A majority of Americans would tolerate higher taxes to help pay for universal health - page 14

From Bloomberg: Universal Health Care Six in 10 people surveyed say they would be willing to repeal tax cuts to help pay for a health-care program that insures all Americans. ... Most of the... Read More

  1. by   HM2VikingRN
    the pnhp study link is explicitly debunked by don mccanne at pnhp:
    although this study is presented under the guise of comparing administrative costs between medicare and the private insurance plans, it is important to note that zycher states that “a term perhaps more useful than ‘administrative’ costs might be ‘non-benefit’ costs.” thus, primarily for the medicare model, he includes much more than administrative costs.
    let’s look at how he adjusts the explicit administrative costs of medicare. as an example, look at how he measures the amount of administration of justice in the medicare program. he notes that medicare spending ($356 billion for 2005) is 17.1 percent of federal non-defense spending ($2081 billion). thus, he concludes, because of the costs of investigating medicare fraud, medicare consumes a prorated 17.1 percent of the government costs of the administration of justice. the dollar amount involved in this calculation alone increases the administrative costs of medicare from 3.1 percent to 5.1 percent. considering dr. zycher’s training as an economist, stating that medicare consumes 17.1 percent of the government’s administrative costs for justice is not simply a distortion of the facts; it is a blatant lie.

    comment: it was dishonest to post a link out of context from pnhp that appeared critical of medicare while it actually debunked a critical study. pnhp explicitly stated the problems with dr. zycher's work. i had stated that medicare operated at around a 5% administrative cost which was in fact an overstatement of medicare's administrative cost of 3%. i also gave private insurance the benefit of the doubt with the 15-25% administrative cost estimate. i am guessing that the real profit figure for private insurance is probably between 20-25% while administration costs range between 5-11%. the evidence to support efficiency advantages of the private health insurance system is just not there.

    here is a link to a reputable researcher who calculated administrative costs honestly. (i strongly suspect that the cafi study was funded by the insurance companies.):

    9. private administrative costs are taken from national health expenditure data, available at www.cms.hhs.gov/nationalhealthex-penddata/downloads/nhe2004.zip. administrative and net costs of private health insurance (including profits) were 14.4% of private insurance payments in 2004. medicare's administrative costs are calculated from tables ii.b1 and iii.b1 of the 2006 medicare trustees report, available at www.cms.hhs.gov/reportstrustfunds/downloads/tr2006.pdf. the estimate includes "administrative expenses" from table ii.b1 ($6.1 billion) and "fraud and abuse control" costs from table iii.b1 ($1.1 billion)—which sum to administrative costs of 2.1% of expenditures ($336.4 billion).
    source: http://www.sharedprosperity.org/bp180.html
    Last edit by HM2VikingRN on Nov 14, '07
  2. by   teeituptom
    Quote from CseMgr1
    I witnessed this firsthand, while I was working as a Case Manager for a major HMO several years ago. Our CEO netted a cool $32 million in bonuses from a merger with another insurance company...just as my requisition for a new stapler had been denied, and our workforce reduced to the point where it was becoming next to impossible to take care of our Members. I quit after that, no longer willing to be associated with this mindless Corporate greed. :angryfire
    Thats the free market, corporate greed reigns supremo
  3. by   nicurn001
    "Fortunately, there is a solution to the predicament (gov't interference in the financing of healthcare). The key is recognizing exactly what is driving spending through the roof. While many conditions have contributed to the spending explosion, one stands out as the fundamental problem with the U.S. health care system today: the consumer, the patient, has been cut out of the decisionmaking loop.
    ZASHAGALKA:
    I came into nursing to care for PATIENTS ,not consumers .The fallacy of people who advocate consumer awareness , as a way of controlling healtcare costs , Is that most of us do not plan our illnesses . When we get sick we don't always have time to research our options re. the financial aspect of our care . Also I don't see many Healthcare providers (on the net, or elsewhere)advertising the cost of non-elective procedures so how am I able to comparison shop for the procedures I know I am to have .
    Even in the case of non elective care , we are all human so there may be a course of treatment prescribed for the condition , but again each body reacts differently to the treatment , therefore the care I receive will be adjusted to that , so how can I predict the costs I am looking at.
    There should be a greater emphasis in patient care upon excellence of nursing / procedural care , than upon things administrative staff can quantify eg ,how many pillows you have , or how often your nurse asks what you want ( in preference to attending to a patient in need )
  4. by   CRNA2007
    Consumer Reports?



