If the health industry as a whole raises prices by a billion to pay for the billion in rebates (which they can do if it's a built-in cost that the entire industry has to pay and there aren't large differences among the companies in administrative costs), it's the equivalent of playing "Got Your Nose" with a toddler.

Except you're not funding a public retiree health insurance option. You're providing general tax revenue to the Treasury. Didn't you guys above just scold Joe for arguing that Medicare taxes were some magic taxes that were different?

Unless, of course, they simply raise the cost and just agree to pay providers more, essentially splitting premium increases from the consumer with providers, without actually providing any additional healthcare or administrative costs.

Data shows ice melting 50% faster than predicted by some polar scientists

Arctic sea ice is melting at a pace so much faster than once thought that the latest projections say it might disappear by as soon as 2022, according to measurements from the European Space Agency.

An analysis from the CryoSat-2 probe, launched two years ago as a purpose-built satellite for studying the thickness of Arctic ice, suggests that 900 cubic kilometres of ice have disappeared every year since 2004.

At such a dramatic rate, scientists say it's possible in 10 years that the Arctic could be ice-free for at least a day.

Again, your taxes didn't go to that specific purpose. The government can use the taxes that are labeled for Medicare for anything it wants.

Notwithstanding any other provision of law, the receipts and disbursements of the Federal Old-Age and Survivors Insurance Trust Fund and the Federal Disability Insurance Trust Fund shall not be counted as new budget authority, outlays, receipts, or deficit or surplus for purposes of - (1) the budget of the United States Government as submitted by the President, (2) the congressional budget, or (3) the Balanced Budget and Emergency Deficit Control Act of 1985

I'm not talking actual collusion - healthcare providers can easily see for their own that companies need to meet a quota and adjust their prices accordingly. It's no more a kickback than people selling corn for more because they know the industry had an ethanol quota they had to legally fill. It provides an incentive for higher costs for providing health care - the more that's paid for health care, the easier it is to meet the 80% quota. Medicare's efficiency in this quota is in part because their patients are, on average, sicker, which increases the costs and makes it easier to have a higher percentage of benefits going to health care.

Bouncing back to AWG news, Arctic ice could vanish in 10 years, scientists warn:

#1983 I can even cite an example from the health care field. Provinces negotiate huge generic drug purchases with the publicly stated purpose of using their tremendous bargaining power to drive down the price.

Data shows ice melting 50% faster than predicted by some polar scientists

Wouldn't work - MLR binds the insurer. They pay the provider more - they simply pay the provider more and still end up having to an 80% (actually, I think it's 85% for large plans) MLR cap.

Unless you're suggesting illegal activities like kickbacks, I guess.

A friend of mine who works for an insurance company claims that the 85% rule is basically garbage, because the margins on a typical policy are much, much lower than 15%, and like all businesses, there's no reason to deliberately have high overhead. According to him, insurance companies already pay out more than 85% of premiums.

A friend of mine who works for an insurance company claims that the 85% rule is basically garbage, because the margins on a typical policy are much, much lower than 15%, and like all businesses, there's no reason to deliberately have high overhead. According to him, insurance companies already pay out more than 85% of premiums.

So how does he explains all the rebate checks that just went out?

Tell you what, Dan, you start up a health insurance company with the promise that if you don't spend enough of your collected premiums on health care, you'll give that extra money to doctors. I'll start one that promises that if I don't spend enough of my collected premiums on health care, I'll give it back to my customers. Let's see who gets more takers.

I don't think Dan was suggesting that constantly raising insurance premiums would be a winning business model. It seemed like he was making the common-sense observation that insurance companies and doctors aren't likely to sit idly by and watch their earning power get reduced year after year without looking for ways to reverse the trend. As things stand, the vast majority of "savings" from Obamacare (and Medicare) come from the phony-baloney idea that doctors can keep being told to accept less and less money. The projected reimbursement rates under Obamacare in future decades are laughably unrealistic.

As things stand, the vast majority of "savings" from Obamacare (and Medicare) come from the phony-baloney idea that doctors can keep being told to accept less and less money.

The projected reimbursement rates under Obamacare in future decades are laughably unrealistic.

As things stand, the vast majority of "savings" from Obamacare (and Medicare) come from the phony-baloney idea that doctors can keep being told to accept less and less money.

You can't conflate doctors AND insurance companies like that -- they are not in cahoots. Providers negotiate rates with insurers - providers couldn't care less about insurer's profitability or whether they get under or over an MLR. Insurers negotiate rates with providers - insurers care about paying a good rate for services, not whether the provider increases its earning power.

Except you're conflating the health care industry with the insurance industry...

