Judge Rules Against Obama Care Mandatory Coverage

[rushmc 18]

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The "left to die outside the ER door" argument is an appeal to emotion and a false premise - EMTALA (passed in 1986) requires hospitals to treat patients regardless of their ability to pay.

Exactly...My wife is an admin at Childrens Hospital, (Yes a brain married a lowlife biker) , she started there over 20 years ago as an ER nurse, they have never once turned anyone away...I'm not sure why so many worry about health insurance, it doesn;t seem to be needed other than for every day health care...If yer hurt, yer covered... Payment ...is a noen issue, ask any illegal .....

How about this idea. Let's pass a law that bans hospitals from passing unrecovered bills on to paying customers. I'm sure your family, and everyone else who works at/for the hospital, won't mind paying for all that care by working for free, any more than all the paying patients mind (or can afford) to pay for it. [/sarcasm] Or just maybe people and politicians could get serious for once about trying to figure out a solution that will work. One thing for sure, the current limitations to the debate (no mandate to buy insurance, no taxes, and no change to EMTALA allowed) leaves us with nothing but a shit sandwich.

Don

I don’t agree
The current system can work for lower costs with three changes

1 Open up state boarders. The current laws in most states require the HQ of the provider to be in that state. The bigger compaines then have to have indidvial state HQ's to meet that requirement. This causes huge cost increases due to duplication of staff and bricks and mortar

2 Make state coverage mandates illegal. Let the companies offer coverage that the customers want. As much or as little. Many states require coverage of many cosmetic procedures. One state requires coverage for a sex change operation

3 Tort reform Nuff said


As for the pre-existing conditions debate I heard a viable option (IMO) on the way to work this morning. This situation is one where I think gov funding could be used to help those with serious conditions when caught moving carries for some reason. I wouldn't mind some of my tax dollars going for this

How much would all of this save?
Well, it would at least save the massive increases and loss of coverage the current HC bill will cause

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[wmw999 2,178]

Here is an article, showing some figures, on why tort reform really isn't the main factor in increasing medical costs.

I tried to find backup data, but finding the cost components of medical care isn't exactly clear (I spent at least 5 minutes on google ). And that goes for both sides of this argument. I'm sure it's out there, I just have more to do. I'm looking for source data, not opinion pieces (if the website has "patriot" or "progressive" or "citizen" as part of it's title, it's probably opinion ).

But regardless, it seems that Texas, which has fairly draconian tort reform, also has comparatively high per-person medical costs. And if you eliminate them, you remove a means for people who were legitimately harmed by practitioners to recover ongoing care costs. And being disabled does cost.

We're good at fixing things, but fixing things is the most expensive way to treat them; consider cars as an example. Take care of it, and it lasts a whole lot longer, and costs less, than if you just keep using it as you damn well please and then fix it when it breaks. That's the current medical model for many people (not just those without insurance).

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[rushmc 18]

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Here is an article, showing some figures, on why tort reform really isn't the main factor in increasing medical costs.

I tried to find backup data, but finding the cost components of medical care isn't exactly clear (I spent at least 5 minutes on google ). And that goes for both sides of this argument. I'm sure it's out there, I just have more to do. I'm looking for source data, not opinion pieces (if the website has "patriot" or "progressive" or "citizen" as part of it's title, it's probably opinion ).

But regardless, it seems that Texas, which has fairly draconian tort reform, also has comparatively high per-person medical costs. And if you eliminate them, you remove a means for people who were legitimately harmed by practitioners to recover ongoing care costs. And being disabled does cost.

We're good at fixing things, but fixing things is the most expensive way to treat them; consider cars as an example. Take care of it, and it lasts a whole lot longer, and costs less, than if you just keep using it as you damn well please and then fix it when it breaks. That's the current medical model for many people (not just those without insurance).

Wendy P.

It is not just one of the things I posted Wendy
It takes all of them together

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[GeorgiaDon 340]

I'm very skeptical.

