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Author: Subject: My Professional Take on The Affordable Care Act

Maximum Peach





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  posted on 10/5/2014 at 12:45 PM
Here's a tidbit on The Affordable Care Act from a health care worker's viewpoint (me).
I will not name either the physician involved, or the facility.

We have an M.D. here at the hospital where I work who is infamous for milking charges from his patients. Patients critically ill, on a ventilator in ICU, are often kept on the ventilator FAR beyond what is reasonable. All the numbers may be good, all the lab work and clinical signs indicate that this person is ready to come off of the ventilator. Yet this M.D. will refuse to write an order to take them off. He will keep them on the vent for days, even weeks longer than is indicated by all the data. Other physicians would have written an order immediately to discontinue the vent.

Why, you ask? $$$, folks. He is paid for his time seeing any ventilator patient, and a Doctor's time in ICU is VERY expensive. Word is that this M.D. has a couple of kids who are both in professional degree programs at prestigious Universities.

This has been going on for a lot of years. I know because I also worked with this physician at another facility from 2005-2007. Even back then I had an ICU nurse comment to me on how he was obviously "milking" charges.

I just found out yesterday that he has been BANNED from ICU at the hospital where I work. It happened some months back but I just found out yesterday. He is still allowed to see patients on the floors which I knew because I just saw him Friday.

Here's the explanation I was given by a co-worker who is also a respiratory therapist: Hospitals now have guidelines for readmissions, ICU admissions, and time spent on a ventilator. It is all scrutinized now because of The Affordable Care Act. So administration had to look seriously at his unethical patient management and then they did something about it.

When you consider how long this physician had been getting away with all this, it makes sense that ACA had everything to do with it since it was just implemented in January.
I've supported ACA all along, in fact I just bought insurance three weeks ago through it. My COBRA from another job expired on September 30th. But we need to remember that ACA involves a LOT more than mandating that everyone have insurance. If it puts an end to unethical practices by sleazebags like this M.D., well, that is a very, very good thing. And it will help bring down the skyrocketing price of healthcare as well.

[Edited on 10/6/2014 by robslob]

 

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Peach Extraordinaire



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  posted on 10/5/2014 at 01:49 PM
Good information. I've been an MRI Engineer since 1985 and if anyone should hate the ACA it's me. But I don't hate it because I've seen first hand the waste in the private sector and outrageous charges and profit margins involved in medical devices sales and service by every single major OEM, GE, Siemens, Philips, Toshiba you name it they all obscenely over charge both in the price of the product and the service contracts. Lastly I personally know 5 people all not old enough for Medicare who were able to get decent insurance policies at less cost through the ACA.

 

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Extreme Peach



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  posted on 10/5/2014 at 01:50 PM
So basically what President Obama was saying in the video, that Alloak claims was him using fear to sell ACA, was true. Some doctors will milk the system even if the treatment is not justified.

You owe our President an apology Alloak.

You can send him your apology here:

http://www.whitehouse.gov/contact





[Edited on 10/5/2014 by Bill_Graham]

 

Zen Peach



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  posted on 10/5/2014 at 02:17 PM
quote:
Here's a tidbit on The Affordable Care Act from a health care worker's viewpoint (me).
I will not name either the physician involved, or the facility.

We have an M.D. here at the hospital where I work who is infamous for milking charges from his patients. Patients critically ill, on a ventilator in ICU, are often kept on the ventilator FAR beyond what is reasonable. All the numbers may be good, all the lab work and clinical signs indicate that this person is ready to come off of the ventilator. Yet this M.D. will refuse to write an order to take them off. He will keep them on the vent for days, even weeks longer than is indicated by all the data. Other physicians would have written an order immediately to discontinue the vent.

Why, you ask? $$$, folks. He is paid for his time seeing any ventilator patient, and a Doctor's time in ICU is VERY expensive. Word is that this M.D. has a couple of kids who are both in professional degree programs at prestigious Universities.

This has been going on for a lot of years. I know because I also worked with this physician at another facility from 2005-2007. Even back then I had an ICU nurse comment to me on how he was obviously "milking" charges.

I just found out yesterday that he has been BANNED from ICU at the hospital where I work. It happened some months back but I just found out yesterday. He is still allowed to see patients on the floors which I knew because I just saw him Friday.