    Quote from nicurn001
    "Fortunately, there is a solution to the predicament (gov't interference in the financing of healthcare). The key is recognizing exactly what is driving spending through the roof. While many conditions have contributed to the spending explosion, one stands out as the fundamental problem with the U.S. health care system today: the consumer, the patient, has been cut out of the decisionmaking loop.
    ZASHAGALKA:
    I came into nursing to care for PATIENTS ,not consumers .The fallacy of people who advocate consumer awareness , as a way of controlling healtcare costs , Is that most of us do not plan our illnesses . When we get sick we don't always have time to research our options re. the financial aspect of our care . Also I don't see many Healthcare providers (on the net, or elsewhere)advertising the cost of non-elective procedures so how am I able to comparison shop for the procedures I know I am to have .
    Even in the case of non elective care , we are all human so there may be a course of treatment prescribed for the condition , but again each body reacts differently to the treatment , therefore the care I receive will be adjusted to that , so how can I predict the costs I am looking at.
    There should be a greater emphasis in patient care upon excellence of nursing / procedural care , than upon things administrative staff can quantify eg ,how many pillows you have , or how often your nurse asks what you want ( in preference to attending to a patient in need )
  5. by   Simplepleasures
    Quote from ZASHAGALKA
    I linked an article a few pages back. Come general election run, you are going to hear Dems saying that the Republican plan is TOO RADICAL A CHANGE, compared to what they are wanting to do. http://www.time.com/time/magazine/ar...682269,00.html



    ~faith,
    Timothy.
    Well, this Dem thinks a radical change would be a step in the right direction.
  6. by   HM2VikingRN
    from ezra klein:
    this may not shock anybody, but a new paper from health affairs finds that consumer-driven care -- also known as the republican party's answer to universal health care -- "would probably widen socioeconomic disparities in care and redistribute wealth in 'reverse robin hood' fashion, from the working poor and middle classes to the well-off. racial and ethnic disparities in care would also probably worsen."
    the reasons for this are largely issues we've talked through in the past. health savings accounts and their ilk are attractive to the healthy, unattractive to the sick, and thus worsen "risk segmentation" in the market. without healthy individuals subsidizing sick folks, more sick folks will be priced out of care. it's possible that attracting health individuals would actually lead to a net increase in those with something called "coverage." but the losses would be concentrated among those who most need health insurance.
    the paper also brings up a finding from the rand health care experiment. cost-sharing didn't affect the health outcomes of most participants. but among the poor, higher cost sharing resulted in "elevated death rates, worse control of hypertension, and other inferior health outcomes."
    source: http://ezraklein.typepad.com/blog/20...gressivit.html accessed today.

    consumer driven health care is no panacaea. the only way to leverage costs down is through a single large national pool. providers need to get back in the habit of competing for customers. i can cite one local example of anticompetitive behaviors in a health care market that (if allowed to happen) would actually drive up costs.

    immanuel st joseph's hospital in mankato mn is controlled by the mayo health system. there are 2 clinics attached to the hospital. isj is owned by mayo, mankato clinic is a clinic owned by local doctors. isj charges mankato clinic more for surgical equipment sterilization than it charges isj clinic. (i have a friend who works in the department so i have the inside information.) because of these and other price gouging behaviors mankato clinic has submitted a proposal to build a second hospital. what is the net result duplication of services such as additional ct machines which will lead to additional (and probably unnecessary) tests. this will drive health care expenditures up rather than down for the local area. these shenanigans can be prevented with a well designed single payer system. mayo should not be able to favor its own clinic through these kinds of anticompetitive behaviors. if it charges x dollars for a service. it should charge the same price to competitors.