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1 Open up state boarders. The current laws in most states require the HQ of the provider to be in that state. The bigger compaines then have to have indidvial state HQ's to meet that requirement. This causes huge cost increases due to duplication of staff and bricks and mortar

There may be some cost savings here, but they would certainly be minimal. The "bricks and mortar" are a one-time expense, perhaps $1 million or less for a really nice building. Salaries might total a couple of million, but the fact is those people are processing claims and such; I really doubt they are being paid to sit on their hands. If all the claims were to be sent to one central office, the jobs would move there, but the limitation would still be how many claims one person could be expected to process/week (or whatever time scale you want). Certainly what would NOT happen is that the insurance company would be able to say "we have 100 people processing claims in each of 20 States, so now we can close 19 offices and have 100 people in the remaining office handle claims from all 20 States". Also, when you have a dispute with your insurance company, it's hard enough to deal with them when they are relatively nearby, but it'll get a lot harder when you're dealing with long distance and different time zones.

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Make state coverage mandates illegal. Let the companies offer coverage that the customers want. As much or as little. Many states require coverage of many cosmetic procedures. One state requires coverage for a sex change operation

The problem with this is the logical fallacy that private for-profit companies are in any way obligated to create products to match the whims of customers. They offer a few choices of some product, and usually all you as a consumer can do is choose from amongst the products that are offered. If it's a product you must have in at least some form (and I would argue any responsible person should have some form of insurance to protect against catastrophic illness or injury), then you HAVE to pick one, even if it sucks, and the company has made a sale.

The only force driving companies to improve their products is competition, the idea that someone else will offer a better product and everyone will buy that one instead. But, insurance is a matter of spreading risk, everyone pays in a little and a few take out a lot when they need it. For health insurance, large companies dominate the market because the amounts paid out tend to be pretty large, so you have to have a lot of subscribers to have the cash flow to pay claims, make a profit, and keep premiums relatively affordable. Profitability (which is what all corporations are really about) is maximized by minimizing payouts (claims), which can be done by limiting the types of procedures that are covered. They can't really cut out common stuff that everybody uses, as that discourages people from buying the product, so instead they pad on inexpensive but often ineffective procedures like "touch therapy" and exclude relatively rare but highly expensive (and lifesaving) treatments like bone marrow transplants. Even coverage for pregnancy is very difficult to obtain, is very expensive, and offers poor coverage if you are privately insured (as opposed to large group policies through employers).

So why don't competitors pop up and offer a better product at a cheaper price? Again its an economy of scale. New startups are by definition small, and with a small cash income (relatively few people paying premiums) you can't afford to risk covering expensive procedures such as bone marrow transplants; one claim could bankrupt the company. The only alternative it to charge extremely high premiums, which will ensure you will not be able to compete with the already established big companies.

The same situation applied to the car industry in relation to safety features and fuel economy. The car manufacturers resisted government mandates, saying "let the customers decide what products they want". Yet, on their own the manufacturers did almost nothing to improve safety or fuel economy, preferring to concentrate on cosmetics and horsepower as cheaper but effective selling points. Customers still have to buy a car (in the US it's pretty hard to function without one, unless you happen to live in a handful of cities with passable public transit, and live near your work, and not have kids). Even if you really wanted a fuel efficient car, if no-one is selling them you end up buying something else, and then the manufacturers could turn it around and say "see, no-one is buying for fuel economy". It was government mandates that forced them to offer customers real choices in terms of safety or fuel economy. Similarly, government mandated minimum standards for health insurance are needed to ensure appropriate products are offered to consumers.

I wonder about the reference to "many states require coverage of many cosmetic procedures". I'm not aware of any states that require coverage of nose jobs, or breast enhancements etc, but I'm sure that's what opponents of state mandates want people to think of when they hear "cosmetic procedures". How about the burn victim who needs skin grafts to restore mobility to a limb, or someone who's had their face half chewed off by a dog, and so on. Procedures to repair injuries such as these are "cosmetic procedures", and are necessary to restore functionality; should they not be covered by insurance? Are they really "unnecessary luxuries"?

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Tort reform Nuff said

In theory some cost savings in terms of malpractice insurance could be realized here. Experience suggests the savings will be small or non-existent. Here in the state of Georgia, rather draconian caps on malpractice awards were passed at the behest of the insurance industry. Curiously, malpractice premiums have not decreased at all, in fact they continue to rise as they did before the caps. The insurance companies have been able to maintain their healthy profit margin, though. The only noticeable effect of the caps has been to make it very difficult for lower income people, such as retirees, to be able to bring legitimate claims to court, as legal fees must be paid out of the award and small awards don't pay enough to cover the lawyers and leave anything for the malpractice victim. Since most of the award is for actual damages (medical costs plus things like loss of future income if the victim is disabled), only people who had a high income before the malpractice occurred have potential awards large enough to pay reasonable legal fees.