Here's the explanation I was given by a co-worker who is also a respiratory therapist: Hospitals now have guidelines for readmissions, ICU admissions, and time spent on a ventilator. It is all scrutinized now because of The Affordable Care Act. So administration had to look seriously at his unethical patient management and then they did something about it.

When you consider how long this physician had been getting away with all this, it makes sense that ACA had everything to do with it since it was just implemented in January.
I've supported ACA all along in fact I just bought insurance two weeks ago through it. My COBRA from another job expired on September 30th. But we need to remember that ACA involves a LOT more than mandating that everyone have insurance. If it puts and end to unethical practices by sleazebags like this M.D., well, that is a very, very good thing. And it will help bring down the skyrocketing price of healthcare as well.


At what cost?

 

Maximum Peach



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  posted on 10/5/2014 at 03:18 PM
quote:

At what cost?


You'd have to elaborate a LOT more than that for me to respond.

[Edited on 10/5/2014 by robslob]

 

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Zen Peach



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  posted on 10/5/2014 at 03:50 PM
At what cost? If $1 is spent to eliminate .80 cents of waste, what's the gain?

Ask a government bureaucrat to provide a cost/benefit analysis and you might has well be speaking Chinese. Never a second thought when it pertains to government programs, rules, regulations. The government sorely needs to incorporate this line of thinking, but it's rarely even considered.

 

Zen Peach



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  posted on 10/5/2014 at 04:35 PM
Dodge, deflect, deny, change the subject.

Maybe muledude can jump in with an answer.


Yeah, I cracked micelf up writing that.

 

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Peach Extraordinaire



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  posted on 10/5/2014 at 05:15 PM
The cost benefit analysis & determination would have to include many many factors. For example, it would have to include the calculation pre and post ACA for those that prior to ACA had no insurance & just walked into a hospital for care. This is a start.

 

Maximum Peach



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  posted on 10/5/2014 at 07:02 PM
quote:

At what cost? If $1 is spent to eliminate .80 cents of waste, what's the gain?

Ask a government bureaucrat to provide a cost/benefit analysis and you might has well be speaking Chinese. Never a second thought when it pertains to government programs, rules, regulations. The government sorely needs to incorporate this line of thinking, but it's rarely even considered.


quote:

The cost benefit analysis & determination would have to include many many factors. For example, it would have to include the calculation pre and post ACA for those that prior to ACA had no insurance & just walked into a hospital for care. This is a start.


MartinD28 had likely the best answer to your cost/benefit analysis line of thinking. People have called The Affordable Care Act socialized medicine. Then what would you call our previous system? County health care systems in Florida went completely broke and had to shut their doors because they could no longer remain financially viable with the volume of patients knocking at their doors without insurance and expecting the government to pick up the bill. THAT was socialized medicine..............and it wasn't working.

The County hospital in the South Bay two miles from me, Valley Medical Center, has been on shaky financial ground for many, many years. The CEO quit five or so years back because he didn't want to deal with it anymore. Now they will have a huge infusion of cash they never had before.

This issue is FAR too complex for me to fully understand and I am certainly not claiming to understand it. I DO know that I got insurance a few weeks ago for $542/month. At 59 years old with atrial fibrillation, high blood pressure and three daily medications, Kaiser wanted around $900/month before The Affordable Care Act.

 

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Peach Extraordinaire



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  posted on 10/5/2014 at 07:52 PM
quote:
quote:

At what cost? If $1 is spent to eliminate .80 cents of waste, what's the gain?

Ask a government bureaucrat to provide a cost/benefit analysis and you might has well be speaking Chinese. Never a second thought when it pertains to government programs, rules, regulations. The government sorely needs to incorporate this line of thinking, but it's rarely even considered.


quote:

The cost benefit analysis & determination would have to include many many factors. For example, it would have to include the calculation pre and post ACA for those that prior to ACA had no insurance & just walked into a hospital for care. This is a start.


MartinD28 had likely the best answer to your cost/benefit analysis line of thinking. People have called The Affordable Care Act socialized medicine. Then what would you call our previous system? County health care systems in Florida went completely broke and had to shut their doors because they could no longer remain financially viable with the volume of patients knocking at their doors without insurance and expecting the government to pick up the bill. THAT was socialized medicine..............and it wasn't working.