Not that this is unusual. I remember distinctly when Obama went from pushing "health care reform" to pushing "health insurance reform" without ever mentioning the new posters, slogans, etc. It felt oddly creepy, even Orwellian. Even now, nearly every public figure who discusses the issue seems to conflate the two... nowadays the Obama fundraising organization just calls it "health reform," which, well, that isn't anything at all, is it?

Sure they can. If these things suddenly became unpopular, they could amend that law with the stroke of a pen, and you'd have no standing to object to their use of your money.

As things stand, the vast majority of "savings" from Obamacare (and Medicare) come from the phony-baloney idea that doctors can keep being told to accept less and less money.

And this, as I've explained in multiple posts that you continue to ignore - is just nonsense... Neither the charity care cuts nor the Advantage cuts impact what the rates will be for open heart surgery, treating the common cold, or mending a broken leg. IPAB proposals might cut those rates -- but then, the AMA/AHA have fended off the '97 plan for 15 years now, so I doubt that they're too worried about it.

Passing Obamacare doesn't magically change the fact that hospitals rack up huge expenses treating the uninsured. In NYC alone, 40 percent of all uninsured patients are illegal immigrants.

What's phony-baloney about it? It happens in just about every other industrialized country in the world, and they spend less money and get better outcomes.

This edition of Waiting Your Turn indicates that waiting times for elective medical treatment have increased since last year. Specialist physicians surveyed across 12 specialties and 10 Canadian provinces report a total waiting time of 19.0 weeks between referral from a general practitioner and receipt of elective treatment.

At 104 percent longer than it was in 1993, this is the longest total wait time recorded since the Fraser Institute began measuring wait times in Canada.

If only there was a way to alleviate the burden posed by uninsured patients by 60%...

Here's a report on wait times in Canada. Does this sound like a cutting-edge system the U.S. should try to emulate?

personally, i think we're well past the tipping point at which we could adequately shield the planet from significant environmental changes.

So you object to me characterizing Obamacare (and Medicare) "savings" as based on a phony-baloney scheme, and yet you admit that those "savings" never actually materialize because the AMA/AHA have "fended off the '97 plan for 15 years now." Interesting.

As for the charity-care "savings," those are purely hypothetical at this point. Passing Obamacare doesn't magically change the fact that hospitals rack up huge expenses treating the uninsured. In NYC alone, 40 percent of all uninsured patients are illegal immigrants. Does anyone really believe that illegal immigrants are suddenly going to begin paying thousands for insurance when they can continue to use ERs for free? And does anyone really believe the government will allow hospitals to fail because of the costs of treating the uninsured?

I swear if the environment suddenly didn't change, you people would be screaming like chicken little over that fact.

Which then led me to the obvious follow-up: "But what happens to the dogs without cash?"

My wife was mad at me for a week.

Mrs. ASmitty is an ER Doctor, and a few weeks back I was at a function with some of her colleagues. One of the doctors, delighted to hear that I was not a physician, took the time to give me an unsolicited lecture on Obamacare. He told the following story:

"Imagine two patients with identical hip fractrues. The first patient sees a primary care provider and surgery is recommended. The primary care provider schedules the surgery, but the first available surgical date is in three months. Then, after three months, the surgery is delayed again for another thee months. Finally, six months later, the patient gets hip surgery. The second patient see a primary care provider, and surgery is recommended. The next day, surgery is scheduled and performed"

"Now," he said with a thin smile crossing his face, "what's the difference between these two patients?" he asked.

"I don't know," I said with bated breath, "what?"

"The first is a human," he said "and the second is a dog." Vets, he explained were a cash practice, so wait times were vastly superior.

Which then led me to the obvious follow-up: "But what happens to the dogs without cash?"

My wife was mad at me for a week.

Fun story, but emblematic of why liberalism is such a farce. Whether it's school choice or healthcare or whatever, liberals would rather that everyone get a lower-quality product or service rather than tolerate a system in which Person A can get better quality than Person B.

Fun story, but emblematic of why liberalism is such a farce. Whether it's school choice or healthcare or whatever, liberals would rather that everyone get a lower-quality product or service than tolerate a system in which Person A can get better quality than Person B.

It will then come down to congressional will -- but if you confine the pain to a small enough segment, with other segments lauding the change - it does have a chance.

If the IPAB plan is as unworkable as the '97 plan - yeah, it will just shelved like the MVPS/SGR swap-out.

No - they are not purely hypothetical. The component that jacked up reimbursement rates is gone. It's been eliminated. And indeed - plenty of hospitals have expressed concerns that the increase in insured patients won't make up the shortfall for what they get in Medicare reimbursement.

However, it's law. It's in effect (or will be, I don't recall the effective date on the change). To either restore it, or, to provide some other manner of funding like an additional say, block grant requires a further piece of legislation.

Same with the Advantage/medigap/choice cuts. They're law. They're in effect.