Tort reform coupled with a legal requirement that the savings be reflected in lower premiums could be helpful, but the mandate for the insurance companies to lower premiums has never been included in any tort reform legislation.

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[wmw999 2,178]

The first two require the feds taking power from the states. Is that a path we want to go down?

Which states require insurance to cover gender reassignment and cosmetic surgery? I couldn't find any. There are policies that do, but if it's not required by the state, then it's the insurer's option.

Or are you talking about cases where Medicaid has paid for gender reassignment or cosmetic surgery? That's different from insurance.

In nearly all cases, these normally elective procedures need considerable review to be covered.

The thing that's needed is to go in and look at the cost components of medical care -- not to attack the emotionally-satisfying targets, but to look at the non-value-add components of health care and start with them. Think of it as a BB project -- the comfortable answer isn't always the right one, you have to gather the data and look at it with an open mind. Let the actual data guide your thoughts, not what you'd like the data to reflect.

Here is some (abstracted) source data.

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[rushmc 18]

So you seem to be more about mandates and gov controls

Bricks and mortar times 52 is not a small deal
Staff and admin costs time 52 is not a small deal
Competitive policies talored to customer needs is not a small deal (required removal of ugly state mandates)

Profit is not evil and that is a big deal

Compeitiors do not pop up because of the gov
Period

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[rushmc 18]

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The first two require the feds taking power from the states. Is that a path we want to go down?This seems to be a choice for use of the comerce clause

Which states require insurance to cover gender reassignment and cosmetic surgery? I couldn't find any. There are policies that do, but if it's not required by the state, then it's the insurer's option.

Or are you talking about cases where Medicaid has paid for gender reassignment or cosmetic surgery? That's different from insurance.

In nearly all cases, these normally elective procedures need considerable review to be covered.

The thing that's needed is to go in and look at the cost components of medical care -- not to attack the emotionally-satisfying targets, but to look at the non-value-add components of health care and start with them. Think of it as a BB project -- the comfortable answer isn't always the right one, you have to gather the data and look at it with an open mind. Let the actual data guide your thoughts, not what you'd like the data to reflect.

Here is some (abstracted) source data.

Wendy P.

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[rushmc 18]

Not a small thing

http://www.cahi.org/cahi_contents/resources/pdf/HealthInsuranceMandates2008.pdf

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[GeorgiaDon 340]

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Bricks and mortar times 52 is not a small deal

The buildings are already built. The cost of utilities and custodial staff is a small deal, relative to the cost of the health care system.

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Staff and admin costs time 52 is not a small deal

No it's not. Do you have any response to my argument that you can't take the existing staff and admin for one state and have them do the work of all 52 states, and do it reasonably well? You would pretty much have to move the existing work force to one state, but the size of your staff would probably not change much. Savings: small deal.

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Competitive policies talored to customer needs is not a small deal (required removal of ugly state mandates)

Only works for larger group policies that have the "muscle" to demand and receive specific services. Individual buyers will only be offered those services the insurer finds it convenient to offer. Purchasers of individual policies will not have the "muscle" to demand that any specific procedures be covered. Also it's easy for big insurers to run roughshod over individuals, doing things like dropping them as soon as they get sick, or denying coverage after the fact by claiming "preexisting conditions" based on unrelated symptoms years before. Such horror stories are legion.

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Profit is not evil and that is a big deal

I never said honest profit is evil. Profit made by selling a product that you don't intend to deliver, or selling a product that is disguised to look like something other than what is is, is indeed evil, especially when it can cost someone their life's earning or even their life.

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Compeitiors do not pop up because of the gov

Competitors can indeed pop up when the government restricts anti-competitive practices or prevents monopolies from forming.
Period

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[Southern_Man 0]

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Do you believe that eventually the govt. will either exempt the "poor" from paying their premiums or at least subsidize them as they do with rent. food, utilities etc?

We already subsidize them.

"What if there were no hypothetical questions?"

[dj123 0]

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What I wonder about is, people can currently choose to "not participate" until they have an accident or serious illness, when they suddenly become "participants". At that point they are uninsurable, so they have to bear the full cost of care out of pocket. Many cannot pay, so after being treated they declare bankruptcy and pass the bill on to those of us who do have insurance.