The County hospital in the South Bay two miles from me, Valley Medical Center, has been on shaky financial ground for many, many years. The CEO quit five or so years back because he didn't want to deal with it anymore. Now they will have a huge infusion of cash they never had before.

This issue is FAR too complex for me to fully understand and I am certainly not claiming to understand it. I DO know that I got insurance a few weeks ago for $542/month. At 59 years old with atrial fibrillation, high blood pressure and three daily medications, Kaiser wanted around $900/month before The Affordable Care Act.



You seem to have a good bit of knowledge - both from personal & professional perspectives. Any more info. you have, please share. That's one way we learn.

Health care is a very complex and detailed industry & study. I watched a very interesting segment tonight on 60 Minutes. Much of the segment had to with gouging by the drug manufacturers. It was stated that in some cases America pays 50 to 80 percent more than foreign countries for cancer drugs. So follow the bucks. Maybe that example is one of the ingredients on why insurance premiums are high.

 

Maximum Peach



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  posted on 10/5/2014 at 08:56 PM
quote:
Health care is a very complex and detailed industry & study. I watched a very interesting segment tonight on 60 Minutes. Much of the segment had to with gouging by the drug manufacturers. It was stated that in some cases America pays 50 to 80 percent more than foreign countries for cancer drugs. So follow the bucks. Maybe that example is one of the ingredients on why insurance premiums are high.
All we've done with this act is trade one set of giant companies conspiring for profits among themselves for a slightly different arrangement where gov't now gets into the act. And there is no history of gov't taking such actions that ends up lowering costs - overall costs, that is.

Hell, the provision already calls for gov't to ensure the profits of the insurers. So we've created "too big to fail" insurers. I thought most of you hated that with the banks!

While its great that one abuser was stopped in the description above, there will be thousands more taking his place as new schemes emerge, gov't adds it's byzantine processes, and politicians use benefits to gain votes from the masses while hiding the true costs from the disinterested (meaning most Americans).

This is far from over. The effects will take years to become apparent, and the end result - when the creators are long out of the public eye - will be a completely unaffordable mess that covers no more than when we started.

Already, millions are being told that their claimed rates are not valid because they lied about income levels. You think politicians are going to boot off the poor voters because of a little lie? Shift the costs and let them stay, saving their votes, will be the solution. It will create just another class warfare tool for politicians to split the electorate.

 

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Zen Peach



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  posted on 10/5/2014 at 11:08 PM
quote:
The cost benefit analysis & determination would have to include many many factors. For example, it would have to include the calculation pre and post ACA for those that prior to ACA had no insurance & just walked into a hospital for care. This is a start.



I was responding only to the situation laid out in the OP, that of controls being put into place to prevent doctors from running up charges that aren't necessary. That's appealing on the surface, but To accomplish this their every move will have to be monitored and reviewed. That's bound to cost quite a bit. Shouldn't that cost be weighed against the dollar benefit?

 

Maximum Peach



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  posted on 10/5/2014 at 11:59 PM
quote:

While its great that one abuser was stopped in the description above, there will be thousands more taking his place as new schemes emerge, gov't adds it's byzantine processes, and politicians use benefits to gain votes from the masses while hiding the true costs from the disinterested (meaning most Americans).


quote:

I was responding only to the situation laid out in the OP, that of controls being put into place to prevent doctors from running up charges that aren't necessary. That's appealing on the surface, but To accomplish this their every move will have to be monitored and reviewed. That's bound to cost quite a bit. Shouldn't that cost be weighed against the dollar benefit?


You guys both seem to be saying the same thing: There are lots of bad, dishonest people in healthcare. So why even try to monitor them? Just give up and let it go unchecked. Besides, it might cost too much to even try.

By the way, how long does it take to look at documentation on a computer screen of how many admissions a particular physician's patients have had, how long his patients stay on a ventilator, how long they stay in ICU? Then compare it to the patient data of other physicians. Isn't that why we have computers? And isn't that the type of thing that highly paid hospital administrators are supposed to be doing with their time?



[Edited on 10/6/2014 by robslob]

 

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Maximum Peach



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  posted on 10/6/2014 at 03:49 AM
quote:
You guys both seem to be saying the same thing: There are lots of bad, dishonest people in healthcare. So why even try to monitor them? Just give up and let it go unchecked. Besides, it might cost too much to even try.
If we're saying the same thing its because the model is broken, and this current proposal will not fix that.