I don't think Dan was suggesting that constantly raising insurance premiums would be a winning business model. It seemed like he was making the common-sense observation that insurance companies and doctors aren't likely to sit idly by and watch their earning power get reduced year after year without looking for ways to reverse the trend. As things stand, the vast majority of "savings" from Obamacare (and Medicare) come from the phony-baloney idea that doctors can keep being told to accept less and less money. The projected reimbursement rates under Obamacare in future decades are laughably unrealistic.

EDIT: Oops - rereading, I see your wife in the ER physician... I'm betting the the other physician was probably in one of the departments that is more of a profit center for the hospital.

Mrs. ASmitty is an ER Doctor, and a few weeks back I was at a function with some of her colleagues. One of the doctors, delighted to hear that I was not a physician, took the time to give me an unsolicited lecture on Obamacare. He told the following story:

So in other words, almost the entirety of Obamacare's budgetary implications is premised on something that has only a chance of actually happening. You'll have to forgive me for being skeptical.

Just because something is "the law" doesn't mean it will work as designed. The mere passage of Obamacare didn't eliminate major problems from America'a healthcare system. Until 30 to 45 million people in the U.S. obtain insurance, wait times and quality of care are shown to remain the same, and costs are contained, Obamacare's promises are purely theoretical.

I don't think conservatism is a farce, and this dichotomny is why nobody enjoys debating with you.

The entire Obamacare system is a tradeoff where 270 million people are being forced to suffer a lower health care quality so that 30 million people can undeservingly enjoy a higher one.

The entire Obamacare system is a tradeoff where 270 million people are being forced to suffer a lower health care quality so that 30 million people can undeservingly enjoy a higher one.

The entire Obamacare system is a tradeoff where 270 million people are being forced to suffer a lower health care quality so that 30 million people can undeservingly enjoy a higher one.

Whether it's school choice or healthcare or whatever, liberals would rather that everyone get a lower-quality product or service than tolerate a system in which Person A can get better quality than Person B.

The entire Obamacare system is a tradeoff where 270 million people are being forced to suffer a lower health care quality so that 30 million people can undeservingly enjoy a higher one.

Funnily enough though, the late adapters didn't choose the Canadian model. All systems have their imperfections, but I'd suggest looking at Switzerland and Taiwan rather than Canada.

Funnily enough though, the late adapters didn't choose the Canadian model. All systems have their imperfections, but I'd suggest looking at Switzerland and Taiwan rather than Canada.

Fun story, but emblematic of why liberalism is such a farce.

How low a standard of care would be appropriate for a poor person? Serious question. What would be your bare-minimum? I think it's a necessary jumping off point for any healthcare discussion.

No serious proponent of the public school system believes that private schools should not exist, or that kids who go to public schools should not be allowed to hire tudors or purchase other educational aids.

Liberals would prefer a system in which EVERYONE has access to a certain baseline standard of care, and if you want to go buy more for yourself, be my guest.

Well, Canada is a wealthy country of only 35 million people, so if they're having trouble with universal coverage, that should have been a major red flag.

Switzerland is a wealthy country of 8 million people and Taiwan is a wealthy country of 23 million people. Assuming those systems are among the world's best, scaling them to a country of 310 million people seems daunting if not impossible.

How low a standard of care would be appropriate for a poor person? Serious question. What would be your bare-minimum? I think it's a necessary jumping off point for any healthcare discussion.

Medicaid already covers an estimated 70 million people in the U.S. The notion that poor people were left to fend for themselves with regards to healthcare is a total myth.

Whether it's school choice or healthcare or whatever, liberals would rather that everyone get a lower-quality product or service than tolerate a system in which Person A can get better quality than Person B.

Except -- as people have pointed out -- Obamacare has very little direct impact on care.

Without knowing much about the Swiss and Taiwenese systems this does raise interesting questions. Are you sure the problems facing Canada are due to population? Zonk (who appears to know a thing or two about healthcare systems) is giving the impression that these countries actually operate different systems. Red flags are all well and good, but they usual mark where further investigation would be useful, not casual dismissal.

That answers my question...not at all. I'm not saying poor people are fending for themselves. I'm asking WHAT YOU THINK THE MINIMUM STANDARD OF CARE SHOULD BE FOR SOMEONE WHO CANNOT PAY. An answer of "Medicaid exists" does not follow.

Joe doesn't know the difference between liberals and communists. This is not surprising.

The U.S. already had that; see the "70 million on Medicaid" above.

The moral of your dog story in #2029 was that a dog without cash would get no treatment (or even die).

As for "minimum standard of care," what are you looking for here? I assume Medicaid doesn't refer people to unlicensed doctors or anything of that sort. I've never read anything about people on Medicaid getting horrendous treatment or dying from neglect.