This seems to me to be unfair.

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"Unfair"? Really? would you like some cheese with that?

Sorry.., I don't have any cheese but here is some food for thought ;
It may be that the insurance policy you buy is a large part of the reason medical treatment is so expensive in the USA.

Care to comment?

Blues,
DJ

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[wmw999 2,178]

Well, even looking at the data (and I hadn't realized how many mandates there were), many of them are, in fact, a very small component of health care cost. Even the paper makes that clear, and makes it clear that reducing the mandates won't necessarily reduce health care costs.

It begins to make it clearer why the insurance industry is segmented across states, for one thing.

I'm interested, though, in your characterization of plastic surgery and gender reassignment as mandated. I don't see them in there, unless you consider breast reconstruction (as in after they've been removed) as a plastic surgery procedure.

Breast reductions are not done for appearance; they're done for back trouble. Really.

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[rushmc 18]

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Well, even looking at the data (and I hadn't realized how many mandates there were), many of them are, in fact, a very small component of health care cost. Even the paper makes that clear, and makes it clear that reducing the mandates won't necessarily reduce health care costs.

It begins to make it clearer why the insurance industry is segmented across states, for one thing.

I'm interested, though, in your characterization of plastic surgery and gender reassignment as mandated. I don't see them in there, unless you consider breast reconstruction (as in after they've been removed) as a plastic surgery procedure.

Breast reductions are not done for appearance; they're done for back trouble. Really.

Wendy P.

Let me look
I could be wrong on the sex change
As for the breast reduction
I know that
My mom had that done
She feels much better now

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[kelpdiver 2]

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Bricks and mortar times 52 is not a small deal

The buildings are already built. The cost of utilities and custodial staff is a small deal, relative to the cost of the health care system.

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Staff and admin costs time 52 is not a small deal

No it's not. Do you have any response to my argument that you can't take the existing staff and admin for one state and have them do the work of all 52 states, and do it reasonably well? You would pretty much have to move the existing work force to one state, but the size of your staff would probably not change much. Savings: small deal.

The buildings are already built? Huh? Office space is expensive, there's no getting around this. And it's much more expensive in some parts than others.

You're correct that the number of staff to do X units of work is going to be pretty constant. However, each office needs a building manager, a regional manager, managers of each of the functional groups, and a sufficiently sized HR department. And each office has to have to have enough people for peak load for their given region, rounding up. There's a considerable reduction in head count when you go to fewer, larger offices.

[kelpdiver 2]

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We're good at fixing things, but fixing things is the most expensive way to treat them; consider cars as an example. Take care of it, and it lasts a whole lot longer, and costs less, than if you just keep using it as you damn well please and then fix it when it breaks. That's the current medical model for many people (not just those without insurance).

Wendy P.

and unfortunately, we're still ignoring the option of taking better care of ourselves as a whole.

[rehmwa 2]

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and unfortunately, we're still ignoring the option of taking better care of ourselves as a whole.

just because the government isn't impotently mandating it and using that as an excuse to take a lot of money for completely unrelated things doesn't mean it's ignored - I suspect anyone that looks in the mirror will have a good idea on whether they are taking care of themselves or not. The government certainly can't do anything impactful about it

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[Gravitymaster 0]

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Do you believe that eventually the govt. will either exempt the "poor" from paying their premiums or at least subsidize them as they do with rent. food, utilities etc?

We already subsidize them.

Correct, so why force everyone into a govt. mandated program when the govt. is just going to subsidize their premiums anyway?

I would still like someone to tell me if they believe there are any restrictions in the Constitution that limit the products or services that the government can force us to buy? If so, please point it out. If not, what's next?

[kelpdiver 2]

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and unfortunately, we're still ignoring the option of taking better care of ourselves as a whole.

just because the government isn't impotently mandating it and using that as an excuse to take a lot of money for completely unrelated things doesn't mean it's ignored - I suspect anyone that looks in the mirror will have a good idea on whether they are taking care of themselves or not. The government certainly can't do anything impactful about it

Actually, it can do a considerable amount.

I read in the past week (details a bit fuzzy now) about how parents had successfully sued a school district to get them to provide the PE time they were mandated to do. This is a nationwide problem that is a direct factor in our problems. Catching kids with weight problems when they still have metabolism and no jobs on their sides is the lowest hanging fruit of all.