The only model that will improve on this is when the providers - insurers, hospitals, doctors, etc. - have to be responsible directly to the consumer. As long as health care insurance decisions are made by third-parties (employers, gov't, etc.) and the providers feel more responsible to them instead of the health care consumer, waste and fraud will flourish. Giant agencies will never make decisions as well as individuals and will never monitor costs to the degree that millions of consumers will.

 

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  posted on 10/6/2014 at 06:47 AM
quote:
quote:
You guys both seem to be saying the same thing: There are lots of bad, dishonest people in healthcare. So why even try to monitor them? Just give up and let it go unchecked. Besides, it might cost too much to even try.
If we're saying the same thing its because the model is broken, and this current proposal will not fix that.

The only model that will improve on this is when the providers - insurers, hospitals, doctors, etc. - have to be responsible directly to the consumer. As long as health care insurance decisions are made by third-parties (employers, gov't, etc.) and the providers feel more responsible to them instead of the health care consumer, waste and fraud will flourish. Giant agencies will never make decisions as well as individuals and will never monitor costs to the degree that millions of consumers will.


How do you you foresee your theory being accomplished - "the providers - insurers, hospitals, doctors, etc. - have to be responsible directly to the consumer"? How do millions & millions of disconnected individual consumers monitor & step in the middle of shenanigans exhibited by the various sectors of the health care industry? I'm not disagreeing with your theory, but it just seems like an impossibility to achieve. I don't think a free market concept works here by bypassing the middle layer. Can you provide some specific details on how this can be actualized from a practical standpoint?

 

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  posted on 10/6/2014 at 09:05 AM
quote:
You guys both seem to be saying the same thing: There are lots of bad, dishonest people in healthcare. So why even try to monitor them? Just give up and let it go unchecked. Besides, it might cost too much to even try.


I'm not saying that at all. I don't believe there are "lots" of "bad" people in health care. No more than in any other industry and I believe that most people are good people and do the right thing most of the time. Sure there are bad apples. The world is not perfect and people will never be perfect no matter how much legislation is passed.

I'm not saying to give up an let it go unchecked. For instance, you saw a problem and could have reported it. That's a good way to check it -- a witness on the scene, not a third party government employee hundreds of miles away looking at a computer screen.

That's a major difference between Liberals and Conservatives IMO. Liberals have a basic mistrust of people, and call on the government to provide every solution possible to make up for it. There's always a government solution and that more laws, rules, and regulations will fix every problem.

But again, at what cost? Is this ever even a part of the conversation? It should be.

Conservatives accept that mankind is basically flawed and we can learn to tolerate a certain amount of problems. Not that reasonable steps can't be taken to minimize them, but trade-offs must be made. You look for the best one possible and that's the best you can hope for.

It's like driving 40 miles out of your way to avoid paying a $1 toll. That makes perfect sense to some, others take the shorter route and realize the fact that nobody likes to pay tolls, but accepts them as a part of traveling by automobile.

 

True Peach



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  posted on 10/6/2014 at 09:08 AM
quote:
Liberals have a basic mistrust of people, and call on the government to provide every solution possible to make up for it.

This tells me you don't understand liberals at all.

 

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Zen Peach



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  posted on 10/6/2014 at 09:37 AM
quote:
quote:
Liberals have a basic mistrust of people, and call on the government to provide every solution possible to make up for it.

This tells me you don't understand liberals at all.


Maybe not, but there seems to be powerful evidence all around us. Is it mistrust, or maybe just a skepticism or an underestimation of people? Liberals seem to want to legislate activities in life to save people from themselves or save the planet.


 

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  posted on 10/6/2014 at 10:13 AM
quote:
quote:
quote:
Liberals have a basic mistrust of people, and call on the government to provide every solution possible to make up for it.

This tells me you don't understand liberals at all.


Maybe not, but there seems to be powerful evidence all around us. Is it mistrust, or maybe just a skepticism or an underestimation of people? Liberals seem to want to legislate activities in life to save people from themselves or save the planet.




There needs to be a balance of legislation and the private sector functions as you (THE CONSERVATIVE), thinks and hopes the private sector could and should operate. Unfortunately in the real world, the private sector and the "free market" do not necessarily function as a text book or Utopians would have us believe. Left to the good people, you still end up with those at the top of the chain calling all the shots and letting drops filter down to the rest of society. If you see that as a good thing, more power to you.

