The reason this happens is for write-off purposes - the uninsured loss to the hospital is charged at the highest rate possible to lower tax liabilities.

I had this experience myself - the bill for a CT was shown to be over $3000 but discounted to $900, a negotiated price with the insurance company. Without the collective purchasing power of the insurance company, there would have been no discount.

[Winstonm]

Btw, isn't it odd that the Republicans are against a law that: a) encourages free market competition, b) lowers taxes by way of healthcare tax credits, and c) is a market-based, rather than government-based solution to healthcare problems

[mike777]

Winstonm, on 2013-October-08, 13:09, said:

Btw, isn't it odd that the Republicans are against a law that: a) encourages free market competition, b) lowers taxes by way of healthcare tax credits, and c) is a market-based, rather than government-based solution to healthcare problems

yes surreal

[mike777]

"While I can empathize with a distrust of government, and a fear that government controlled health care will waste billions of dollars and often be mismanaged, where you and I part company is with respect to the notion that private enterprise does a better job:


I wish I could write as clear as MikeH does.


in two sentences he makes his key point. He does not trust in private markets to do better much better.

What is unclear is what he thinks is better.

fwiw I strongly agree that ocare is not socialized medicine...just a step forward

I note Canada is not just a single payer system. It would be nice to hear from others who do not get a check from the govt. anyone?

[ArtK78]

Winstonm, on 2013-October-08, 13:03, said:

The problem is this is actually backwards from reality - it is the insurance companies because of their purchasing power who get the discounted rates. The person who pays his own way is penalized. The reason this happens is for write-off purposes - the uninsured loss to the hospital is charged at the highest rate possible to lower tax liabilities.

A common misconception. The "write-off" does not lower tax liabilities. If you don't receive the income, it is not subject to tax. There is no "write-off." Only if you have already included the billed amount as income before the write-off is there a deduction.

For tax purposes, the difference between the amount billed and the amount received is a non-event.

[kenberg]

I woke up this morning and realized that I am totally fed up with this game of road chicken with the nation's future. Wheter we are speaking of the Weather Underground or the Tea Party, enough is enough. I think of myself as open to duscussion on most points, but if the Republican Party cannot or will not bring their extreme wing under control then that's it for me, I will happily sign a pledge to not vote for any Republican anywhere under any circumstances, regardless of his good qualities, regardless of the defects of his opponent, regardless of anything. Bring it to an end or be gone.

[y66]

Quote

The path forward is glaringly obvious even to a growing number of House Republicans: a clean continuing resolution to fund the government for a few weeks or months, and an unconditional increase in the debt limit.

If Mr. Boehner continues to refuse to put those measures on the floor, Republicans and Democrats should join together to sign a discharge petition to force a vote, which would undoubtedly pass. And then the talks about what would be good for the country’s future can begin. -- NYT Editorial Board

Quote

Updated 10/9/2013 at 8:00 a.m.

Washington (CNN) – There appeared to be enough votes in the House on Wednesday to approve legislation to reopen the federal government, according to an ongoing CNN survey of House members.

CNN's vote count

All 200 Democrats and 19 Republicans support passing a continuing resolution with no additional legislative strings attached that would reopen the federal government, which has been partially closed for a week over a bitter policy dispute between Republicans and Democrats on health care. With three vacancies in 435 member House, 217 votes are currently the minimum needed for the measure to win approval in the House.

The 19 Republicans who support a government funding bill with no strings attached are:

Walter B. Jones, R-North Carolina: Said during an interview with MSNBC that he wished the House "would pass a clean CR."

Mike Coffman, R-Colorado: Announced he supported a government funding bill with no strings attached in a Denver Post opinion-editorial.

Tim Griffin, R-Arkansas: "Tweeted the he would support a clean government funding bill."

Bill Young, R-Florida: A spokesman tells CNN that Young would support a clean government funding bill.

Dennis Ross, R-Florida: A spokeswoman told CNN Ross would support a one-year government funding bill at sequestration levels with no strings attached.