Individuals self checking does not work to solve the national problem. What we see is a growing divide between the fit getting really fit, and the fat getting really fat. Funny enough, Australia seems to be doing the same. Overall, they're nearly as obese as the US, but they're still the homeland for triathletes.

[rehmwa 2]

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What we see is a growing divide between the fit getting really fit, and the fat getting really fat.

and how does the government propose to take the really fit people and make them fat?

and how much will it cost us?

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[kelpdiver 2]

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What we see is a growing divide between the fit getting really fit, and the fat getting really fat.

and how does the government propose to take the really fit people and make them fat?

and how much will it cost us?

given your phrasing, it doesn't seem you are asking a serious question. Or you simply mistyped. Elaborate?

[Amazon 7]

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What we see is a growing divide between the fit getting really fit, and the fat getting really fat.

and how does the government propose to take the really fit people and make them fat?

and how much will it cost us?

Weekly vouchers for McDonalds or BurgerFling or one of the other hundreds of fast food places that are doing so well at super-sizing Americans.

[rushmc 18]

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What we see is a growing divide between the fit getting really fit, and the fat getting really fat.

and how does the government propose to take the really fit people and make them fat?

and how much will it cost us?

Weekly vouchers for McDonalds or BurgerFling or one of the other hundreds of fast food places that are doing so well at super-sizing Americans.

Oh sure
Another government entitlement

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[rehmwa 2]

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What we see is a growing divide between the fit getting really fit, and the fat getting really fat.

and how does the government propose to take the really fit people and make them fat?

and how much will it cost us?

given your phrasing, it doesn't seem you are asking a serious question. Or you simply mistyped. Elaborate?

my fault - the smiley for cynicism wasn't enabled. But, those fit people are just lucky, most just inherited those genes, they really do owe it to the rest of us to get a bit fatter. It might not help, but it's a LOT easier and it FEELS good to pass laws that would validate that position even if we don't enforce them. And isn't that what legislation is all about?

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[kelpdiver 2]

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But, those fit people are just lucky, most just inherited those genes,

This sounds like Darius's post today that rich people are lucky people.

Since I want to keep this thread serious, I'll say that the fit people are the ones that play real sports, rather than virtual sports on their playstation. Anyone can be a BOP (back of the pack) triathlete, and be in reasonable fitness.

[GeorgiaDon 340]

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Bricks and mortar times 52 is not a small deal

The buildings are already built. The cost of utilities and custodial staff is a small deal, relative to the cost of the health care system.

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Staff and admin costs time 52 is not a small deal

No it's not. Do you have any response to my argument that you can't take the existing staff and admin for one state and have them do the work of all 52 states, and do it reasonably well? You would pretty much have to move the existing work force to one state, but the size of your staff would probably not change much. Savings: small deal.

The buildings are already built? Huh? Office space is expensive, there's no getting around this. And it's much more expensive in some parts than others.

You're correct that the number of staff to do X units of work is going to be pretty constant. However, each office needs a building manager, a regional manager, managers of each of the functional groups, and a sufficiently sized HR department. And each office has to have to have enough people for peak load for their given region, rounding up. There's a considerable reduction in head count when you go to fewer, larger offices.

I said small deal, not no deal at all. Of course there will be some savings, but I doubt there would be a really dramatic reduction in payroll. Unless the "managers of each of the functional groups" are significantly underemployed, you won't be able to have each manager suddenly be responsible for 4 or 5-fold more people and still have efficient oversight. So there will be some economy of scale and some savings, but probably not a huge fraction of the payroll.

Health care expenditures currently account for more than 16% of the US GDP, and they have been growing at an average rate of 6.7%/year, well above inflation or the growth of the rest of the economy, for decades. Similar or identical procedures cost double (or more) here compared to other developed countries, and while the standard of care is generally excellent for those who can afford it, outcomes are not two-fold better than in Western Europe or Canada. Closing a few buildings and laying off a few vice-presidents will not even be a blip on the chart of rising costs. Of course a penny saved is a penny earned, if it'll save some expenditures (and not result in even longer processing times or bungled claims due to overextended staff), go for it. But that's not going to be close to addressing the problem the mandate for everyone to buy insurance was trying to address.

So, back to that question. How do we solve the problem of people using medical services they can't pay for (either through insurance or their own funds), while still respecting EMTALA and the constitution?

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)