I think there are a lot of bad apples in the health care industry, & it is an industry that smacks of greed from many levels. You can start with the drug manufacturers, the insurance providers, and go from there. How much do they really give a $hit about people? How much can they squeeze out of people is more of their motivation.

 

Zen Peach



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  posted on 10/6/2014 at 10:46 AM
quote:
Liberals have a basic mistrust of people, and call on the government to provide every solution possible to make up for it.

This tells me you don't understand liberals at all.


Maybe not, but there seems to be powerful evidence all around us. Is it mistrust, or maybe just a skepticism or an underestimation of people? Liberals seem to want to legislate activities in life to save people from themselves or save the planet.




I think there are a lot of bad apples in the health care industry, & it is an industry that smacks of greed from many levels. You can start with the drug manufacturers, the insurance providers, and go from there. How much do they really give a $hit about people? How much can they squeeze out of people is more of their motivation.


See what I mean?

But lets examine the two that you mention. Health insurers are #86 in profit margin at 3.3%. Any less greedy than that and it starts getting difficult to justify staying in business.

I would agree the major drug companies are a different story, coming in at #7 with a 16.5% average profit margin.

 

Zen Peach



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  posted on 10/6/2014 at 11:26 AM
quote:
quote:
Liberals have a basic mistrust of people, and call on the government to provide every solution possible to make up for it.

This tells me you don't understand liberals at all.


Maybe not, but there seems to be powerful evidence all around us. Is it mistrust, or maybe just a skepticism or an underestimation of people? Liberals seem to want to legislate activities in life to save people from themselves or save the planet.




I think there are a lot of bad apples in the health care industry, & it is an industry that smacks of greed from many levels. You can start with the drug manufacturers, the insurance providers, and go from there. How much do they really give a $hit about people? How much can they squeeze out of people is more of their motivation.


See what I mean?

But lets examine the two that you mention. Health insurers are #86 in profit margin at 3.3%. Any less greedy than that and it starts getting difficult to justify staying in business.

I would agree the major drug companies are a different story, coming in at #7 with a 16.5% average profit margin.


In passing, the generic drug makers are much further down the list at 5.3%. They must be hiring far less greedy individuals to run them.



 

Zen Peach



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  posted on 10/6/2014 at 11:28 AM
quote:
quote:
Liberals have a basic mistrust of people, and call on the government to provide every solution possible to make up for it.

This tells me you don't understand liberals at all.


Maybe not, but there seems to be powerful evidence all around us. Is it mistrust, or maybe just a skepticism or an underestimation of people? Liberals seem to want to legislate activities in life to save people from themselves or save the planet.




I think there are a lot of bad apples in the health care industry, & it is an industry that smacks of greed from many levels. You can start with the drug manufacturers, the insurance providers, and go from there. How much do they really give a $hit about people? How much can they squeeze out of people is more of their motivation.


See what I mean?

But lets examine the two that you mention. Health insurers are #86 in profit margin at 3.3%. Any less greedy than that and it starts getting difficult to justify staying in business.

I would agree the major drug companies are a different story, coming in at #7 with a 16.5% average profit margin.


What everyone forgets with the drug companies is the tremendous risks they take when developing new drugs and the limited of time they can hold a patent. For this reason high profits on the drugs that do make it to market are justfied. Without this no company would take the kind of risk necessary to develop new life saving drugs.

 

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  posted on 10/6/2014 at 12:35 PM
quote:
quote:
quote:
Liberals have a basic mistrust of people, and call on the government to provide every solution possible to make up for it.

This tells me you don't understand liberals at all.


Maybe not, but there seems to be powerful evidence all around us. Is it mistrust, or maybe just a skepticism or an underestimation of people? Liberals seem to want to legislate activities in life to save people from themselves or save the planet.





I think there are a lot of bad apples in the health care industry, & it is an industry that smacks of greed from many levels. You can start with the drug manufacturers, the insurance providers, and go from there. How much do they really give a $hit about people? How much can they squeeze out of people is more of their motivation.


See what I mean?

But lets examine the two that you mention. Health insurers are #86 in profit margin at 3.3%. Any less greedy than that and it starts getting difficult to justify staying in business.