    insurance reimbursements for state employees at isj are at a level 4 (more expensive). mankato clinic is level 2. (less expensive). because there are large groups of state employees in mankato more employees are mankato clinic patients. because of cost shifting by the mayo system mankato clinic proposed changing to a level 3 clinic. the advantage health plan stopped this price increase. these are concrete examples of how large groups can act to restrain costs and also foster patient choice.
  7. by   HM2VikingRN
    Ezra Klein debunks the Radical Republican argument at:
    The Republicans plans don't offer that. But Ramesh knows they need to seem like they do. So he writes, for instance, of Bush's plan will "make it possible, for example, for [people] to keep their policies when they switch jobs." Yes, Bush's plan makes it possible, but not likely. Conversely, the Democrats' plans actually allow you to keep your policy when you switch jobs.
    http://ezraklein.typepad.com/blog/20...l-republi.html
  8. by   nicurn001
    CRNA2007
    "Consumer Reports?"
    Elaborate.

    I thought of leaving my response there , but even if CR did a report on healthcare costs , it would be a general report , which would not enable me to a ) know what my individual healthcare provider would charge for a single procedure , or enable me to negotiate with my provider for that single procedure ,as I am sure my provider would point out that the CR report was not relevant to the market I live in .
  9. by   CRNA2007
    robin hood didn't steal from the rich and give to the poor. he stold from the rich and gave back to the taxpayers...


    Quote from hm2viking
    from ezra klein:
    this may not shock anybody, but a new paper from health affairs finds that consumer-driven care -- also known as the republican party's answer to universal health care -- "would probably widen socioeconomic disparities in care and redistribute wealth in 'reverse robin hood' fashion, from the working poor and middle classes to the well-off. racial and ethnic disparities in care would also probably worsen."
    the reasons for this are largely issues we've talked through in the past. health savings accounts and their ilk are attractive to the healthy, unattractive to the sick, and thus worsen "risk segmentation" in the market. without healthy individuals subsidizing sick folks, more sick folks will be priced out of care. it's possible that attracting health individuals would actually lead to a net increase in those with something called "coverage." but the losses would be concentrated among those who most need health insurance.
    the paper also brings up a finding from the rand health care experiment. cost-sharing didn't affect the health outcomes of most participants. but among the poor, higher cost sharing resulted in "elevated death rates, worse control of hypertension, and other inferior health outcomes."
    source: http://ezraklein.typepad.com/blog/20...gressivit.html accessed today.

    consumer driven health care is no panacaea. the only way to leverage costs down is through a single large national pool. providers need to get back in the habit of competing for customers. i can cite one local example of anticompetitive behaviors in a health care market that (if allowed to happen) would actually drive up costs.

    immanuel st joseph's hospital in mankato mn is controlled by the mayo health system. there are 2 clinics attached to the hospital. isj is owned by mayo, mankato clinic is a clinic owned by local doctors. isj charges mankato clinic more for surgical equipment sterilization than it charges isj clinic. (i have a friend who works in the department so i have the inside information.) because of these and other price gouging behaviors mankato clinic has submitted a proposal to build a second hospital. what is the net result duplication of services such as additional ct machines which will lead to additional (and probably unnecessary) tests. this will drive health care expenditures up rather than down for the local area. these shenanigans can be prevented with a well designed single payer system. mayo should not be able to favor its own clinic through these kinds of anticompetitive behaviors. if it charges x dollars for a service. it should charge the same price to competitors.