That sounds like doublespeak. Very little "direct" impact.

Things like waiting times have an impact on care.

And are you suggesting that one of the stated goals of Obamacare was not to improve quality?

In any event, the point remains: You cannot provide increased care for tens of millions of people at the same cost while not decreasing quality.

Republicans grudgingly accept that poor people shouldn't die in the street (well, not the Good Face, I guess), but still rail on about the inherent "unfairness" of paying for "someone else's" medical care.

Nope, it's not people like zonk who tell lies, as a poster linked above to Politifact and Factcheck.org.

What lie have I told?

What lie have I told?

I think it's the one about "Doctor for America". Unless "Northern Exposure" is steering me wrong (and it never has in the past) that program has been in place since at least the mid-90s.

Ummm... where did you get the "70 million"? I think the number is closer to 35-40 million - and technically, a fairly decent chunk of them are also Medicare covered, with Medicaid as extended coverage to help with copays, premiums, etc.

Medicaid now covers an estimated 70 million Americans and would cover an estimated 7 million more in 2014 under the Obama health law's expansion.

Really though, our society's relationship with death and our obsession with staving it off for as many pointless days, weeks or months as possible is deeply unhealthy.

Perhaps I'm reading it wrong, but Ray's quote seemed to imply that the poor were receiving an uneccessarily high standard of care.

OK, OK -- this is correct... but 'Obamacare' significantly boosted the program -- virtually the entirety of Title V of of the law is dedicated towards changing the existing PCL program and creates other components that didn't previously exist.

No, my quote implied - in fact directly stated - that Obamacare sacrifices the care of 270 million people in order to improve the care of 30 million people.

Medicaid now covers an estimated 70 million Americans and would cover an estimated 7 million more in 2014 under the Obama health law's expansion.

source: http://news.yahoo.com/anti-medicaid-states-earning-11-000-too-much-143508666.html (Aug. 14, 2012)

Well than give the error to me; my apologies. I drew the implication from the "so that 30 million people can undeservingly enjoy a higher one" language.

Samuel " Joe the Plumber" Wurzelbacher is not politically correct and he's proud of it. And to prove it, the Ohio Republican congressional candidate told a crowd of about 125 supporters in Arizona that the government should "put a damn fence on the border going with Mexico and start shooting."

"I'm running for Congress and that should be a bad thing to say," Wurzelbacher said, as the Prescott eNews first reported. "You know what, that's how I feel. I'm not going to hide it because I'm running for an office. I want my borders protected and I'm very, very adamant about that."

Wurzelbacher's remarks came during a Friday fundraising dinner for Arizona State Sen. Lori Klein. Last year Klein, an adamant gun rights activist, was criticized by gun control advocates after she pointed her raspberry-pink handgun at a reporter's chest during an interview to show him the laser sighting.

"It's just so cute," she said of her .380 Ruger handgun, before assuring the Arizona Republic reporter that while the gun had no safety, she "didn't have my hand on the trigger."

Well, when A is forced to pay for something for B, I tend to conclude that B is getting something he didn't deserve.

I'm funny like that.

Well, when A is forced to pay for something for B, I tend to conclude that B is getting something he didn't deserve.

Well, when A is forced to pay for something for B, I tend to conclude that B is getting something he didn't deserve.

I'm funny like that.

Well, when A is forced to pay for something for B, I tend to conclude that B is getting something he didn't deserve.

There are two novels that can change a bookish fourteen-year old's life: The Lord of the Rings and Atlas Shrugged. One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs.

Though... IIRC -- I thought Switzerland, not Canada, had the second highest administrative costs after the US?

2055. Joe Kehoskie Posted: August 14, 2012 at 03:11 PM (#4208148)



Medicaid already covers an estimated 70 million people in the U.S. The notion that poor people were left to fend for themselves with regards to healthcare is a total myth.

When you design one (or, more likely - unless you're Singapore or something - have one evolve haphazardly over time) you're balancing a variety of factors - access (who has what level of coverage), timeliness/responsiveness, quality (in terms of outcomes), and cost among them.
The US does amazingly well wrt to timeliness, for those who can afford it (which is most people). We do really, really poorly wrt cost. Our health outcomes are so-so. We famously don't do very well wrt access.
It is virtually impossible to design a system whereby we improve wrt each of these things - you have to pick and choose as to what matters to you and your society.

I really would like to see what a truly Libertarian society would look like. It'll be a curiosity to say the least, and I wonder if a people of like minded people can make it work.

I really would like to see what a truly Libertarian society would look like. It'll be a curiosity to say the least, and I wonder if a people of like minded people can make it work.

I think we ask this all the time, but don't get a lot of places.

I wonder if a people of like minded people can make it work.

No serious proponent of single payer health care believes that people with the means should not also be able to pay their own money for additional care.