I would agree the major drug companies are a different story, coming in at #7 with a 16.5% average profit margin.


What everyone forgets with the drug companies is the tremendous risks they take when developing new drugs and the limited of time they can hold a patent. For this reason high profits on the drugs that do make it to market are justfied. Without this no company would take the kind of risk necessary to develop new life saving drugs.


Go watch the 60 Minutes segment that I alluded to earlier. You may have a different take after seeing that. Oh...I forgot... 60 Minutes is on a liberal media station so I guess the doctors & hospitals represented probably provide a liberal bias...even to the scientific & quantifiable research presented.


 

Maximum Peach



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  posted on 10/6/2014 at 03:15 PM
quote:
quote:
quote:
You guys both seem to be saying the same thing: There are lots of bad, dishonest people in healthcare. So why even try to monitor them? Just give up and let it go unchecked. Besides, it might cost too much to even try.
If we're saying the same thing its because the model is broken, and this current proposal will not fix that.

The only model that will improve on this is when the providers - insurers, hospitals, doctors, etc. - have to be responsible directly to the consumer. As long as health care insurance decisions are made by third-parties (employers, gov't, etc.) and the providers feel more responsible to them instead of the health care consumer, waste and fraud will flourish. Giant agencies will never make decisions as well as individuals and will never monitor costs to the degree that millions of consumers will.
How do you you foresee your theory being accomplished - "the providers - insurers, hospitals, doctors, etc. - have to be responsible directly to the consumer"? How do millions & millions of disconnected individual consumers monitor & step in the middle of shenanigans exhibited by the various sectors of the health care industry? I'm not disagreeing with your theory, but it just seems like an impossibility to achieve. I don't think a free market concept works here by bypassing the middle layer. Can you provide some specific details on how this can be actualized from a practical standpoint?
The Swiss already do it. Individuals buy their own level of care directly from insurers. Gov't regulates a number of factors so that reasonable protections exist.

It's not a free market, but insurers must satisfy and compete for customers, or risk loosing them. At the same time, incentives exist for individuals to monitor their charges and protect their overall costs from billing mistakes or fraud. They are not the cheapest health care, but are about 20-30% less expensive than what we spend.

 

____________________
Obamacare: To insure the uninsured, we first make the insured
uninsured and then make them pay more to be insured again,
so the original uninsured can be insured for free.

 

Peach Extraordinaire



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  posted on 10/6/2014 at 03:51 PM
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You guys both seem to be saying the same thing: There are lots of bad, dishonest people in healthcare. So why even try to monitor them? Just give up and let it go unchecked. Besides, it might cost too much to even try.
If we're saying the same thing its because the model is broken, and this current proposal will not fix that.

The only model that will improve on this is when the providers - insurers, hospitals, doctors, etc. - have to be responsible directly to the consumer. As long as health care insurance decisions are made by third-parties (employers, gov't, etc.) and the providers feel more responsible to them instead of the health care consumer, waste and fraud will flourish. Giant agencies will never make decisions as well as individuals and will never monitor costs to the degree that millions of consumers will.
How do you you foresee your theory being accomplished - "the providers - insurers, hospitals, doctors, etc. - have to be responsible directly to the consumer"? How do millions & millions of disconnected individual consumers monitor & step in the middle of shenanigans exhibited by the various sectors of the health care industry? I'm not disagreeing with your theory, but it just seems like an impossibility to achieve. I don't think a free market concept works here by bypassing the middle layer. Can you provide some specific details on how this can be actualized from a practical standpoint?
The Swiss already do it. Individuals buy their own level of care directly from insurers. Gov't regulates a number of factors so that reasonable protections exist.

It's not a free market, but insurers must satisfy and compete for customers, or risk loosing them. At the same time, incentives exist for individuals to monitor their charges and protect their overall costs from billing mistakes or fraud. They are not the cheapest health care, but are about 20-30% less expensive than what we spend.


This sounds interesting. I'm sure there is source info. on this. Before I Google & get a bunch of hits, can you recommend a good site that details the best representation of this.

What makes the gov't. regulation different in Sweden, & I'm assuming less than in the monopolistic competition that exists in the USA?

Does the gov't. oversee the individual incentives?

It does not surprise me that the cost of health care is cheaper in Sweden. Our costs increase year after year way beyond the level of inflation. There's plenty in our system that's not kosher.

 
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