    insurance reimbursements for state employees at isj are at a level 4 (more expensive). mankato clinic is level 2. (less expensive). because there are large groups of state employees in mankato more employees are mankato clinic patients. because of cost shifting by the mayo system mankato clinic proposed changing to a level 3 clinic. the advantage health plan stopped this price increase. these are concrete examples of how large groups can act to restrain costs and also foster patient choice.
  10. by   HM2VikingRN
    Your response to http://allnurses.com/forums/2495804-post175.html makes no sense at all.
  11. by   ZASHAGALKA
    Quote from teeituptom
    Thats the free market, corporate greed reigns supremo
    NO. Motivated self-interested, under the pressure of competition, is the best situation for all parties involved. Always has been.

    Insurance companies are shielded by gov't from having to compete directly for your business - that isn't the free market. (The gov't created the financing scheme that makes it advantageous for employers to provide you insurance while at the same time making it too expensive for you to pay for, yourself.)

    The problem here is the gov't.

    Or, to steal Roy's quote: "If I had a nickel for everytime the free market was blamed for the acts of government; I'd BE the government."

    Big Insurance, Inc., isn't competitive because the gov't protects them. When you remove competition from the free market, you no longer HAVE a free market. What you have is what we have now: a failed gov't financing scheme for healthcare. But do. Let's trust them even more.

    After all. How much worse could they screw it up than they already have? Oh, yeah. Right. I forgot. This is the gov't we're talking about.

    Have fun with some future Dick Cheney deciding if you should have surgery or rather, if he should fund his war. Choices, choices.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Nov 14, '07
  12. by   ZASHAGALKA
    Quote from nicurn001
    I came into nursing to care for PATIENTS ,not consumers.
    So long as your patients aren't the consumers of their own care, they will never have the autonomy to be the directors of their care. YOUR patients have a more vested interest in their health outcomes than the gov't does for them. Or, and don't take it personally, they have a higher stake in the outcomes than even you do.

    I trust THEM to direct their own care more than anybody else.

    That being the case, the power belongs with the patient. The ONLY way to ensure that power is to give them control of the spending.

    He who buys it, owns it. If the gov't buys your care; IT owns your care, not you.

    I'd rather my patients own their own care. That is only possible if they ARE consumers.

    To do less, to design a system that does less - that's uncompassionate.

    To say you can design a system that does less and still claim that patients would have any power under such a scheme: that's dishonest.

    I consider CARING for my patients to include empowering them. If that makes them consumers, more power to the people.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Nov 14, '07
  13. by   ZASHAGALKA
    Quote from HM2Viking
    Ezra Klein debunks the Radical Republican argument at:
    The Republicans plans don't offer that. But Ramesh knows they need to seem like they do. So he writes, for instance, of Bush's plan will "make it possible, for example, for [people] to keep their policies when they switch jobs." Yes, Bush's plan makes it possible, but not likely. Conversely, the Democrats' plans actually allow you to keep your policy when you switch jobs.
    http://ezraklein.typepad.com/blog/20...l-republi.html
    Until they attach so many strings to that private insurance that it either bankrupts the companies or bankrupts you to afford it.

    This is what is being done now.

    Do you know WHY 47 million people don't have insurance? Because, if you don't have a job to enlist the gov't's/employer's bed to help pay for it, you can't afford it.

    The gov't is ALREADY in the business of pricing you out of the market. God forbid you buy your insurance directly instead of being channeled into the employer driven business that denies you a choice and shields big insurance, inc. of the trouble of having to compete for your business. Neither gov't nor employers want you to have that kind of control. To avoid it, you are priced out of the market. This isn't an accident. The gov't is in bed with financing healthcare and they aren't in bed with you.

    God forbid you exercise real choice in your life. No.

    Uncle Daddy is a much better 'benevolent patrician' for your life, than you are. Just trust Uncle Daddy. He knows better than you what is good for you. You do know, this is going to be a much harder sell than simple polling platitudes. Don't you?

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Nov 14, '07

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