Mike Simpson, R-Idaho: Statement: "Similar to Sen. Rand Paul, I could support a very short-term clean CR, perhaps one or two weeks, while we continue to negotiate on a longer-term bill."

Frank LoBiondo, R-New Jersey: LoBiondo penned an editorial in the Philadelphia Inquirer that said he supported a clean government funding bill.

Jon Runyan, R- New Jersey: Runyan penned an editorial in the Philadelphia Inquirer that said he supported a clean government funding bill.

Pete King, R-New York: Told CNN he supports passing a clean government funding bill.

Michael Grimm, R-New York: Grimm told CNN he would support a clean government funding bill.

Jim Gerlach, R-Penn.: A spokesman told CNN that Gerlach would support a clean government funding bill if it came to the floor.

Pat Meehan, R-Penn.: Statement on October 1: "I believe it’s time for the House to vote for a clean, short-term funding bill."

Michael Fitzpatrick, R-Penn.: Fitzpatrick penned an editorial in the Philadelphia Inquirer that said he supported a clean government funding bill.

Lou Barletta, R-Penn.: A spokesman told CNN that Barletta would vote yes if a clean government funding bill came to the floor. On Tuesday morning, the spokesman said while Barletta is now focused on passing a compromise that includes repealing of the medical device tax, it is fair to include him as a yes vote for a funding bill with no strings attached.

Charles Dent, R-Penn.: Told CNN he supports a clean government funding bill. "I think now it's imperative that we just fund the government," he said.

Robert Wittman, R-Virgina: A spokeswoman tell CNN Wittman would vote yes on a clean government funding bill.

Scott Rigell, R-Virginia: Told CNN on October 1 that he supported passing a clean government funding bill.

Frank Wolf, R-Virginia: A spokesman tells CNN that Wolf will support a clean government funding bill.

David Reichert, R-Washington: October 7 statement: "I will continue to vote for any legislation that keeps the federal government open."

[Winstonm]

ArtK78, on 2013-October-09, 05:12, said:

A common misconception. The "write-off" does not lower tax liabilities. If you don't receive the income, it is not subject to tax. There is no "write-off." Only if you have already included the billed amount as income before the write-off is there a deduction.

For tax purposes, the difference between the amount billed and the amount received is a non-event.

Thanks for the correction - then why the discrepancy?

[blackshoe]

Like Ken, I'm fed up with this nonsense. I am, and have been most of my adult life, a registered Republican. The reason for that is that the stated goals and I ideals of no other party matched my own as closely as theirs. But stated goals aside, what the Republican Party is now showing, by their actions, their goals and ideals to be, no longer matches mine, not even close. That would make me a Democrat, I suppose, if that were my only other choice. Fortunately, it's not. I can be a Libertarian, or an Independent, or even a Communist, if I so desire. Or I can have no political party at all. I can be a party of one.

I suppose that registering as a Republican gives some "support" of some kind to the Party - they can say "see? look how many Republicans there are". If we want to express displeasure with what they're doing, one way is to to de-register. If enough Republicans do that, maybe the ones remaining will wake up. Or maybe not.

There is a danger, I think, in "I'll never vote again for a Republican, even if I think he's the best candidate for the job". Many decry the two party system, saying it's not flexible enough. It seems to me that whether or not that's true, a one party system would be worse.

[Winstonm]

The fairy dust is flying fast and furious around Washington as some Republican lawmakers are now claiming that a debt default would be a positive for the country, and others are claiming the money is there in tax revenues to pay our debts (just not enough for debt service and a federal government is something they don't mention.)

This, IMO, is the inherent danger from putting people in positions of authority who are subject to holding unverifiable beliefs. This small group is so firmly convinced that their way is the only true path for government that they cannot imagine being wrong, so no argument can sway them. But it is only the safety net provided by youthful ages, health, money and jobs, or imagination that gives this group the shield from reality to hold to their faith. The sadly ironic twist to this tale is that if you took any one of them out of his circumstances and could magically make him a 65-year-old with no family wealth, who relies solely on social security and medicare to survive, his distaste for government interference would evaporate.